Challenges in Change: The Perils and Pitfalls of Implementing a Palliative Care Program in the Neonatal Intensive Care Unit

Approximately 25 000 pediatric deaths occur annually in hospitals. More than 50% of these deaths occur in the neonatal intensive care unit. In a 10-year cohort study that examined those pediatric patients who would qualify for palliative care, only 4% of them received palliative care. This article describes the development of an algorithm and program to deliver neonatal palliative care. Challenges of implementing the program and the use of Kotter's 8-step process to facilitate change in the unit's culture are discussed. Looking ahead, the use and evaluation of the SOFT Care algorithm in the neonatal intensive care unit will help to demonstrate improved outcomes in neonates who receive palliative care.