433 - Butterflies and ribbons: the positive impact of educational strategies to optimize communication with parents after the perinatal loss of a co-twin

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 433
Publication Number: 433.147

Beatrice Boutillier, Sainte Justine Hospital, Montréal, PQ, Canada; Alexie Bigras-Mercier, CHU Sainte-Justine, Montréal, PQ, Canada; Nicholas Embleton, Newcastle University, Newcastle upon Tyne, England, United Kingdom; Sophie Belanger, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Audrey Larone Juneau, CHU Sainte-Justine, montreal, PQ, Canada; Keith .J. Barrington, Université de Montréal, Montréal, PQ, Canada; ANNIE Janvier, University of Montreal, Montréal, PQ, Canada

Presenting Author(s)

Beatrice Boutillier, MD (she/her/hers)

Fellow
Sainte Justine Hospital
Montréal, Quebec, Canada

Background: In neonatology, multiples pregnancies are common. Unfortunately, it is not rare for one baby to die. Communication with parents in these circumstances has been demonstrated to be sub-optimal, sometimes because clinicians avoid the subject, are unaware of the death and/or ask harmful questions.

Objective:

To assess the impact of two different educational strategies to optimize how clinicians support families with the perinatal loss of a co-twin/triplet.

Design/Methods:

The “Butterfly project”, created in England, is a 4-hour online course open to all clinicians, accredited by the major nursing and paediatrics associations.

The second training course “Ribbon project” (using the perinatal ribbon, chosen by the hospital’s bereaved parent advisory group who disliked the butterfly symbol) is adapted from the Butterfly project. The training takes place in in a large level 4 NICU in Quebec (free of charge and accredited), is a 1h course, available to all NICU clinicians

Participants in both programs are surveyed to assess: 1) knowledge gained, 2) knowledge utilization, and 3) recommendations from participants. The Ribbon program is also evaluated in the unit with audits.

Results:

In the butterfly project, all participants (n = 734) reported the training exceeded or met their expectations, 97% reported they learned new skills and 48% had already applied them. Many participants were grateful for the course in their answer to open-ended questions, for example:“I feel a lot more confident in supporting parents in this situation.”

In the ribbon project (n = 174 participants), 97% were satisfied or very satisfied with the training and 97% report feeling more comfortable talking to bereaved parents in this situation. Knowledge improved pre-post training. In clinical audits (between 2020 and 2022): 100% of cases were identified (28/28) on the incubator and the baby(ies)’ admission card, 100% of the surviving twins/triplets kept their identification (#1, #2, #3) after speaking with parents, all changed room after the death of their co-twin-triplet, all had the name of their co-twin/triplet on the discharge summary. All clinicians (55) knew what the ribbon symbol meant when asked during surprise audits at the bedside; 38/55 (71%) felt comfortable dealing with parents in this situation and for those who did not, they knew who to ask for help.

Conclusion(s):

Different educational strategies to optimize communication with families after the perinatal loss of a co-twin are appreciated and have a positive impact.