NEO-SOP-003: Family information and presence in the neonatal unit

Standard operating procedure (SOP) · NEO-SOP-003 · Version 0.1 · Draft for local review

Supports: 37.3

1. Purpose

To make sure families of neonates receive clear, regular and understandable information, and are present in and involved in their baby's care, so that they can take part in decisions and support their baby (37.3).

2. Scope

3. Definitions

4. Background

Parents of a sick newborn often feel frightened, powerless and separated from their baby. Clear information and early involvement reduce distress, improve trust and support decisions made together. Parents' presence supports the infant's development, feeding and comfort, and provides a second set of eyes on the baby's wellbeing.

Information that is given differently by each member of staff, or only when a parent asks, leaves families uncertain. A set, shared approach to updates protects families and staff.

5. Responsibilities

6. Materials and equipment

• A private family room or quiet space near the unit, with seating and a telephone.
• Written information about the unit, visiting rules, infection control and the baby's care, in the families' main languages.
• Daily update record in the notes, with date, time, names of people present and the family's questions.
• Access to a professional interpreter, by phone or in person, for every family who needs one.
• Breast pumps, kangaroo care chairs and skin-to-skin guidance materials where the unit provides them.

7. Safety

Families are never left without contact information for the unit, and never told that a baby is 'fine' or 'stable' without an explanation of what that means. Information about a death or serious harm is always given in person, by a senior clinician, in a private room, and never over the telephone alone, unless the family cannot attend and the senior clinician has agreed the approach with them.

8. Before you start

1. Identify the family's main language and any communication need, and record how they wish to be contacted.
2. Ask the parents who may receive information and who may be present, and record their names and relationship in the notes.
3. Confirm the baby's current condition and the plan for the next 24 hours with the senior clinician before the update.

9. Procedure

9.1 Daily structured update

1. At a set time each day, the consultant or senior doctor meets the family in the private room, with the primary nurse where possible.
2. Give the key information in the same order each time: how the baby is today, what has changed, the plan for the next 24 hours, what the family can do, and any decisions needed.
3. Use plain language, avoid abbreviations, and check understanding by asking the parent to repeat the main points.
4. Invite and answer questions. Write down any question that cannot be answered now, and give a time when it will be answered.
5. Record the update in the notes: date, time, people present, the information given, the questions asked, and the plan agreed.

9.2 Family presence

1. Explain the visiting and presence policy in writing on admission, including hours, infection control rules and how to take part in care.
2. Encourage parents to hold, feed and provide skin-to-skin contact with the baby, unless a clinical reason prevents it, which is recorded.
3. Where the unit has limited space or hours, agree a plan for presence and contact, and review it at each update.
4. Do not exclude a parent from the unit without a documented clinical or safety reason agreed with the consultant, and tell the parent the reason and how to appeal.

9.3 Serious changes and difficult conversations

1. When there is a serious change, inform the family as soon as possible, in person where safely possible, and no later than the end of the shift.
2. Explain the change, what is being done, the options, and what the next steps are. Give the family time to ask questions.
3. Arrange a follow-up conversation within 24 hours of a serious change, or sooner if the family asks.
4. For end-of-life decisions, follow the unit's end-of-life policy and offer the family a private space, support and the chance to spend time with their baby.

10. Decision points

11. Special situations

• Families in a different country or community: check how they prefer to receive information, and whether a family member or community representative should be present, always with the parent's agreement.
• Parents with a disability or who are blind or deaf: provide information in an accessible format and in a way they can use.
• Parents under the age of 18: involve a safeguarding lead and check the arrangements for consent and support.
• Baby transferred to another unit: give the family the name and contact number of the receiving team, and explain how updates will continue.
• Bereavement: offer a bereavement follow-up under HSP-SOP-005 and a named contact for questions in the weeks after the death.

12. Escalation

• Family not updated for more than 24 hours without a documented reason: inform the unit manager the same day.
• Complaint or family distress that cannot be resolved at the bedside: refer to the consultant and, if needed, the complaints process.
• Safeguarding concern raised by a parent or staff member: follow NEO-SOP-004 immediately.

13. Monitoring

The unit manager audits 20 family records each month, or all if fewer, for the daily update, the family presence plan, interpreter use and the recording of serious-change conversations. Results go to the neonatal governance meeting each quarter, and family feedback is reviewed at the same meeting.

14. Records

• Daily update record in the notes.
• Presence and visiting plan, signed by the family and the unit manager or senior nurse.
• Consent and conversation records for serious decisions.
• Interpreter request and use record.
• Complaints and feedback records.

15. Training

All staff who speak to families complete communication training at induction and every two years. The training covers difficult conversations, use of interpreters, and how to give information in plain language. Consultants and senior nurses also complete training in breaking serious news.

16. Related documents

17. Evidence

This SOP is based on the reference sources listed below, the requirement of criterion 37.3 of the ASF standards, and the local family presence policy, which must be checked at each review.

E-learning for this document

• No course linked yet. Request a family communication course from the academy (see the Standard 37 request list).

References

1. World Health Organization and UNICEF. Kangaroo mother care: a practical guide. WHO, 2003.
2. UNICEF and WHO. Baby-Friendly Hospital Initiative: revised, updated and expanded for integrated care. 2018.
3. United Nations. Convention on the Rights of the Child, Article 9 and Article 12. 1989.
4. Haig KM, Sutton S, Whittington J. SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety. 2006.
5. National neonatal service family-information standards and the unit's local family presence policy (to be inserted by the unit at adoption).

Change history