Background: Children with potentially life-limiting illnesses have complex needs. Their care requires specialized knowledge and skills. Limited evidence describing the pragmatic considerations for the development and implementation of a sustainable pediatric palliative care service exists. Our new service was implemented in a tertiary hospital and research center in Saudi Arabia. The available palliative care services before this initiative focused on the adult cancer population. Pediatric patients have always been eligible, but referrals have historically been scarce. There was also no board-certified Pediatric Palliative Care physician in the organization.

Aim. We aim to describe the key considerations and steps in developing and implementing an innovative and dynamic nurse-led specialized pediatric palliative care service. This initiative was aligned with the mission, vision, and values embodied by the organization's 2020 Strategy.

Method. The service was implemented using seven crucial steps: (1) assessing the needs; (2) defining the scope of service; (3) engaging stakeholders; (4) marketing the service; (5) implementing the service as a pilot project, (6) collecting data about the served population (e.g. demographics, symptom burden, provided interventions); and (7) gathering 360-degree feedback (e.g. from the patient, family, healthcare providers). Throughout the journey, as data and feedback were collected and analyzed using the Redcap™ database, the scope of service was regularly adjusted.

Results. By adopting the described methodology, we reached our goals to maximize the most vulnerable children’s quality of life, improve pain management, decrease care fragmentation between clinical services and settings, increase children and family satisfaction, and overcome staff challenges to engage in terminal care within the organization. A nurse-led service was also found to be a viable model for pediatric palliative care delivery.