Transcript Child Life as Adjunct to Sedation

Child Life Interventions
Reduce Need for Sedation
Julia Jones MEd, CCLS, Child Life Coordinator
Megan Gray, CLS, BS, Child Life Specialist
Kathy Webster, MD, Director Pediatric Critical Care
Cindi LaPorte, RN, Manager Pediatric Critical Care, Pediatrics
Special Thanks to:
Jim Ryva, RDMS, The LUMC Radiology Department, and Mark Popenhagen, PsyD
Confidential: For Quality Improvement Purposes Only
Project Aim Statement
Children undergoing non-painful imaging procedures (CT/MRI), are often
given sedation because they cannot hold still. Associated risks of
pediatric sedation can include drowsiness and post anesthesia agitation.
Preparation for sedation also requires that the child be NPO for at least
6 hours (light meal) prior to the procedure, causing irritability and
frustration.
Involvement of a Child Life Specialist in the care of children undergoing
imaging procedures can reduce turn around time for scans. The Child
Life Specialist (trained in child development and behavior) can tailor
patient education about the CT/MRI to best fit the patients’ needs.
The aim of this project was to partner Child Life Specialists with the
Department of Radiology to create a more child-friendly environment
within the Radiology Department and to reduce pediatric sedation for
non-painful procedures and improve patients’/families’ hospital
experience.
Goal: To decrease the number of children requiring
pediatric sedation for imaging procedures
Confidential: For Quality Improvement Purposes Only
Changes Made
Child Life & Radiology Partnership
– Increased communication via paging, phone referrals and
EPIC documentation
– Developed program criteria
– Established program hours: Monday thru Friday 9am-5pm
Child Friendly Atmosphere
– Implemented an interactive distraction quilt for children’s
use while waiting for their procedure
Confidential: For Quality Improvement Purposes Only
Changes Made
Program Education
– Patients
• Built a CT/MRI model
• Created a photo album, involving children as actors
• Burned a CD of MRI sounds
– Physicians and staff
• Introduced program to staff and posted information to
prompt referrals
Confidential: For Quality Improvement Purposes Only
Education Steps to Success
•
Discuss imaging procedures using developmentally
appropriate diversional techniques (Photo album, MRI/CT
model, and MRI sounds)
•
Allow patient and parent(s) to become familiar with model
and materials
•
Manage any misconceptions
•
Tailor further education to those responses
•
Educate parent(s) on supportive techniques for their
child
Confidential: For Quality Improvement Purposes Only
Patient Education by Child Life Specialists Led to a 50%
Reduction in the Need for Pediatric Sedation
30
25
28
Number
20
15
13
10
5
0
Patients Educated
Patients Sedated
Confidential: For Quality Improvement Purposes Only
Findings
A Child Life Specialist can play an integral part in
helping pediatric patients and their families
with imaging procedures
–
–
–
Patients provided education prior to imaging
experienced a 50% reduction in the use of pediatric
sedation
Some children will always require sedation for imaging
however, patient education will result in
• A less frightening experience for the child
• An increase in the child’s subjective level of
control
The addition of a second full time Child Life specialist
significantly improved response time to referrals and
has positively impacted the goals of the Child Life
program
Confidential: For Quality Improvement Purposes Only
Program Feedback
“A fabulous service that is reducing risks and
improving care for our young patients!”
Attending Physician
“Of all the scans my daughter has had, this was
the easiest one.”
Parent of a 3 year old with end stage cancer
Confidential: For Quality Improvement Purposes Only
Next Steps
• Develop a Patient/Parent survey to
discover the patient’s perspective of the
program
• Explore opportunities for Epic prompts to
guide referrals to Child Life
• Explore new Child Life partnership
opportunities with Loyola departments
that provide care to children
Confidential: For Quality Improvement Purposes Only
References
American Society of Anesthesiologists (1999). Practice guidelines for
preoperative fasting and the use of pharmacologic agents to reduce the
risk of pulmonary aspiration: Application to healthy patients undergoing
elective procedures, Anesthesiology, 90, 896-905.
McGee, K. (2003). The role of a child life specialist in a pediatric radiology
department, Pediatric Radiology, 33, 467-74.
Confidential: For Quality Improvement Purposes Only