Improve care of kids with pediatric coordinator
Do you have the appropriate equipment and medication to care for a critically ill child? Is it easy to access? Has your staff completed a formal pediatric resuscitation course? Are staff adequately trained in pediatric assessment? If you’re like many ED managers, the answer to the above questions is "no." Research shows that a significant number of EDs lack what is needed to give children appropriate care.1,2
According to joint guidelines by the Elk Grove Village, IL-American Academy of Pediatrics and the Dallas-based American College of Emergency Physicians, you should have pediatric coordinators to ensure that the needs of children are met in your ED.3 "While there are various ways to implement this, the critical feature is that specific individuals are responsible and accountable for pediatric care," says Emory Petrack, MD, FAAP, FACEP, chief of the division of pediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland.
For EDs that don’t see many children, it is absolutely essential to "consciously" focus on improving pediatric care, stresses Petrack, who is the physician coordinator for pediatric care at his ED. "Identification of specific physician and nurse pediatric coordinators is an excellent mechanism for creating this focus," he says. This ensures that the entire ED staff are prepared to handle pediatric emergencies, that appropriate equipment is available and staff know how to use it, that appropriate policies and procedures are established, and that a pediatric quality improvement (QI) plan is developed, says Petrack.
Here are effective ways to utilize pediatric coordinators:
• Choose the appropriate individuals for this role. The nursing and physician coordinators should have a background in pediatrics and emergency medicine and a strong interest in providing high-quality care to children in the ED, says Petrack. The physician coordinator role can be assumed by the medical director or may be taken by another physician with the requisite skills and interest, he says. "It is essential to have individuals with the focus and passion to make sure that pediatric issues are addressed," he says.
In Los Angeles County, the 55 hospitals designated as Emergency Department Approved for Pediatrics (EDAP) are required to have a pediatric liaison nurse. All nurses are required to have eight hours of pediatric emergency education every two years, says Nancy McGrath, RN, MN, CPNP, CEN, pediatric nurse practitioner and pediatric liaison nurse for the department of emergency medicine at Harbor — University of California at Los Angeles Medical Center in Torrance, CA. "In addition, the nurse should have at least two years’ experience in pediatrics and have completed a two-day postgraduate course on pediatric emergencies," she adds.
• Understand that the position doesn’t need to be full time. Even if you can’t afford to hire a full-time pediatric coordinator, you still should implement this role, stresses McGrath. She points to a 2001 survey by the Los Angeles County Pediatric Liaison Nurse Board of Directors, which found the average time commitment allotted by the pediatric liaison nurses was only four to eight hours a week. "More time is needed to fully perform this role, but staffing issues and budgetary concerns often make it impossible," McGrath says. "To compensate for time, the nurse must be creative to be successful in the role."
For example, McGrath advises pediatric liaison nurses to find ways to collaborate with ED staff in order to fulfill the responsibilities of the role. She suggests the following:
— Have the ED clinical nurse specialist or educator assist the pediatric liaison nurse with quality improvement, educational offerings, monitoring of continuing education, orientation of new staff, and daily equipment checks of pediatric supplies.
— Have the prehospital care coordinator alert the pediatric liaison nurse to transport issues and educational needs of prehospital providers.
— Have the ED medical director work closely with the pediatric liaison nurse to facilitate optimum pediatric emergency care.
— Ensure the physician and nursing coordinators function as a team. Petrack’s ED has bimonthly "RN-MD" meetings in which issues related to care for children are discussed in a multidisciplinary fashion. "The agenda for these meetings is created through collaboration between a nursing coordinator and myself," says Petrack.
— Have the coordinator develop a pediatric QI program.
The pediatric liaison nurse should audit a sample of pediatric charts on a regular basis from the following categories, says McGrath: deaths, arrests and intubations, suspected child abuse or neglect, transfers to and/or from another facility, admissions from the ED to an adult ward or intensive care unit, selected return visits to the ED, and pediatric transports via the emergency medical services system.
ED policies and procedures often have been revised as a result of the chart reviews, she says. For example, a checklist was developed by the pediatric liaison nurses for suspected child abuse to facilitate the paperwork required in this sensitive situation, says McGrath. (See checklist, below.) "The implementation of this checklist has streamlined the process in EDs throughout Los Angeles County," she reports.
| Checklist for suspected child abuse | ||
| 1. | Suspected Child Abuse form completed | _____________ |
| 2. | Department of Justice (DOJ) 900 Physical Assessment Form completed | _____________ |
| 3. | Department of Children and Family Services (DCFS) telephone call documented | |
| Time and operator name | _____________ | |
| (LA County 1-800-540-4000). | _____________ | |
| 4. | DCFS report number documented on the Emergency Record | _____________ |
| 5. | Copy of Suspected Child Abuse form and DOJ 900 forms sent to Scan Coordinator | _____________ |
| 6. | Copy of chart given to the Pediatric Liaison Nurse for review | _____________ |
| 7. | Copy of Suspected Child Abuse form and DOJ 900 attached to the chart | _____________ |
| 8. | Suspected Child Abuse form and DOJ 900 mailed to the appropriate county within 36 hours | _____________ |
| 9. | Appropriate law enforcement agency notified in the case of alleged sexual assault. | |
| Name and badge number of reporting officer | _____________ | |
| documented on the Emergency Record | _____________ | |
| Source: Pediatric Liaison Nurses of Los Angeles, Torrance, CA. | ||
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References
1. McGillivray D, Nijssen-Jordan C, Kramer MS, et al. Critical pediatric equipment available in Canadian hospital emergency departments. Ann Emerg Med 2001; 37:371-376.
2. Illinois Department of Public Health. Illinois EMSC Needs Assessment Summary 1994-1995. Springfield, IL; 1996.
3. American College of Emergency Physicians and the American Academy of Pediatrics. Care of children in the emergency department: Guidelines for preparedness. Ann Emerg Med 2001; 37:423-427.
Resources
The American College of Emergency Physicians (ACEP)/ American Academy of Pediatrics (AAP) policy statement, Care of Children in the Emergency Department: Guidelines for Preparedness (published in the April 2001 issues of Annals of Emergency Medicine and Pediatrics) can be downloaded free of charge at the AAP web site (www.aap.org). Click on "Policy Statements." Under heading "C," click on "Care of Children in the Emergency Department: Guidelines for Preparedness" The policy statement also can be purchased for $1.95 a copy, including shipping and handling. (Credit cards are not accepted for orders under $20.) To order, contact: AAP Publications Department, P.O. Box 747, Elk Grove Village, IL 60009-0747. Telephone: (800) 433-9016 or (847) 981-7924. E-mail: [email protected].
Sources
For more information about pediatric coordinators, contact:
• Nancy McGrath, RN, MN, CPNP, CEN, Harbor-UCLA Medical Center, Department of Emergency Medicine, Box 410, Torrance, CA 90509. Telephone: (310) 222-2339. E-mail: [email protected].
• Emory Petrack, MD, FAAP, FACEP, Division of Pediatric Emergency Medicine, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave., M/S MTH6097, Cleveland, OH 44106. Telephone: (216) 844-8716. E-mail: [email protected].
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