Keep pediatric patients happy and informed
Paying attention can be a key to more smiles
Some low-cost measures can avoid postsurgery spending on the hospitalization of children. Ten years ago, a study was made of 40 children about to undergo surgery.1 Twenty of the children watched a $31 video about what they were going to experience before, during, and after surgery, and the other 20 did not. The 20 who watched the video reported less pain, got up and moved about sooner, and were discharged sooner than the 20 who didn't watch the video.
The investigators calculated that the average net savings per child who viewed the video was $214 — the equivalent of a half-day or more in the facility.
Another group of investigators at Yale Uni vers ity School of Medicine in New Haven, CT, found that if a child were given a sedative before surgery, negative post-op reactions could be prevented.2 The study showed that sedating children prior to administration of general anesthesia not only reduces pre-op anxiety, but also may improve post-op behavioral outcomes such as bed-wetting and loss of appetite.
The researchers studied 86 children between the ages of two and seven who received general anesthesia prior to a surgical procedure. Half were premedicated with midazolam (Hoffmann-La Roche's Versed), and half were given placebo. One week after surgery, post-op anxiety was reduced in the medicated children.
The investigators offer this advice to ease children's worries about surgery:
• Explain why they are having surgery and what will be involved. Use an educational tool such as a video or a coloring book.
• Offer a preadmission tour of the hospital.
• Try to allow parents in the operating room.
Children at Hendrick Medical Center in Abilene, TX, smile more than they used to now that the pediatric unit there has been responding more quickly to their needs, keeping the pain away more effectively, and, in general, paying more attention than they used to. New strategies in the unit include:
• All nurses respond to call bells.
• Beepers tell nurses when a patient is calling and why.
• Nurses go over the physician's orders with parents right away and follow up later to make sure they understand.
• The nurse manager intervenes when parents voice complaints. Problems are solved as they occur.
• Nurses attempt to maintain the child's home schedule for meals, bathing, and medication in the case of chronic disease.
• When parents need to take a break, volunteers sit with their children.
• Nurses receive a special pain management program that eases their concerns about administering pain medication to children.
• The nurses developed a special child-friendly chart to help young patients articulate their level of pain.
• Pain meds are administered primarily through IV lines rather than through painful intramuscular injections, making children less reluctant to admit when they are in pain.
Reference
1. Pinto RP, Hollandsworth JG. Using videotape modeling to prepare children psychologically for surgery. Health Psychology 1989; 8:79-95.
2. Kain ZN, Mayes LC, Wang S, et al. Postoperative behavioral outcomes in children: Effects of sedative premedication. Anesthesiology 1999; 90:758-765. n
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