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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:

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child life interventions reduce need for 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
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
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 made4
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
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

findings
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
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
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
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