Collaboration for Comfort: Helping Children Cope Julie Piazza, MS, CCLS University of Michigan C.S....
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Collaboration for Comfort: Helping Children Cope Julie Piazza, MS, CCLS University of Michigan C.S. Mott Childrens Hospital And Ben Miller, BS, CCLS University of Iowa Childrens Hospital Slide 2 Objectives Explore the evidence based research and benefits of developing a Comfort Plan for pokes and procedures Identify personnel & financial resources required to develop a Comfort Plan through education initiatives Discuss bridges and barriers to implementation, provide strategies through staff/family partnerships that help to overcome them providing direction for future growth Slide 3 Sharing the Problem & the History Memory of early immunization pain is evident Venipuncture and IV insertions are the 2 most common sources of pain in hospitalized Children demonstrated high levels of pain and distress with needlesticks Parents reported anxiety and distress when their child undergoes needlestick procedures. Health care providers find performing needlestick procedures in fearful and anxious children a challenge. Slide 4 Key Components of the University of Michigan Poke Program Needle phobia is a reality for many ! Building relationship through Patient Family Centered Care Communication and Preparation Non-Pharmacological Therapies Drugs and devices Positive Recognition Evidence based practice (EBP) Comfort, Distraction = Improved Satisfaction Poke Program Networking: University of Iowa & others Slide 5 Differences Between Conducting Research and Using Research (EBP) Conducting Research Purpose: to generate new knowledge May or may not benefit the subjects in the research Review by a Review Board to protect the subjects Typically done by PhD prepared researchers Research Utilization Purpose: to put existing knowledge into practice Done expressly to benefit the patient Does not need approval by a Review Board Expected of all staff nurses Slide 6 Improving Practice: Through Evidence Based Practice Triggers for the change Clinical Problem Organizational Problem Knowledge Outcomes of the change Decreased pain and anxiety Decreased time for procedure Increase satisfaction Patient and parent Staff Slide 7 A Systematic Approach for Success Assemble and critique relevant literature Synthesis tables Translate the evidence Select outcomes Guidelines, policies, processes Pilot Evaluate and modify Institute the change and monitor You dont have to see the whole staircase just take the first step -Martin Luther King, Jr. Slide 8 Patient and Family Centered Care Dignity and Respect Information Sharing Participation Collaboration Empowerment The Poke Program supports the principles of Patient-Family Centered Care Ellie's Story Slide 9 Patient and Family Centered Care The Poke Program supports the principles of Patient-Family Centered Care Slide 10 What does the literature say? Preparation Distraction Positioning Parents as helpers and coaches Positive recognition Drugs and Devices Place your information into synthesis tables. Slide 11 Change Package: Best Practices Lucile Packard Childrens Hospital at Stanford 1.Assess and communicate about pain routinely with families and patients. 2.Ask patients and families daily how well pain is controlled. 3.Create an individualized pain plan for every patient, including family input. 4.Educate patients and families about pain management practices and options. 5.Educate staff about how to talk to children & families about pain and its treatment 6.Use standard protocols/order sets to manage anticipated (e.g. procedural) pain. The Poke Program includes these best practices Slide 12 Reducing Anxiety/Pain and Providing Comfort C.S. Mott Childrens Hospital 1.Assess and communicate about pain routinely with families and patients: Collaborative practice guidelines: Spinal fusion surgery, Duramorph analgesia for urological patients, PRC screen, PACU pre-op call 2.Create an individualized plan with input from the child/parent Poke Program 3.Ask patients and families about pain and comfort 4.Educate patients and families about pain management practices and options 5.Educate staff about how to talk to children & families about pain and its treatment Pain conferences and CE programs 6.Pain order set in MiChart helps guide multimodal approach Slide 13 Preparation and Information Poke and procedure preparation Use Best Words High distress and anxiety Emphasize coping skills vs. information Practice skills and processes Deep breathing/blowing bubbles Positioning Slide 14 Comfort Positions Help Position correlates with development Comfort positions make it easier for all Teach parents to hold securely Teaching others how to hold Articulate the research on comfort positions Sell the idea of parents as partners Parental holding and positioning decreases distress Slide 15 15 Slide 16 Distraction is a powerful tool Take a stimulus and reframe it Developmental appropriate Stimulus needs to be engaging Individualize Distraction is used Before During After: speed the recovery/decrease the memory Distraction can reduce pain by 50 %. Slide 17 Parents as Partners Acknowledge their expertise Need to be supported through their own anxiety Help parents to learn best words Guide them to function as a coach and helper Encourage them before, during and after Positive recognition of behaviors that worked Eye contact and affirmative body language Partner with a parent to achieve better outcomes Slide 18 Positive Recognition Be specific about what went well Calling out positive behaviors helps the child remember and reinforce future success Prizes do not keep a behavior reinforced Involve child in the plan and refine the plan for next time I liked the way you held still like a statue during your poke. Slide 19 Drugs and Devices Breasting feeding 24 % sucrose (infants 6 mos. and younger) Drops on anterior tongue with use of a pacifier Vapocoolant spray Short duration and shallow effect Topical Anesthetics LMX4 and LMX5 (20 minutes at least) J-tip (a few seconds) Intradermal Injections Buffered Lidocaine Normal Saline Slide 20 Drugs and Devices Buzzy Vibration and cold Slide 21 Poke-A-Dot The Comfort Dog Poke A Dot becomes the messenger. Slide 22 The Poke and Procedure Plan Includes best practice Patient centered Parent participation Simple Team oriented Communication Empowering Slide 23 Making the Poke Plan Work Team Work Phlebotomy, Physicians, RNs Child Life, Psychologists, Social Work MAs, Techs, Unit host, clerical staff Communication Planning and organization Feedback Asking for help and identifying problems/solutions Slide 24 Work Flow for UMHS Slide 25 Poke Program Growing Fast! Audio Education On GetWell for Parents / Kids Digital Whiteboard Education Roll outs to CES, Peds Infusion, & PACU!! M Learning Module Available: NSG__68 Pilot Rounding with Phlebotomy Info Sheet: Family Center Comfort Zone Pilot Slide 26 Poke Program Growing Fast! Poke-a-Dot has Friends! University of Iowa - Perky Munson Medical Center Poky the Penguin Sparrow Hospital Pokey the Turtle Westchester Childrens Hospital - Ladybug Hawaii Kapiolani Childrens Hospital Wisconsin Childrens Hospital Cow Slide 27 Process Audit Poke/Procedure unit audit (v. #2) Date:Unit: Census: Patient # ______ (room and bed number) Subject number: How old is the patient? 1-6mos 7 -12mos 1 3yrs 4- 6yrs 7-12y 13-18y adult Did the patient have a poke plan on the door? Yes No Refused by pt Did the poke plan have past experiences assessed? Yes No Did the poke plan have preferred positions identified Yes No Did the poke plan have at least one distraction technique Yes No Did the poke plan include a topical anesthetic? Yes No (written in the notes section) Was sucrose checked marked for infants 6 months or younger? Yes No NA Comment: Monitoring and measuring work process and work flow. Slide 28 Learning New Skills: Poke Plan Implementation How to introduce the poke plan on patient care rounds? We all do better with instruction and education when learning new skills Utilize the team huddle for psychosocial rounds and poke plan updates Positive recognition A round man cannot be expected to fit in a square right away. He must have time to modify his shape. Mark Twain Slide 29 Transferring Ideas Slide 30 Resources Required Recommended Staff Nurse Manager Pediatric Pain Team Phlebotomy Team Nurse Educator Child Life Specialist Nurses Nursing Assistants None of us is as smart as all of us. Ken Blanchard Slide 31 Resources Required Personnel Assignments Who? It ended up that EVERYBODY blamed SOMEBODY when NOBODY did what ANYBODY could have done. This is a story about four people named EVERYBODY, SOMEBODY, ANYBODY and NOBODY. EVERYBODY was asked to do it. EVERYBODY was sure SOMEBODY would do it, but NOBODY did it. SOMEBODY got angry about that because it was EVERYBODYs job. EVERYBODY thought ANYBODY could do it but NOBODY realized that EVERYBODY wouldnt do it. Slide 32 Resources Required Personnel Assignments Who? Initiates the education Follows up to ensure completion Reviews the plans prior to needlesticks Advocates for patient preferences Provides education regarding Comfort positioning Distraction coaching Best words Empowerment and skills development Slide 33 Resources Required Office supplies Printed Comfort Plans Printed educational handouts Printed evaluations Stickers Hope is the thing with feathers, that perches in the soul And sings the tune without the words, and never stops at all - Emily Dickinson Slide 34 Handouts Workflow C.S. Mott UI Childrens Comfort Plan Similarities and differences Education for Parents Comfort positioning Advocating Pain relief options Distraction techniques Slide 35 Education The 5 Cs Mantra of the Unit Care: We care about you Comfort: We want you to be comfortable Create: We are going to create a plan Choices: We have choices to make this a positive experience Cope: Working together as a team we can help you