Q & A's

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Post your questions, comments or answers here.

Q) What's the main difference between caring for adults and caring for children?


Q) This is a question for the students and also an attempt by this technophobic nurse (go ahead and laugh) to use this site: What do you think of the bed with the dinosaur head on the homepage? Kate


A) Kate, you did great with the swiki. Here are some of the issues I noticed were different in Pediatrics.

  • It encompasses a wide clinically different age range. Neonates (0-7 days), Infants (7d - 2 years) and Children (2y-14y).
  • Children collapse very fast as compared to adults thus continuos monitoring of vitals is very important.
  • There are Pediatric specific blood disorders which are chronic but near curable Egs Some Leukemias, Thallesemia and Idiopathic Thrombocytopenic Purpuras. Survivorship programs are very effective in such cases.
  • Kids cry at the top of their lungs while you try and take care of them.

Jiten

A) It would be an interesting study for people to figure out how to measure the patient and staff outcome from having dinosaur head bed in the patient room. Do people like it? What do people feel about it? Does it help or hinder procedures and communications? Can we collect evidence such implementation works or not? (It was installed in a Texas hospital) - Ellen

Q) How many more physicians do we need in the US? Based on this number, how many more medical school spots should be added to the current medical school system?

~David Herren 9/12/07

Q) What are the challenges and opportunities for using information technology in pediatric care center?


Q) Why aren't children's using virtual playground or other entertainment technology as distraction technology to distract the patients and their family?

A) Found an interesting description about Believe in Tomorrow Foundation - Ellen


Q)


A)To Jiten: Yes kids crash quickly and that was my concern with the dino-head-bed. Caregivers need to have quick/easy access to all points of a kid's bed, esp. the head. I was thinking i would not want to work around that. I can also imagine it might provoke one of those screaming episodes you mentioned. Re support/chronic Illness: grossly underserved. I would love to see some awesome "Family" room designs; something better than the rows of vinyl seats. Warm, private areas, maybe a shower!!, nice tables. Parents opting to stay w/ their child get strung out quickly due to lack of sleep/privacy/hygeine opportunities. There's often no-place to simply grieve privately. Even if the hospital offers areas of respite, parents don't want to leave their child's area. Re I.T./Distraction: What would that look like? From a very basic level I work w/ teenagers who constantly drop/break/"borrow" the TV/VCR remotes. Recently we had them bolted to the bedside stands but thats not working well either, plus the buttons are hard to clean and infection control is a VERY BIG DEAL. Help.


Team Alpha Questions

Q) At your hospitals, what incentives are offered for staff who follow proper hand washing procedures? Are there any penalties for staff who do not follow proper hand washing procedures? How is this accountability measured or enforced (ie. does management track who does [not] wash their hands and how)? Team Alpha A: No incentives; it is an essential part of good care. We (so i'm told) follow the CDC's hand hygeine guidelines. There are spies who periodically monitor compliance. When hospitals are inspected by the Joint Commission of Hospital Accreditation and the surveyors observe a breach in hand hygeine policy, it is a MAJOR ding. Any staff member in violation would be put on a disciplinary path. I will say that to keep totally within the guidelines is almost impossible. The ideal is never to touch a patient without hand washing, which means I can't simply adjust their IV pump or even siderail without washing again. Compliance at this level is difficult. Kate RN at CF Center Q) What does the wayfinding system consist of at your hospital? (ie. electronic and paper mapping, external building directions/cues, information desks, interior design layout, location of entrances, etc.) Team Alpha A: Working within hospitals, I have been exposed to various modalities for wayfinding. Maps are routinely distributed from information desks. (Maps are especially helpful to hand patients and visitors when they are navigating medical campuses with multiple buildings and parking lots.) In addition to maps, I have seen colored stripes on the floors and walls that lead the person to their final destination. From an interior design standpoint, I have seen flooring and wall coloring that helps patients and visitors in their wayfinding (i.e. "follow the green carpet until you get to...," "sit in the waiting room with red chairs....," and "walk down the corridor with the blue walls...") Many hospitals use entrances and lobbies as geographical landmarks when providing directions and often parking lots/decks will correlate to a specific entrance. Signage is also very important. In a recent construction project at my place of employment we had many walk-throughs for signage. It was important for us to make external and internal signage visible, easy to understand (not oversimplified but not too complex), and uniform (location of signs (suspended vs. wall-hanging), size, color, and verbage) throughout the hospital. In the final stages we hired a wayfinding consultant to help us with the final touches. I have not seen electronic mapping. Tonya

Q) Have you noticed patients and visitors experiencing problems due to wayfinding? Do these people seem to have increased stress and anxiety about not understanding their physical environment? Team Alpha A: I recently tried to find my away around the new portion of Egleston and felt lost. I would guess stress levels for families are high. Also there are a large number of Non-english speaking families who come to Egleston and I wonder how well they are accomodated other than signs in Spanish and a list of translators. Kate Yes, this has been a problem throughout the renovation. They have placed signs and have tried to use clues, "butterfly elevators" to help people find their way. Because some outpatient areas are so difficult to locate now, ie mri, they have actually started using ambassadors to walk families from registration. Lisa Q) Does your building employ the use of 'landmarks?' If so, how have they been made 'landmarks?' Is it because people continually visit them, or because they are nodes of activity, or because they have special labels? (ie. themes, animals, colors) Team Alpha

Q) Are there items/signage/wayfinding systems at the 'level' of children? For example, are all the signs and wayfinding devices placed at adult eye-level? If so, do the children seem to use these strategically-placed systems? Team Alpha A: Not that I've noticed, cool idea. If anyone wants to go to Egleston and wander around let me know and I would meet you which might keep security from bothering you. Kate Most of the signs have been designed for the adults I assume. You can walk around Egleston for days and sadly, no security will ever even question you. Lisa

Team Transformer Questions

Q1) What is the diffence in care processes and patient room design for asthma and sickle cell patients? A: My guess is not much; rooms aren't generally designed to a particular disease. Both here would need Oxygen but that's fairly standard. Any specific questions re sickle cell could be answered by Jacqueline Geter NP in the Egleston AFLAC center. I would facilitate a meeting/tour if requested. Kate

-I'd say the main difference with the two is Sickle Cell kids tend to have longer hospital stays and are admitted more frequently. Our frequent flyers also expect all the amenities because they spend so much of their childhood at the hospital. Although Asthma exacerbations is the number one cause for hospitalization in kids in this area, the same child tends to not be hopitalized as much and they don't usually stay near as long. As far as the different designs for rooms I think that the needs for the room are the same. - Melissa

Q2) Are there any remote monitoring applications in place for any of the disease conditions being treated? - We have Video EEG Monitors on the floor I work on (5 East at Egleston) which are used to record seizure activity. It's actually quite cool. We have a computer at the nurse's station and several rooms set up with equipment as well as our playroom. So basically if the patient has a seizure the caregiver presses a button, the TV shuts off and the bright lights come on until we turn off the alarm. This enable our MDs to monitor the brain waves along with the physical movement of the patient. This helps them determine what type of seizures or epilepsy a patient might have, if they are a possible canidate for surgery to stop the epilepsy. - Melissa


Q3) What is the difference in cost between a standard patient room and a universal room? I don't think there is a difference until you go to ICU.Lorie I agree- there are different ways of charging a pt as far as insurance goes, but the only major design differences are between general floor rooms and ICU rooms.- Melissa

Q4) Does anyone have any experience with the added costs and related benefits of becoming a nursing magnet hospital? I'm not sure how much it cost because a lot of work goes into it. I'm sure you have to pay to submit your application. It looks really good to be a magnet hospital. It attracts a higher quality of potential staff. Lorie


Q5) Is there a pediatric survivorship program in place? If yes, how effficient is the transfer of this program to adultcare after the child outgrows the pediatric age limit. We do have one but I'm not sure about the it. I would contact the person above. I'm not sure about the transition of care. I know for some of our patients they are going to have a shock when they go into the adult world. I have done both and we baby our patients and the adult world does not.Lorie

A: I work with teenagers and adults "outgrowing" cystic fibrosis. The Transfer of care from a largely pediatric disease into adulthood (due to the recent development of some great drugs) is poor in this circumstance. Our center was created to aid this transition, but we are finding that few "adult" Docs feel comfortable treating CF. Same holds true for Nursing staff in Adult facilities; they know little about CF. The patients often resist any transfer of their care and wind up begging/pleading with the pediatrician to retain them. Kate

Q6) In your opinion, what would be the advantages (and disadvantages) of making pharmeceuticals publicly distributed? A: I'm not sure what's being asked, could you rephrase?

Team Lefthook Questions

1. What is the positive environmental distraction for child? A: Varies greatly with age. Do you mean during an invasive or frightening procedure or just to keep them occupied in their room? In radiology, were you need to keep kids still for pictures, things on the ceiling are great distracters. MRI has fish on the tiles and CT used to have a light up space scene. It worked great to have the kids stare at the twinkling stars as the CT took there picture. In radiology, distraction may save the child from needing sedation for the test. Lisa

2. What is the difference in spatial cognition/wayfinding ability between children and adults? Still not sure I want kids wandering around alone trying to find their way. Lisa


3. How to get the drawing of floor plans of old and new hospital? A: I would suggest calling the Engineering Department to inquire at 404-785-6153 (Egleston)

4. Is there any 3D model from the design company? No that we have access to at this point Lorie

5. Where are there changing tables located in a children's hospital? Yes in the largest stall on the end ususlly. This is so they are out of the way.Lorie I honestly think I've ever onkly seen one changing table in our hospital in a family bathroom on our floor, otherwise, it's the bed or the crib of the pt in the hospital.- Melissa

6. Are there lactation rooms being built into children's hospitals or have they been in them historically? We have lactation removes by our NICU. One of the employees in the ED use them regularly. This is a great service to our employees so they have some where private to go. The mothers of babys can continue to breastfed.Lorie It would be nice to have atleast one on each floor. - Melissa

Team Lego Questions

1. Do you have child life program in your hospital?Yes we do. Lorie

2. If you have, how does it work? We have a full time specialist in the ED. SHe helps when there is a trauma. She talks with the child and keeps them calm. We can do what we have to and she explains it. SHe provides books, games, view master, video games, coloring sheets, give aways(bubbles,cars,sticky men) and movies.Lorie

  • How often does a child life specialist meet a patient?They are referred by the staff or can go in and talk to patient if needed themselves. We use her when we have painful procedures(iv starts, suturing, incision and drainage of boil and casting.)Lorie

There are generally Child Life Specialists assigned to different floors adn ours always did rounds on all our patients and went through them all to see where she could help.

  • how many patients does a child life specialist meet?I not sure of the number but it alot in the ed Lorie
  • I heard there are teachers who involve in patients’ education. Are they also child life specialist or do they belong to other kinds of program related to patients’ education? The child life specialist are a separte group. The teachers are just like the ones in the school system. Lorie

A: We have a child Life department at Egleston and a separate School room. The Main teacher's name is Anne Drennon and her number is 404-785-1230. She'd be happy to answer any questions. 3. What other kinds of activities your hospital do for patients’ educational or psychological support? A; Again, I work in a freestanding mini-hospital apart from (but part of) Egleston, but I know there are Chaplains and Social Workers,a family library, crazy dress-up days by the staff, special events like sports celebrities who visit, special recognition of patient birthdays. The other nurses will know more./ We have clowns that go around and see the kids. They play bingo. We blow bubbles and try to have fun with the kids/Lorie

Lorie, thank you for all your answers and helps!! I will try to contact with Anne Drennon if I have further questions!

Newly undated questions

4. I'm curious that when physicians and families need to talk about thier child's condition, especially when it is very serious, where do they talk about it? In the patient room with the patient in present or go somewhere? I just thought that if I'm a family member, I might not want my child to hear his/her real situation becasue it might be too much to deal with them. If they go somewhere, where is it and how far would it be? Do you think that there is a need for a space which is within the unit and closer to pateint room for this kind of discussion? A: I think there is a huge need for such areas. Last spring I was visiting/spending nights with a close family friend at Scottish.16 yr old with a fractured leg,hip,pelvis,jaw and neck. Her best friend and driver of the car that crashed was killed. We did not want to be far from her, but to give her any kind of privacy or quiet there was no place nearby to go so we sat in the hallway outside her room. It was pathetic although the staff was very tolerant and walked around us! Physicians generally spoke with her parents in front of her, which as you point out can be far from ideal.Kate A: We need such a room in radiology as well. Often important diagnosis are made based on their scans and we really don't have any private place for the doctors to speak with the parents. Recently, a child was diagnosised with a brain tumor and the neurooncologist had to tell the parents in the middle of a busy department. She showed the parents the child's scan at the nurses station. It would be ideal to have a room set up with a computer so that the doctor could have privately shown these parents the dreadful news. Lisa

Thank you!

Team Tricycle Questions

1. Do patients have perception of time while in hospital? a: I would say No. Any routine they are used to is disrupted. Stuff happens to them day and night, although we do our best to minimize this. Sleep deprivation is a factor given, In my opinion, little attention. This too causes stress and disorientation. Kate/ We have clocks in the rooms for families to use. They usually over estimate the time they are there and time they are waiting.Lorie Time goes by very slowly for the kids and families. Lisa

2. Do the hallways or work areas feel crowded? A. Hallways no, work areas yes. Kate/ In the ED we have stretcher in the hallway, pumps, IV carts and 2 fun centers(portable dvd players) We don't have enough room for everything we have.Lorie I think that depending on what area you are in the crowding issues depends on the time of day and the floor but I agree with Lorie there is definately not enough room to store everything.... and especially to Joint Comission standards. Space is a premium and each unit needs a room just to store pumps, monitors etc. In MRI we got dinged for putting wagons in the hallway but our children leave the department groggy from sedation and we have no area to store a much needed wagon. They have built a wagon bin in the new building near the front enterance but this is very far from radiology. Joint commision puts a lot of restrictions on our already tight space. Lisa 3. What is the hardest area to find at the hospital for staff and visitors? A: I don't know. You might consider walking into Scottish or Egleston and seeing what it means to find,say, the Chapel, restrooms, cafeteria, ICU waiting rooms. Of course I'm partial since I work there, but I think it is very difficult to find MRI at Egleston since the renovation.

4. What all is involved in sickle cell anemia treatments? A: Call Jacqueline Geter N.P. at Egleson AFLAC center, tell her Kate from the CF Center told you to call. She specializes in Sickle Cell. From an Emergency Department perspective, evaluation includes an assessment and lab work. Therapeutic interventions for sickle cell patients include resting/very minimal activity, warm blankets, pain management, oxygen, and large amounts of IV and oral fluids. On rare occasions we will give a blood transfusion in the Emergency Department. Poor oxygenation (from pneumonia or respiratory illnesses, scuba diving, excessive exercise, etc.), exposure to cold, and infections are some of the things that can predispose a sickle cell patient to have a crisis - it is important that patients avoid activities or exposure to illnesses that can exacerbate the disease and that healthcare providers treat such underlying factors. Tonya Comfort is a big factor if the child is in pain crisis. Lisa

5. What all is involved in asthma treatments? A: Calming anxious parents and kids, Aerosolized medications via mask or nebulizer, maybe oxygen, IV therapy.Close monitoring of vital signs and lung sounds.Usually a day or 2 in the hospital. It's very scary and unfortunately often the result of non-compliance or lack of education/understanding in use of their controller medication. Kids die from acute asthma attacks but this is largely preventable. what else do you need to know? kate