Kids in the Emergency Department: Guidelines Stress Rapid Assessment and Intervention

 

Children and infants who end up in the ED often require specialized emergency care, yet, the majority of children in the U.S. are not cared for in a children’s hospital ED, according to Sally K. Snow, RN, BSN, CPEN, FAEN, the Emergency Nurses Association liaison to the American Academy of Pediatrics Committee on Pediatric Emergency Medicine.

“When kids get sick or injured they can deteriorate rapidly, and you have to be confident in rapid assessment and intervention and know that your facility has the equipment and protocols in place to deliver quality care,” says Snow, who also is trauma program director at Cook Children’s Medical Center, Fort Worth, Texas.

To help EDs provide optimal pediatric care, the ENA teamed up in 2009 with the AAP and the American College of Emergency Physicians to develop a set of guidelines called the Joint Policy Statement — Guidelines for the Care of Children in the Emergency Department. The ENA, AAP and ACEP are working to educate every ED in the country about the need for equipment and education to prepare for the unique needs of children in the ED and are hoping the guidelines eventually become standards for the Centers for Medicare and Medicaid Services and the Joint Commission.

The guidelines cover such points as pediatric-specific equipment, medications, protocols and staff competencies. Another key principle is addressing the psychosocial needs of children, special-needs children and their families.

“Nurses need to involve the family in a child’s care and consider allowing family presence during procedures and resuscitation,” says Denise Downey, RN, MSN, ED nurse educator, Children’s Hospital, Boston.

Nurses also should tap into the expertise of the primary caregiver, according to Downey. For example, nurses should ask such questions as: How do you know when your child is in pain, hungry or needs toileting? What helps your child feel secure? How do you suction your child’s tracheostomy?

Leadership is another key element in optimal pediatric emergency care, according to Fran Damian, RN, MS, ED nursing director, Children’s Hospital Boston.

“You have to make sure orientation and competency programs are thorough and competency is validated and routinely updated, not just annually,” she says. “Emergency nurses also need to understand their role in advocating for pediatric patients, such as questioning a physician if they don’t feel comfortable with an order.”

The guidelines also require a hospital to designate an RN coordinator for pediatric emergency care. According to Snow, this generally does not require adding a full-time position.

“What is important is to identify a pediatric champion who has expertise in pediatric emergency care and is passionate about ensuring that the ED is prepared to care for kids,” she says.