Lisa Gray: Miss Sally Can you see your slides.
jillian walsh chla: I can hear me yep.
Sally Snow: Perfect are we ready to start.
Lisa Gray: I believe we are people are so join in, but I think it's a good time we'll go ahead and get started.
Sally Snow: All right, um well i'll introduce myself briefly I, my name is Sally snow, I am a long term friend of the msc in the pediatric readiness project Steering Committee and in the in the msc program I have been a nurse for more years than you need to know.
Sally Snow: Almost 50 and I am currently a retired emergency and trauma nurse.
Sally Snow: pediatric focus mostly for most of my career.
Sally Snow: And I do some consulting work, as you can see, with the EIC and some other.
Sally Snow: quotes but.
Sally Snow: that's what that's why they.
Charlene C: elevate 978 710 and.
Lisa Gray: Just a reminder to everyone to please mute and this this webinars this breakout isn't automatically muted, so if you could please mute so we can hear Sally Thank you.
Sally Snow: i'm pretty good at talking over people.
Sally Snow: That.
Sally Snow: days, yes I don't have to.
Sally Snow: Okay next slide please.
Lisa.
Sally Snow: All right, this may look a little familiar, in fact, I think we saw it, a couple of times before, but you know what they say you have to say something three times before people get it some time so let's let's go with the third time, so what our policies and.
Sally Snow: Procedures the posted.
Sally Snow: Please mute guys.
Kaylee Briolat: Can you please mute Thank you.
Michelle Moegling: Sally you're muted.
Sally Snow: How, in the world that I get needed did you.
Sally Snow: mute everybody.
Sally Snow: it's Okay, if you did.
Sally Snow: All right, we ready.
Sally Snow: Let me get.
Sally Snow: Let me get back in business here.
Sally Snow: alright.
Sally Snow: So again, water policies and procedures supposed to do for us.
Sally Snow: um well, they should lead us to lay out what we expect on a particular subject with the goal of achieving safe and high quality pediatric emergency care that's number one.
Sally Snow: They need to be simple uncomplicated focus statements that are clear and concise.
Sally Snow: They should provide for a way to bring down costs and efficient bring efficiency up though should provide a path that decreases variation.
Sally Snow: errors and reduces confusion and it should be clear who is has accountability and and really everybody who's responsible for for following policy and procedure.
Sally Snow: It has accountability for it, but most important it's in this process is defined and utilize the experts and the resources available to get the policy right, the first time.
Sally Snow: Next slide Lisa.
Sally Snow: So you should answer these questions, why do we need this policy if you can't answer that question, maybe you don't need it it's something you need to decide up front.
Sally Snow: Ask yourself is this clinical or an operational policy what's the subject we're trying to define always keeping in my values vision and culture.
Sally Snow: With with simple appropriate language or their boundaries or constraints and what expectations, do we need the policy to meet.
Sally Snow: Is it flexible, or we adhering to a standard format established by the institution, what is your institutions policy on policies it's always best to read that first.
Sally Snow: And finally who's responsible for the policy and who is affected by it, you must get input from the end user, the person who has to implement the policy and procedure and adhere to it must have input to ensure it successful next slide Lisa.
Sally Snow: So let's talk a little more specific about policies and procedures now.
Sally Snow: What are some of the policies you need in place to care for kids Obviously there are more policies needed than these but, in my experience as a facilitator, sometimes reviewing page ready facilities, these are some of the ones that I see that are often missing or may need the most work.
Sally Snow: Next slide.
Sally Snow: recognize this little icon I thought it was brilliant to put this in here you'll see a lot of it.
Sally Snow: During this presentation, because I really want you to think about what questions you may have, as we talked through these policies.
Sally Snow: understanding that i'm going to provide you with some sample policies at the end if we have time we'll look at a few of them and i'll give meredith and Michelle and Lisa all of the policies that I have to share and then you'll be able to look at them at your leisure next slide.
Sally Snow: So let's talk about child abuse screening recognition and reporting, this is extremely important, especially in a general emergency department or staff may not see or recognize subtle signs of abuse and low volume ED.
Sally Snow: In nonverbal children, child abuse is often Mr overlooked and it can be devastating and the consequences are lifelong.
Sally Snow: So what's the purpose of a child abuse policy and procedure should the focus be on the patient, so your purpose statement leads with something like all suspect that are obvious cases of child physical, emotional sexual abuse and neglect identified and reported dot dot dot.
Sally Snow: What about a focus on the law should we lead with the presence is to ensure compliance, the purpose is to ensure compliance with laws and regulations.
Sally Snow: How about a focus on the hospital or the staff should it state, the purpose of the policies to prevent present an overview of steps to be taken by the staff when child abuse is suspected.
Sally Snow: Perhaps combination of all those is appropriate, I think it the orders important and the primary focus should be on the patient, the child next slide Lisa.
Sally Snow: So, in your policy statement you might see things like this.
Sally Snow: suspected child abuse, should be reported in accordance with hospital policy and established law.
Sally Snow: or all hospital employees and physicians must comply with State law for reporting suspected abuse or how about all pediatric patients are screened for evidence of abuse and managed in accordance with established standards and laws.
Sally Snow: The policy can be extensive may be very extensive, including things like the plan for education of staff who are responsible for that i'll show you an example of that a little bit lighter.
Sally Snow: And it should include a statement regarding screening of all children with a standardized validated screening to.
Sally Snow: The evidence shows that ED these are five times more likely to detect abuse if its present.
Sally Snow: When using a standard screening tool that's a significant increase in the number of kids that you'll identify as at risk for abuse, if you use a screening tools highly recommended that you do that.
Sally Snow: Mortality increases with recurrent episodes of non accidental trauma and children, and we never want to hear that a patient that we discharged came back critically injured or dead from child abuse that we missed the time before next slide Lisa.
Sally Snow: So your definitions and your child abuse policy should include who's required to report by law, these are.
Sally Snow: legal responsibilities.
Sally Snow: The legal department can inform you about that in my state Texas, the Texas family code lays out who are mandatory reporters.
Sally Snow: The penal code in some states like that out, but those kinds of things should be included in your definitions and your child abuse policy.
Sally Snow: You need to define the types of abuse, so what is physical abuse what's emotional abuse, sexual abuse, neglect some policies include a statement about exploitation and willful intent.
Sally Snow: How detailed these specific definitions are in your policies entirely up to you, you may want to just refer to an appendix with all of the detailed definitions.
Sally Snow: that's entirely up to you, general eds may add child abuse to their elder or vulnerable adults abuse policy but there needs to be specific pediatric definitions defined and spelled out in your policy if it's included within your adult policy next steps next next slide.
Sally Snow: The procedure should definitely include the use of a standard screening tool, there should be detailed documented instructions of how to describe injuries.
Sally Snow: How to document statements of the patient and the caregiver we know those need to be done in quotes verbatim.
Sally Snow: Notification of law enforcement child protective services or whatever your state calls child protective services.
Sally Snow: social worker documentation is important if a forensic exam is performed that needs to be clearly documented if there are issues of chain of custody of evidence, those need to be defined.
Sally Snow: What consulting services are needed in your hospital who admitted it's a patient that's been abused my experiences it's always trauma trauma admits, for the first 24 hours in a in a.
Sally Snow: verified designated trauma Center that's pretty much the way it goes what other consultants, do you need do you have a child abuse pediatrician.
Sally Snow: The hospital, where I spent the majority of the last few years of my career, we had a.
Sally Snow: team of pediatric sexual assault nurse examiners nurse practitioners, a child abuse abuse pediatrician we call them the care team child abuse resource and evaluation team.
Sally Snow: And they were the experts, they did all of the evaluation of child abuse patients they they consulted on all of them, and just as an aside i'll let you know that in tarrant county Texas before there was a care team.
Sally Snow: There was no conviction of a child sexual assault defendant without a confession after the care team was implemented and we got.
Sally Snow: The experience sexual assault nurse examiner and our child abuse pediatrician we convicted lots of sexual predators in tarrant county and that's an important thing to do.
Sally Snow: Is a transfer warranted.
Sally Snow: For a forensic exam or higher level of care, due to the child's condition that needs to be part of the procedure, we need to document disposition, will the child be discharged admitted or transferred.
Sally Snow: And this is a policy that needs a quality review component to assure compliance i'm going to share.
Sally Snow: A recently approved child abuse toolkit which includes a validated screening tool and interventions that were developed by the pediatric committee of the Texas governor's Ms and trauma advisory council.
Sally Snow: With meredith and Lisa and Michelle and so you'll have that and it will really help inform your policy and procedure development.
Sally Snow: i'm also going to provide several examples of complete policies that are shared with me that were shared with me by.
Sally Snow: My colleague Nancy mcgrath from California there's one of the original text and the California eat out program and that will be very helpful to you as well, next slide Lisa.
Sally Snow: So what about the purpose when it comes to a child abuse policy Is there anyone in this group what wait wait i'm talking about triage now arna Hello.
Sally Snow: Okay let's move on to triage and reassess.
Sally Snow: We beat child abuse, no pun intended.
Sally Snow: So the purpose of a triage and assessment policies to establish the process for providing initial assessment of patients are writing to the ED for care in accordance with evidence based triage practices.
Sally Snow: Is there anyone in this group who's not using the injury Severity Index five level ED triage program I know that if we have international participants that could be different, I know.
Sally Snow: Canada has its own USA I hope you're all aware that he and I now owns yes and they've recently made available a continuing education module for pediatric asi that can be accessed on the new era university website.
Sally Snow: And i'll put that in the chat if I get a second in a minute in full disclosure i'm an emt Member in the chair of that you know foundation, but have a highly recommend this resource for educating your nursing staff on ios especially around pediatrics.
Sally Snow: The other purpose of the policy on triage and reassessment is to establish parameters for when and where to reassess patients and what that documentation looks like next slide.
Sally Snow: So you need to define your triage levels with pediatric specific examples i've looked at many a triage policy in an adult only or.
Sally Snow: Primarily, adult facility that doesn't include the specific examples of what level one level two Level three level four level five look like.
Sally Snow: When it comes to kids so it's important that you have specific pediatric examples some hospitals are using screening staff like PD a paramedic to quickly assess patients for more urgent need some have a nurse call the router nurse who quickly determines who needs to be seen.
Sally Snow: And, or who needs to be directed to a treatment area.
Sally Snow: So how do you manage patients arriving by ambulance versus walk ins those need to be defined what vital signs, do you take it triage.
Sally Snow: Does anyone get a full assessed does everyone get a full assessment or is a focus assessment separable and when that needs to be spelled out.
Sally Snow: Do you do you directly bed patients are you or do you send some to the waiting room.
Sally Snow: What kinds of nurse initiated interventions, do you have in place, can a nurse order an x Ray on an obviously deformed forearm can they order lab can they do a strip screen and triage.
Sally Snow: Are you giving medications for elevated temperature so those kinds of nurse initiated interventions, need to be spelled out, or at least referenced in your policy.
Sally Snow: One of the things that's complicating this a little bit is some expanded use of providers in triage that's necessitate necessitated some in some cases, a complete overhaul of the screening process up front so that's something to keep in mind if that's something you're doing.
Sally Snow: Next slide please.
Sally Snow: Some policies benefit from the use of a figure like this triage algorithm visual cues are helpful and draw attention to materials that important that are important, it provides information at a glance, including this danger zone bottles that's included in this this graphic next slide.
Sally Snow: Use of graphics and picture Graham pictograms is helpful this reference to the pediatric assessment triangle helps focus on those patients that need immediate attention, besides there nothing colorful and they draw people's attention to them next slide Lisa.
Sally Snow: If patients are directed to the waiting room after triage or policy needs to God how often those patients should be reassessed.
Sally Snow: If medications are administered response medication needs to be documented as in favor control medications so if you're given a kid a.
Sally Snow: tylenol before you send them out to the waiting room, you need to be able to have a method to reassess those kids.
Sally Snow: If they don't get back to the treatment area in a timely manner it's important to teach triage nurses to instruct parents to come back to triage if the patient's condition changes.
Sally Snow: What is the expectation for reassessing patients during their ED stay whether they're in the treatment area or not, what are the documentation expectations.
Sally Snow: Your policy should also address triage red flags and you may include a table for how to manage fever in children i'll show you an example of that in a few minutes.
Sally Snow: Ian PC and other references can help identify what should be included in this list of red flags there they're pretty obvious but it's important to have those kinds of things in your policy next slide.
Sally Snow: let's talk about the vital signs policy and procedure next the ball sounds policy can be a standalone.
Sally Snow: or part of the nursing assessment policy for the purposes of this discussion we'll talk about it as a standalone.
Sally Snow: So the purpose of the vital signs policies typically to establish what vital signs should be assessed on patients and when and under what circumstances, they should be reassessed and then what should abnormal when should abnormal vital signs be reported to the provider next slide.
yeah.
Michelle Moegling: Can you please mute yourself.
But.
Sally Snow: So kind of definitions, do you need in your vital signs policy definition is necessary to establish the policy for what vital signs should be assessed.
Sally Snow: And when to notify the provider of abnormal findings education is really important to establishing the guideline and should be developed with medical staff leadership to avoid conflict between docs and nurses when notification.
Sally Snow: occurs everybody needs to know up front.
Sally Snow: When to expect to be notified about an abnormal vital.
Sally Snow: sign it should include weighing patients in kilos kilos only and documenting a pain assessment dirt using age appropriate pain scales.
Sally Snow: include a figure with those pain scales in your policy I know this is more assessment and vital signs that you can't mention it too often.
Sally Snow: Frequency for repeat vital signs is an important parameter to consider in your policy don't make the policy more stringent than you can comply with.
Sally Snow: and conduct frequent review of records to determine compliance, you can always take more vital signs than the policy states, but you can't take lists.
Sally Snow: So your vital signs policy should say something like that you repeat vital signs as a patient's condition dictates, if you think that certain levels of patient should be repeated to 15 or two hours or four hours.
Sally Snow: pretty much everybody thinks that revolve son should be repeated at some point before discharge admission or transfer but don't say in your policy, something you can't comply with that's a certainly are legal red flag.
Sally Snow: Next slide.
Sally Snow: So pick them normal vital signs reference and provide the staff with badge buddies.
Sally Snow: or normal pediatric violent for me normal PDF file some parameters it's especially important in a general ED where the volume of pediatric patients is moderate to low.
Sally Snow: posters and triage and recessive station with normal vital signs is important.
Sally Snow: In the resuscitation agreement, a triage room make sure your normal vital signs reference matches your emr and the alarm parameters include pediatric values have seen many em ours that don't break down.
Sally Snow: incremental age groups for pediatrics it's just all pediatric vital signs are clumped into a couple of age categories if if not only one so make sure those match.
Sally Snow: establish the when and why and how providers will be notified about abnormal vital signs and how that notification is going to be documented.
Sally Snow: The provider doesn't need to know if a school age child comes with 101 temperatures when they sunny and if the patient's not had.
Sally Snow: an antibiotic and has a normal level consciousness and normal heart rate and respiratory right they don't need to know about it right, then, on the other hand, an infant with 101 temperatures a reason to notify the provider so make sure those.
Sally Snow: Those pieces of the policy procedure or well in service and everybody agrees to what is important to do.
Sally Snow: Notification or provider when a patient has abnormal vital signs is one of the bundles that we used in the pediatric readiness, quality and collaborative.
Sally Snow: that took place in 2019 and 2020 when we first started looking at that we found a deficit in a lot of ERS but a quality improvement effort with education to the step, resulting in a lot our compliance so it's something you can turn around next slide.
Sally Snow: So let's talk just a minute about patient family centered care.
Sally Snow: Some of these concepts may be difficult to implement in general er, but I would submit to you that the sick or injured adult would benefit from the presence of a loved one most of the time, I know I would.
Sally Snow: For the purpose of this discussion, though let's talk about why family centered care is important to the care of children and their families in the er.
Sally Snow: Parents and caregivers know their child's baseline best so they know what it looks like when their child is in pain, they know what calms them when they are upset so it's really important to have a parent and caregiver with the child at all times.
Sally Snow: Their perspectives and information provided by families children, young adults are essential components for high quality.
Sally Snow: Clinical decision making decisions made together as a team or, more likely to succeed.
Sally Snow: patients and families are integral partners with the healthcare team and again from a buyer perspective and a compliance perspective, you need those people to be with you.
Sally Snow: Evidence validates that there's a direct correlation between patient satisfaction and family centered care in which nurses play a vital role we don't always want to talk about patient satisfaction but it's a reality, and it it.
Sally Snow: Is it's proven that having the family involved from the beginning, is going to improve your patient satisfaction scores.
Sally Snow: Next slide.
Sally Snow: In terms of definitions, you want to define patient family centered care patient and family Center cares and approach to health care, that is grounded in the mutually beneficial partnerships among patients families in health care providers.
Sally Snow: The American Academy of pediatrics American college of emergency physicians and the emergency nurses association as a joint policy statement on patient family centered care in the emergency department.
Sally Snow: That can help inform your policy statement purpose and procedure i'll share that with meredith and she can.
Sally Snow: share it with you all, one of the things that it includes is an assessment that you can do.
Sally Snow: On your er to help you assess whether your er is ready for.
Sally Snow: His his family centered we'll also talk in a few minutes about family presence during procedures and resuscitation which is decades old and evidence based.
Sally Snow: So what about family goals and outcomes when it comes to a patient family centered care policy.
Sally Snow: each child and family should be empowered to make choices and decisions organizational policies procedures and provider practices.
Sally Snow: should be flexible, so that services can be tailored to the needs beliefs and cultural values of each child and family and the health care teams communication should be collaborative with patients and families, integrating their feedback into the care for the patient in terms of assessment.
Sally Snow: Look around is your er child and family friendly.
Sally Snow: Next slide.
Sally Snow: Some of the interventions, you might address with your family centered care policy or do you have a welcoming environment, what kind of information are you providing to parents and families.
Sally Snow: Do you individualize the approach is there a discussion and review of the plan of care, you want to involve parents in every aspect of the patient's care encourage family presence foster open communications and develop trusting relationships next slide.
Sally Snow: let's talk for a minute about family presence, I hope that everybody listening to this workshop today.
Sally Snow: is doing some form of family presence family presence during procedures and resuscitation again is a decades old concept that's evidence based.
Sally Snow: But in some settings still meets with resistance, especially from some physicians administrators and sometimes the lawyers.
Sally Snow: The policy should be clear about when family can be present and under what circumstances they may not be present.
Sally Snow: it's very important that the concept be fully embraced by the organization and there must be buying from the medical staff.
Sally Snow: surgeons and surgical subspecialties are especially important, the last thing you want is a neurosurgeon walking in and trying to kick a family member out during our cessation families have a right to be present under the right circumstances staff safety has to be the highest priority.
Sally Snow: In family presence during recitation does not typically result in any disruption of necessitated efforts it's a central that a dedicated staff social worker or chaplain be son to attend to the needs of the family.
Sally Snow: Certainly the evidence indicates that families begin the grieving process sooner in may in fact be the ones who asked that the efforts be discontinued and there's no evidence that litigation is increased when families are allowed to be present during resuscitated recess at the.
Sally Snow: next one.
Sally Snow: So, in summary, when developing your policies and procedures don't reinvent the wheel, there are people out there who are willing to share policies and procedures, the EIC has the.
Sally Snow: The national pediatric readiness project has a toolkit for pediatric readiness, it has tons of them.
Sally Snow: utilize your experts in your professional organization resources use the yes, I see toolkit for page ready get input from everyone involved with implementing the policy procedure and educate the staff with every new in revised policy rollout.
Sally Snow: I want to thank you all so much for your participation in this collaborative you're doing such important work toward making the eds in this country pediatric ready.
Sally Snow: And championing the pursuit of excellence and pediatric emergency care, thank you for the opportunity to talk to you about policy and procedure development.
Sally Snow: i'll be sharing lots of resources with meredith was sample policies that you can adopt and tweak to fit your hospitals needs so let's answer some of those questions that you've put in the chat.
Sally Snow: What do you got meredith and Lisa are Michelle and Lisa i'm sorry.
Michelle Moegling: The slides will be posted just after the presentation, they aren't able to be posted at this moment, but they will be posted this afternoon.
Michelle Moegling: And then we had lots of questions about that.
Michelle Moegling: Does your do your policies and specific asi levels that a pediatric patient with suspected na te has to be.
Michelle Moegling: And also, if they must be seen by an md or can it be a mid level.
Sally Snow: I don't think there's any specific.
Sally Snow: rule about whether they can be have to be seen by a physician or mid level me obviously at some point if there's going to be an admission or a referral to a child or forensic exam physicians going to have to may have to see them.
Sally Snow: Tell me, the first part of that question to give me Michelle.
Michelle Moegling: They were asking if there's a specific si level for non accidental trauma.
Lisa Gray: You put in the policy.
Sally Snow: I don't have the asr in front of me but, but I think it depends on the condition of the child, I typically see suspected abuse or concerns for abuse being given a higher level, because it does require additional resources.
Michelle Moegling: I think we usually do a minimum of a three and if they have like significant burns or anything like that you're gonna have, of course, a higher level.
Michelle Moegling: Let me start the bottom here.
Michelle Moegling: Lots of questions about putting do you require blood pressures on every child.
Sally Snow: That really depends on the institution and the physician leadership.
Sally Snow: And and nursing leadership the you know the the the.
Sally Snow: Page ready materials says yes, you should do blood pressure on every patient, because if you don't do a blood pressure on a three year old, how do you know that they have hypertension and may have some.
Sally Snow: You know, some early onset kidney disease so So yes, there is a way to get an effective blood pressure on every child now.
Sally Snow: Is it mandatory it's something that you have to decide as a group of leaders nursing and physician leaders and and make part of your policy but, if your policy says, you get a blood pressure on every child, then you should get a blood pressure on every child.
Sally Snow: it's, what do you think Michelle, what do you guys do.
Michelle Moegling: I think so many people try and focus on a certain age to get a blood pressure and that really should not be the consideration it should be, are they acutely ill.
Michelle Moegling: We have to get we require blood pressures across our system, even in our communities for anybody that's an asi one through three.
Michelle Moegling: And then, four and five if they're stable and look great then they can get those in the back, but blood pressure is really important, especially as we look at sepsis across the nation.
Michelle Moegling: has been a big focus you really need those blood pressures, so I think and people I think are afraid to do it on young kids or think they can't, but it is important to really be able to get a blood pressure on a young child and and.
Sally Snow: It really.
Sally Snow: It really does take a technique and practice and and knowing some little tricks of the trade about how what makes it easier, I mean sometimes just your language, if you can just say, do you mind if I hug your arm or your leg down here it's just a matter of.
Sally Snow: Of.
Michelle Moegling: Knowing how to approach this.
Sally Snow: parent in the family.
Michelle Moegling: and using.
Michelle Moegling: And utilizing distraction.
Michelle Moegling: Exactly, you can use, you can get them to watch the numbers and watch them go down, and it is it's talking to them through it.
Sally Snow: Give them something to play with the toy to hold or it's definitely all about technique.
Michelle Moegling: Yes, sir.
Lisa Gray: I think that we found in our adults.
Lisa Gray: Income combined ED that you see the majority, the majority of the patients, you see, are adults and it's go in take your blood pressure and Lee it takes a little more time, but you can figure out tricks, for the most part.
Michelle Moegling: Now is.
Lisa Gray: Everybody in.
Lisa Gray: Every child is not trackable but, for the most part, I think it's just convincing folks it'll take a little bit it might take you a little bit longer but it's a very important number to have in your overall picture of a kid.
Michelle Moegling: yeah yeah.
Sally Snow: You can see nurses get the parent to let them get their blood pressure, taken and, once the kids see that it doesn't hurt mondo think it's a bad idea, then they're cooperative your rightly said, it takes time.
yeah.
Michelle Moegling: And document why, if you can't get it.
Michelle Moegling: You don't have a policy that says that you have to get it document why you can't get it, if you have a.
Michelle Moegling: kicking and screaming child or they're going ballistic well they're probably not hypertensive so document their what they look like and what they're doing.
Deanna Parker: I have a question, yes, so I work at a general ED we have about 12 to 1500 pediatric patients, a month.
Deanna Parker: When looking at pediatric readiness certification and full transparency, this section is the one that like wait on me the most.
Deanna Parker: Maybe that's the administrative side of me going oh my gosh so I just wanted to ask a little bit of guidelines, there were.
Deanna Parker: When I use the tool kit and i'm on the website it gave samples of different policies and at our organization, we have.
Deanna Parker: We have quite a bit of policies related to our pediatric population and there's not a set expectation of you have every single policy on a particular aspect you provided samples.
Deanna Parker: That guide to care, but not necessarily that you have to have a policy that matches each one of those Am I correct.
Michelle Moegling: If you look at the kids readiness, the national pediatric readiness, it does have a list of policies that you should have.
Deanna Parker: It does it says, this is a sample of relevant.
Michelle Moegling: Policies yes teacher, so they actually use those winners scoring your to give you, your score for pediatric readiness it doesn't have to be a separate policy for your pediatrics it can be intertwined with your adult policy.
Deanna Parker: Like in our Community of ours are.
Michelle Moegling: And that's perfectly fine especially like we have our triage because we have received speeds across our Community hospitals as well.
Michelle Moegling: We only see kids in our children's hospital, but they are going to present to the closest sites, so you want to make sure that that policies intertwined with your pediatric patients.
Deanna Parker: Perfect Thank you so much, I just wasn't sure if I had a feeling that that was on there, because those were really important one.
Michelle Moegling: yeah those are to make.
Deanna Parker: Sure, but I really appreciate it, thank you.
Lisa Gray: Thank you deanna eat.
Lisa Gray: yeah I think i'm sorry go ahead.
Sally Snow: Just one more thing it is really important, and and perfectly acceptable for you to to integrate your pediatric policy within your adult policy.
Sally Snow: But but it's not Okay, for you to just like I surveyed a hospital one time that took the burn policy and just stuck the PD word in front of it and it had no.
Sally Snow: Relevant applicability to the treatment of a pediatric burn so it, though it's fun to do that, but make sure there is a relevant pediatric focus to that policy.
Michelle Moegling: Absolutely really good point Sally I think lovely Thank you.
Deanna Parker: Am I am I somewhat normal and the fact that this section is the one feels a.
Lisa Gray: little better.
Deanna Parker: Okay, thank you.
Sally Snow: it's a lot.
Deanna Parker: Even ever.
Deanna Parker: finds it about it.
Lisa Gray: Even as.
Lisa Gray: mentors it's hard to say Okay, how can, how can you make policies and procedures easily digestible and effective for you all to take and run with it, it is it's a hard topic to approach the only other thing I wanted to add he didn't.
Deanna Parker: have it.
Deanna Parker: Yet, and so it's like wow that's heavy.
Lisa Gray: The only other thing I wanted to add to your question is yes, and in the toolkit and the assessment, there are suggestions and ideas, I would also encourage you to if you have particular.
Lisa Gray: A particular patient population with impedes obviously children even special health care needs.
Lisa Gray: Whatever that might look like or you have a particular diagnosis that you're maybe staff are struggling to embrace a process on don't do those as well don't just think okay i've got these i'm good looking institution specific.
Lisa Gray: I think it's really we lose sight of.
Lisa Gray: I can tell you some things at my hospital that we did that we really needed some help with and working on to make better that maybe weren't even on the list of here's the suggestions that's a great point.
Michelle Moegling: Jason and you have a large volume of pediatric patients.
Michelle Moegling: Based on I mean you're what you said, if you're saying out over 1000.
Deanna Parker: Again it's Mr Lee.
Deanna Parker: Decent volume.
Deanna Parker: And, and the whole purpose behind this is is I my goal as the leader is I even with that amount of volume, there is still some nervousness and.
Deanna Parker: And I want the team to feel competent and comfortable and ready to go at any moment with those that we just have some work to do, we do a great job, but this is just tremendous and really thankful that you off put this together.
Michelle Moegling: And if you have a local if you have a children's hospital that you can pair with they may have some great evidence based guidelines.
Michelle Moegling: That that'll help you with some of the things that frequently present to your er and they may be willing to share those as well, so that you are like meeting like evidence based guidelines for caring for asthma and other things like that.
Deanna Parker: perfect and thank you for how willingly you all are sharing slides and information it's very helpful.
Michelle Moegling: Great Thank you.
Sally Snow: Michelle i'm looking back at the chat and i'll see several people commenting about the use of CAP refill document in Cap refill instead of blood pressure, and I would.
Sally Snow: Say that CAP refill is part of basic circulation assessment in a pediatric patient that's something that should always be documented I can't say that I think it should replace blood pressure assessment because it's really it's not it's not the same thing so.
Michelle Moegling: yeah no I agree.
Lisa Gray: You know, one of the last questions does anybody have a good at any good ideas of intake and finally a feedback on what was what doesn't doesn't work on policies and procedures was i'm guessing that your question.
Lisa Gray: is specific to your frontline staff and their their feedback, I think a lot of times we think about a lot of I think in 2021, if you will, we we we safety huddle a lot.
Lisa Gray: And you could you could carve out a little bit of time during your shift change or safety huddle in the emergency department to say hey.
Lisa Gray: Even once a week we've implemented X y&z new policies or new procedures, this week, any staff feedback on usability easy access so on and so forth that's just one that I have no Michelle ourselves, you have others.
Michelle Moegling: yeah I think huddles or a great time to both roll out new initiatives or new topics or focus on something each month, but I think those are also a time to get feedback from staff.
Michelle Moegling: If you have staff that doesn't like to give feedback because they're afraid or whatever.
Michelle Moegling: The case may be, we know that happens, sometimes you can try just doing surveys, or like even paper or survey monkey or red CAP whatever you have that it can be anonymous but you really need do need feedback from people.
Sally Snow: Do you want me to share my screen and show a couple of these policies that I have pulled up just so people can see what they construction look like.
Michelle Moegling: Sir.
Sally Snow: Do I have access to share my screen.
Lisa Gray: And you see it.
Sally Snow: mm hmm.
Lisa Gray: Let me look here.
Sally Snow: yeah okay.
Sally Snow: Yes, no I didn't let's see which one i'm looking for.
Sally Snow: So this policy is.
Sally Snow: related to a neutral assessment and has some information oh look that's my presentation what's.
Lisa Gray: Your pronunciation.
Though.
Michelle Moegling: If you guys have not looked at the end a triage policy, they have a whole or they have a whole chapter.
Michelle Moegling: On pediatric specific.
Michelle Moegling: items and things to be considerate of.
Michelle Moegling: it's a really it's a really good reference.
Sally Snow: Okay, have lost my share button Lisa.
Michelle Moegling: Is.
Sally Snow: I had a.
Michelle Moegling: move the mouse is that there.
Sally Snow: Was.
Sally Snow: Let me see if i'm out of full screen and that's what the problem is I don't know let's see yep there we go.
Sally Snow: Now, do you see a policy.
Yes.
Sally Snow: So this is the, this is an assessment policy it then you can see it's got a fairly lengthy.
Sally Snow: policy statement.
Sally Snow: And then down here below are very extensive definitions, so that it's very clear what what an assessment is what a focused exam is physical assessment psychological assessment.
Sally Snow: who's qualified to do that what a social assessment look like and then the procedure for performing an initial assessment and it's very detailed and I want to thank the many of the Ada nurses in California shared their policies and procedures with me in the last few days.
Sally Snow: To be able to share with you guys and i'll share all of these with.
Sally Snow: Michelle.
Great.
Michelle Moegling: And I remember, as you make policies and procedures remember policies are really to guide regulations and they have to be followed by like to the T where procedures are you have a little bit there, how to do things and give you that little bit of wiggle I think.
Sally Snow: Well, I thought I had a second one pulled up I don't see it.
Sally Snow: that's too bad I did have a second one pulled up that was a triage policy.
Sally Snow: Well, sorry about that um any other questions or things you guys want to discuss related to policies and procedures.
Sandra Chavez: So question, I think it may have been addressed, but again super grateful for seeing the sample policies and just having those available.
Sandra Chavez: And I don't know if it's just school has kind of like really stuck with me the whole concept of plagiarism so I don't know if it's fair to kind of.
Sandra Chavez: Take a policy and then just kind of tweak it to one's own organization to be able to make it something that's going to work for that facility, I guess, I just want to make sure it is okay, before I look at doing something like that.
Lisa Gray: I would say yes, and you can even if if you have asked about it, you can even include in your references.
Lisa Gray: Like when a pop like I use an example from children's or you know, so you can you can give credit to the organization that you borrowed the policy from.
Michelle Moegling: or reach out to them if you found it on just on the web reach out.
Michelle Moegling: To them, and ask them.
Sally Snow: and several of the policies that I will send to Michelle have been in the identified so they're generic policies and have been provided.
Sally Snow: so that people can use them and Lisa brought up a point I should have an intended to make, and that is.
Sally Snow: how important it is to reference your policies wherever you're getting the information about site, the red flags in the triage policy, for instance.
Sally Snow: If you've got those from emc mpc use mpc as a reference or look and see where the npc got that information so references are really important, especially if somebody wants to go in and read some more about that particular issue that you've brought up.
Sandra Chavez: Thank you that's helpful.
Lisa Gray: Any other questions or conversations anybody wants to start.
Lisa Gray: You have.
Lisa Gray: nine minutes left.
Michelle Moegling: And as you think about this, think about what is your, what is your aim what percent of policies do you want to create by a certain time.
Michelle Moegling: or even defining that you want 100% of people to follow your new triage policy, it can be whatever it is you want it to be, and then really go through those key drivers and think about what do you want what parts Do I need and how am I going to get to that.
Michelle Moegling: The more you can use quality improvement and show how you created this and what drivers and really you can share that with people as you start to build that it makes you started thinking about all the different components, you need in a policy.
Lisa Gray: So somebody let's see here I don't have a name attached to just review process, so I think that this looks.
Lisa Gray: Part of this might look a little bit different depending where you are, I think so, for example, i'm a property manager in my previous.
Lisa Gray: LIFE I would I even set my own reminders on my own calendar to review policies within an x number of.
Lisa Gray: Years, for example, but my organization where policies and procedures live also have a specific policy around how frequently policy should be.
Lisa Gray: reviewed revised so on and so forth, so I think there's two pieces of it um if you, for example, are a peck and you are building a program.
Lisa Gray: You might start one of your initial policies and procedures may need to be reviewed, a little bit more frequently i'm different from your organizational policies or process, because the work is evolving.
Lisa Gray: Or you might be starting to see more and more kids so kind of carving that out for you as a peck versus you as your you what your organization expects around policies and procedures have I articulated that very well.
Lisa Gray: talia Michelle you want to add on.
Michelle Moegling: I think every Organization has a policy on how often things have to be reviewed, whether it's two years or three years, and if you are creating new ones it's really creating some.
Michelle Moegling: sort of spreadsheet or some way to track your dates on all of your policies, so you know when to when they're up for renewal.
Michelle Moegling: And you don't want them all to be on the same at the same time.
Sally Snow: I agree with it.
Michelle Moegling: Because that is overwhelming.
Lisa Gray: I think another lesson learned from my my organization is the policy of nurse, and those who are responsible for reviewing the policy during that process where maybe not as close to the actual work.
Lisa Gray: As they ideally could have been so perhaps as a peck you could and i'm saying this, I was a leader in my organization as well.
Lisa Gray: So i've been on kind of both ends, so I think that you can.
Lisa Gray: kind of maybe create your own process of when it's time for review and those formal reviewers are reviewing maybe engaging some of your clinical supervisors or key key individuals who are passionate about caring for kids.
Lisa Gray: and have them review as well, maybe make you know print them part of your review process.
Michelle Moegling: and especially your frontline staff, because if they're the ones, using that and having to follow it, make sure it works for them, and I mean there's certain things that they have to do.
Michelle Moegling: And they don't get an option but look at how it's written and when there is wiggle room give them that see what works or if it doesn't ask what would work better, rather than you can't just tell me it doesn't work, I really need like.
Michelle Moegling: What what process, do you think would work better.
Sally Snow: asked you know, in a staff meeting you might make a standing agenda item is there, anybody who has feedback on a particular policy this this month.
Sally Snow: That they think they're having stroke they're struggling with seeing how its implemented any suggestions about how those might be changed, I mean, but sometimes people won't say a word, unless you ask them.
Michelle Moegling: very true.
Michelle Moegling: Okay, everybody say anybody else have any other questions.
Sally Snow: Great discussion Gus.
Michelle Moegling: Yes, thank you very much, everybody.
Michelle Moegling: And everybody have a great afternoon.
Deanna Parker: Thank you, you too.
Michelle Moegling: Thank you.
Sandra Chavez: Thank you.
Michelle Moegling: Thank you Lisa I will not be on the after call.
Michelle Moegling: Thank you.
Lisa Gray: Have a good afternoon you later.
Michelle Moegling: Also tomorrow.
Michelle Moegling: Okay bye.
bye.