Journal of Pediatric Nursing (2015) 30, 4–5
Correspondence
Improving Pediatric Emergencies One Rural Hospital at a Time 1 Austin Clay was a calm natured, loving, beautiful baby boy. In February, 2009, he had just celebrated his first birthday with his three older siblings and his parents. The family had just moved into a new home in a rural area in southeast Georgia and had a lot to celebrate. Two short weeks later, they were burying their precious baby. Austin was at his new home with his siblings and a baby sitter when he slipped out of an open door and made his way to the pond unbeknownst to anyone. The sitter and his siblings found him a very short time later and called 911. He was taken to the closest hospital which was a small, rural hospital where, unfortunately, he did not receive proper emergency care. He survived for two more days after being airlifted to a nearby Children's Hospital where he ultimately went into cardiac arrest and was not able to be resuscitated. As we all know, pediatric medical care is difficult and most medical staff that care primarily for adults don't want to come within a foot of a pediatric patient. However, in rural hospitals where those physicians and nurses become the front line for these pediatric patients in crisis, we, as the professionals who specialize in pediatric medicine, should make sure we do all that we can to equip them with the emergency skills needed not only to provide the age appropriate care for that patient, but also to improve their medical outcomes and ultimately their quality of life. Austin was not breathing but had a heartbeat when he arrived at that rural hospital. No one performed chest compressions and he was not intubated for over an hour. No nasogastric tube was placed and the respiratory therapist was bag-mask ventilating him with an adult sized mask. After an hour, the emergency staff felt that he was stable enough to transfer by ground to another larger, yet still rural hospital. His mom, a nurse at
1
Holly Zerwig is a Pediatric Intensive Care Nurse at Memorial University Health Medical Center in Savannah Georgia. She has 8 years of nursing experience in various areas of practice but found her true calling in the PICU after one of her own children passed away after a near drowning accident. Holly and her husband of 18 years live in Metter, GA with their three teenagers. Holly has her BSN from Georgia Southern University in Statesboro, Georgia. 0882-5963/© 2015 Elsevier Inc. All rights reserved.
another hospital, knew immediately that he needed to be flown to the Children's Hospital and fought to expedite the transfer. Unfortunately, this kind of “hands off” approach to pediatric patients is found in areas where medical staff don't frequently care for this part of our population and found far too often. No one wants to see a child hurt or fighting for their lives, and unfortunately this kind of patient usually results in one of two responses: an intubated infant that simply needed aggressive naso-tracheal suctioning, or, most often, staff being too afraid to be aggressive enough with a critically ill child and someone like Austin dies unnecessarily. This is why the establishment of Children's Hospital Shadow programs would benefit everyone from the medical staff to the patient. Historically, shadow programs have been beneficial to hospitals for many reasons. Students shadow various medical staffing positions from the physician to the bedside nurse to help them decide what professional path they want to pursue. Some hospitals use shadow programs to allow prospective employees to come and “work” a shift before committing to the position in an effort to improve employee retention rates (Shermont & Murphy, 2006). Finally, there are specialties such as psychiatric medicine and trauma that involve such specific and specialized care that they have created shadow programs to assist other disciplines how to best treat these cases (Ryrie, Roberts, & Taylor, 1997). This is the type of shadowing program our hospital is implementing in conjunction with various rural hospitals in our surrounding area. In our area of Savannah, Georgia, we are surrounded by rural areas that subject our pediatric population to various traumatic situations that often happen in those areas. Tractor accidents, pond related near-drownings, ATV accidents and hunting or gun related accidents are just a few of the cases that we get from our rural hospitals. These cases are the times when rural hospital staff need to be well versed on how to immediately treat and stabilize these patients in order to get them transported to a higher level of care and as quickly as possible. Since pediatric patients are not “just smaller adults” we need to educate the rural facilities on how to fluid resuscitate the pediatric hemodynamic shock patient, sedate the intubated, mechanically ventilate pediatric patient, and select age/size appropriate equipment for the pediatric patient. At the same time, we also want to decrease
Correspondence unnecessary admissions to the PICU by teaching how to properly NT suction an RSV baby or give more aggressive nebulizer treatments to an acute asthmatic in order to get the exacerbation controlled without having to come to the PICU. We hope to educate rural area nurses and physicians by having them come and shadow our PICU nurses and physicians for several days to learn some of these basic skills. We have a pretest to evaluate their basic knowledge and to give them an idea of the kinds of things we want them to learn. There is also posttest to evaluate their success in the program and plan on having a “badge buddy” with some of the basic information as a quick reference guide that can be easily accessed in case of an emergent situation. We also want them not to hesitate to call our physicians should they be not sure how to handle a pediatric emergency that presents in their facility. We hope that with this program we can improve the overall outcomes of pediatric emergencies by getting the proper, age appropriate care to them at the primary facility prior to transferring to a higher level of care. Our ultimate
5 goal is to equip rural facilities with the knowledge that they need in order to prevent any more situations like Austin's. We want every child to have a fighting chance to get back home to their parents where they belong. This is why we are trying to improve pediatric emergency care one rural hospital at a time.
Holly Zerwig, RN, BSN Memorial Health University Medical Center, Savannah, GA E-mail address: [email protected] http://dx.doi.org/10.1016/j.pedn.2014.10.007
References Ryrie, I., Roberts, M., & Taylor, R. (1997). Liaison psychiatric nursing in an inner city accident and emergency department. Journal of Psychiatric and Mental Health Nursing, 4, 131–136. Shermont, H., & Murphy, J. (2006). Shadowing: A winning recruitment tool. Nursing Management, 30–40.
Correspondence
Improving Pediatric Emergencies One Rural Hospital at a Time 1 Austin Clay was a calm natured, loving, beautiful baby boy. In February, 2009, he had just celebrated his first birthday with his three older siblings and his parents. The family had just moved into a new home in a rural area in southeast Georgia and had a lot to celebrate. Two short weeks later, they were burying their precious baby. Austin was at his new home with his siblings and a baby sitter when he slipped out of an open door and made his way to the pond unbeknownst to anyone. The sitter and his siblings found him a very short time later and called 911. He was taken to the closest hospital which was a small, rural hospital where, unfortunately, he did not receive proper emergency care. He survived for two more days after being airlifted to a nearby Children's Hospital where he ultimately went into cardiac arrest and was not able to be resuscitated. As we all know, pediatric medical care is difficult and most medical staff that care primarily for adults don't want to come within a foot of a pediatric patient. However, in rural hospitals where those physicians and nurses become the front line for these pediatric patients in crisis, we, as the professionals who specialize in pediatric medicine, should make sure we do all that we can to equip them with the emergency skills needed not only to provide the age appropriate care for that patient, but also to improve their medical outcomes and ultimately their quality of life. Austin was not breathing but had a heartbeat when he arrived at that rural hospital. No one performed chest compressions and he was not intubated for over an hour. No nasogastric tube was placed and the respiratory therapist was bag-mask ventilating him with an adult sized mask. After an hour, the emergency staff felt that he was stable enough to transfer by ground to another larger, yet still rural hospital. His mom, a nurse at
1
Holly Zerwig is a Pediatric Intensive Care Nurse at Memorial University Health Medical Center in Savannah Georgia. She has 8 years of nursing experience in various areas of practice but found her true calling in the PICU after one of her own children passed away after a near drowning accident. Holly and her husband of 18 years live in Metter, GA with their three teenagers. Holly has her BSN from Georgia Southern University in Statesboro, Georgia. 0882-5963/© 2015 Elsevier Inc. All rights reserved.
another hospital, knew immediately that he needed to be flown to the Children's Hospital and fought to expedite the transfer. Unfortunately, this kind of “hands off” approach to pediatric patients is found in areas where medical staff don't frequently care for this part of our population and found far too often. No one wants to see a child hurt or fighting for their lives, and unfortunately this kind of patient usually results in one of two responses: an intubated infant that simply needed aggressive naso-tracheal suctioning, or, most often, staff being too afraid to be aggressive enough with a critically ill child and someone like Austin dies unnecessarily. This is why the establishment of Children's Hospital Shadow programs would benefit everyone from the medical staff to the patient. Historically, shadow programs have been beneficial to hospitals for many reasons. Students shadow various medical staffing positions from the physician to the bedside nurse to help them decide what professional path they want to pursue. Some hospitals use shadow programs to allow prospective employees to come and “work” a shift before committing to the position in an effort to improve employee retention rates (Shermont & Murphy, 2006). Finally, there are specialties such as psychiatric medicine and trauma that involve such specific and specialized care that they have created shadow programs to assist other disciplines how to best treat these cases (Ryrie, Roberts, & Taylor, 1997). This is the type of shadowing program our hospital is implementing in conjunction with various rural hospitals in our surrounding area. In our area of Savannah, Georgia, we are surrounded by rural areas that subject our pediatric population to various traumatic situations that often happen in those areas. Tractor accidents, pond related near-drownings, ATV accidents and hunting or gun related accidents are just a few of the cases that we get from our rural hospitals. These cases are the times when rural hospital staff need to be well versed on how to immediately treat and stabilize these patients in order to get them transported to a higher level of care and as quickly as possible. Since pediatric patients are not “just smaller adults” we need to educate the rural facilities on how to fluid resuscitate the pediatric hemodynamic shock patient, sedate the intubated, mechanically ventilate pediatric patient, and select age/size appropriate equipment for the pediatric patient. At the same time, we also want to decrease
Correspondence unnecessary admissions to the PICU by teaching how to properly NT suction an RSV baby or give more aggressive nebulizer treatments to an acute asthmatic in order to get the exacerbation controlled without having to come to the PICU. We hope to educate rural area nurses and physicians by having them come and shadow our PICU nurses and physicians for several days to learn some of these basic skills. We have a pretest to evaluate their basic knowledge and to give them an idea of the kinds of things we want them to learn. There is also posttest to evaluate their success in the program and plan on having a “badge buddy” with some of the basic information as a quick reference guide that can be easily accessed in case of an emergent situation. We also want them not to hesitate to call our physicians should they be not sure how to handle a pediatric emergency that presents in their facility. We hope that with this program we can improve the overall outcomes of pediatric emergencies by getting the proper, age appropriate care to them at the primary facility prior to transferring to a higher level of care. Our ultimate
5 goal is to equip rural facilities with the knowledge that they need in order to prevent any more situations like Austin's. We want every child to have a fighting chance to get back home to their parents where they belong. This is why we are trying to improve pediatric emergency care one rural hospital at a time.
Holly Zerwig, RN, BSN Memorial Health University Medical Center, Savannah, GA E-mail address: [email protected] http://dx.doi.org/10.1016/j.pedn.2014.10.007
References Ryrie, I., Roberts, M., & Taylor, R. (1997). Liaison psychiatric nursing in an inner city accident and emergency department. Journal of Psychiatric and Mental Health Nursing, 4, 131–136. Shermont, H., & Murphy, J. (2006). Shadowing: A winning recruitment tool. Nursing Management, 30–40.
