GUEST EDITORIAL
BUILDING ON OUR COLLABORATIVE EFFORTS FOR THE FUTURE OF CHILDREN
Sally K. Snow, BSN, RN, CPEN, FAEN, Fort Worth, TX
NA continues to strengthen the collaborative relationship with our partners in pediatric emergency care. You heard from me last year in CONNECTION and in a spring 2013 guest editorial in this Journal as I wrote about the groundbreaking joint policy statement Guidelines for Care of Children in the Emergency Department 1 and our ongoing work with the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), and the Emergency Medical Service for Children (EMS for Children) program. Several additional policy statements and technical reports were co-authored in 2014. Publication of the Death of a Child in the ED Policy Statement 2 and accompanying Technical Report 3 in the Journal of Emergency Nursing, Annals of Emergency Medicine, and Pediatrics represents the first time the ENA, AAP, and ACEP published our collaborative work simultaneously. Early in 2015 two additional co-authored works were finalized and approved by the ENA, ACEP, and AAP Boards of Directors. The technical report on Patient- and Family-Centered Care 4 includes the ENA self-assessment tool that can be used by emergency departments to review their efforts to provide a patient- and family-centered
E
Sally K. Snow is Trauma Program Director at Cook Children’s Medical Center, Fort Worth, TX, and a Director on the ENA Board of Directors. For correspondence, write: Sally K. Snow, BSN, RN, CPEN, FAEN, Cook Children’s Medical Center, 801 Seventh Ave, Fort Worth, TX 76104-2796; E-mail: [email protected]. J Emerg Nurs 2015;41:179-80. 0099-1767 Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2015.03.011
May 2015
VOLUME 41 • ISSUE 3
environment. This self-assessment tool, which is the sole resource recommended by the technical report for assessing emergency departments, can be found on the ENA Web site at this link: http://www.ena.org/practice-research/Practice/ Documents/FamilyCenteredCareTool.pdf. The technical report on Best Practices in Patient Flow for Pediatric Patients in the Emergency Department 5 describes ED overcrowding and its effect on patient safety, quality, and throughput. Efforts to improve care delivery include the use of clinical practice pathways and guidelines such as nurse-initiated protocols. Innovative staffing models including physician-led team triage and the value of employing nurse practitioners and physician assistants in the emergency setting to reduce wait times for less urgent ED patients. Wait times are a known factor in patient satisfaction. The impact of value-based reimbursement is reviewed in the report, and the authors believe that “tightening health budgets and the introduction of value-based reimbursement have contributed to an increased focus on improving patient flow and patient satisfaction without compromising quality of care.” The report concludes, “ED care and patient flow can be improved by implementing best practices at key steps along the continuum of care.” Another policy statement in the works with our pediatric emergency care partners is Transitions of Emergency Care for Children. In the ED environment, where conditions are highly variable, unstructured, and potentially unreliable, steps to address communication and handoff of care between out-of-hospital providers and the ED staff, nurses, and physicians, along with interfacility and intrafacility transfer of patient care, will be discussed and recommendations for a standardized approach will provide guidance to emergency care givers. A co-authored policy statement on Medication Safety in Pediatric Emergency Care is also being developed. This statement will describe current best practices for medication safety, including weighing patients in kilograms only, having distraction-free medication preparation areas, using smart pumps with soft and hard stops, using computerized physician order entry, and, when feasible, having access to a pharmacist with training in pediatrics in the emergency department. If such access is not feasible, it is recommended
WWW.JENONLINE.ORG
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GUEST EDITORIAL/Snow
that a pharmacist with training in pediatrics be accessible via phone or online. This statement emphasizes the nurse’s responsibility for medication administration as determined by his or her state nurse practice act. Other collaboration efforts approved by the ENA Board include a policy statement on Performance Metrics in the Pediatric Emergency Department and a policy statement and technical report on Pediatric Pre-hospital Readiness. Stay tuned for progress on these important collaborative opportunities. I encourage you to take time to read the recently published results of the 2013 NPRP assessment. 6 Work began in early April to develop plans to follow up on the National Pediatric Readiness Project (NPRP). ENA participated in a stakeholders meeting in Washington, DC, with our NPRP partners, AAP, ACEP, and EMS for Children, and others to begin to strategize about next steps in improving pediatric readiness in US emergency departments. Although the results of the 2013 NPRP assessment show remarkable improvement since 2003, there is still work to be done. ENA will have opportunities to engage our members to provide resources that will increase the availability of pediatric equipment, competently trained staff, policies and procedures, and quality/performance metrics that will help us measure the success of our efforts to improve care for children in our emergency departments. ENA will lead the charge to build partnerships through our network of pediatric committees in every state to identify teams of pediatric champions, including physician and nurse coordinators in every emergency department. The evidence is clear that these teams of champions are the single most effective way to ensure pediatric preparedness in US emergency departments. 7
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JOURNAL OF EMERGENCY NURSING
I look forward to continuing to work with our pediatric emergency care partners and you, our members, to improve our ED readiness to care for children and continue our very productive collaboration on behalf of our pediatric patients. REFERENCES 1. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint policy statement—guidelines for care of children in the emergency department. J Emerg Nurs. 2013;39(2):116–131. 2. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Committee. Death of a child in the emergency department [position statement]. J Emerg Nurs. 2014;40(4):301–304. 3. O’Malley P, Barata I, Snow S, et al. Death of a child in the emergency department [technical report]. J Emerg Nurs. 2014;40(4):e83–e101. 4. Dudley N, Ackerman A, Brown KM, et al. Patient- and family-centered care of children in the emergency department [technical report]. Pediatrics. 2015;185(1):e255–e272. http://pediatrics.aappublications. org/content/135/1/e255.full. Accessed April 3, 2015. 5. Barata I, Brown KM, Fitzmaurice L, et al. Best practices for improving flow and care of pediatric patients in the emergency department [technical report]. Pediatrics. 2015;185(1):e278–e288. http://pediatrics. aappublications.org/content/135/1/e273.full. Accessed April 3, 2015. 6. Gausche-Hill M, Ely M, Schmuhl P, et al. National Assessment of Pediatric Readiness of Emergency Departments. [published online ahead of print April 13, 2015]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2015.138. http:// archpedi.jamanetwork.com/article.aspx?articleid=2214165&resultClick=3. Accessed April 13, 2015. 7. Gausche-Hill M, Schmitz C, Lewis RJ. Pediatric preparedness of United States emergency departments: a 2003 survey. Pediatrics. 2009;120(6):1229–1237.
VOLUME 41 • ISSUE 3
May 2015
BUILDING ON OUR COLLABORATIVE EFFORTS FOR THE FUTURE OF CHILDREN
Sally K. Snow, BSN, RN, CPEN, FAEN, Fort Worth, TX
NA continues to strengthen the collaborative relationship with our partners in pediatric emergency care. You heard from me last year in CONNECTION and in a spring 2013 guest editorial in this Journal as I wrote about the groundbreaking joint policy statement Guidelines for Care of Children in the Emergency Department 1 and our ongoing work with the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), and the Emergency Medical Service for Children (EMS for Children) program. Several additional policy statements and technical reports were co-authored in 2014. Publication of the Death of a Child in the ED Policy Statement 2 and accompanying Technical Report 3 in the Journal of Emergency Nursing, Annals of Emergency Medicine, and Pediatrics represents the first time the ENA, AAP, and ACEP published our collaborative work simultaneously. Early in 2015 two additional co-authored works were finalized and approved by the ENA, ACEP, and AAP Boards of Directors. The technical report on Patient- and Family-Centered Care 4 includes the ENA self-assessment tool that can be used by emergency departments to review their efforts to provide a patient- and family-centered
E
Sally K. Snow is Trauma Program Director at Cook Children’s Medical Center, Fort Worth, TX, and a Director on the ENA Board of Directors. For correspondence, write: Sally K. Snow, BSN, RN, CPEN, FAEN, Cook Children’s Medical Center, 801 Seventh Ave, Fort Worth, TX 76104-2796; E-mail: [email protected]. J Emerg Nurs 2015;41:179-80. 0099-1767 Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2015.03.011
May 2015
VOLUME 41 • ISSUE 3
environment. This self-assessment tool, which is the sole resource recommended by the technical report for assessing emergency departments, can be found on the ENA Web site at this link: http://www.ena.org/practice-research/Practice/ Documents/FamilyCenteredCareTool.pdf. The technical report on Best Practices in Patient Flow for Pediatric Patients in the Emergency Department 5 describes ED overcrowding and its effect on patient safety, quality, and throughput. Efforts to improve care delivery include the use of clinical practice pathways and guidelines such as nurse-initiated protocols. Innovative staffing models including physician-led team triage and the value of employing nurse practitioners and physician assistants in the emergency setting to reduce wait times for less urgent ED patients. Wait times are a known factor in patient satisfaction. The impact of value-based reimbursement is reviewed in the report, and the authors believe that “tightening health budgets and the introduction of value-based reimbursement have contributed to an increased focus on improving patient flow and patient satisfaction without compromising quality of care.” The report concludes, “ED care and patient flow can be improved by implementing best practices at key steps along the continuum of care.” Another policy statement in the works with our pediatric emergency care partners is Transitions of Emergency Care for Children. In the ED environment, where conditions are highly variable, unstructured, and potentially unreliable, steps to address communication and handoff of care between out-of-hospital providers and the ED staff, nurses, and physicians, along with interfacility and intrafacility transfer of patient care, will be discussed and recommendations for a standardized approach will provide guidance to emergency care givers. A co-authored policy statement on Medication Safety in Pediatric Emergency Care is also being developed. This statement will describe current best practices for medication safety, including weighing patients in kilograms only, having distraction-free medication preparation areas, using smart pumps with soft and hard stops, using computerized physician order entry, and, when feasible, having access to a pharmacist with training in pediatrics in the emergency department. If such access is not feasible, it is recommended
WWW.JENONLINE.ORG
179
GUEST EDITORIAL/Snow
that a pharmacist with training in pediatrics be accessible via phone or online. This statement emphasizes the nurse’s responsibility for medication administration as determined by his or her state nurse practice act. Other collaboration efforts approved by the ENA Board include a policy statement on Performance Metrics in the Pediatric Emergency Department and a policy statement and technical report on Pediatric Pre-hospital Readiness. Stay tuned for progress on these important collaborative opportunities. I encourage you to take time to read the recently published results of the 2013 NPRP assessment. 6 Work began in early April to develop plans to follow up on the National Pediatric Readiness Project (NPRP). ENA participated in a stakeholders meeting in Washington, DC, with our NPRP partners, AAP, ACEP, and EMS for Children, and others to begin to strategize about next steps in improving pediatric readiness in US emergency departments. Although the results of the 2013 NPRP assessment show remarkable improvement since 2003, there is still work to be done. ENA will have opportunities to engage our members to provide resources that will increase the availability of pediatric equipment, competently trained staff, policies and procedures, and quality/performance metrics that will help us measure the success of our efforts to improve care for children in our emergency departments. ENA will lead the charge to build partnerships through our network of pediatric committees in every state to identify teams of pediatric champions, including physician and nurse coordinators in every emergency department. The evidence is clear that these teams of champions are the single most effective way to ensure pediatric preparedness in US emergency departments. 7
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JOURNAL OF EMERGENCY NURSING
I look forward to continuing to work with our pediatric emergency care partners and you, our members, to improve our ED readiness to care for children and continue our very productive collaboration on behalf of our pediatric patients. REFERENCES 1. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint policy statement—guidelines for care of children in the emergency department. J Emerg Nurs. 2013;39(2):116–131. 2. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Committee. Death of a child in the emergency department [position statement]. J Emerg Nurs. 2014;40(4):301–304. 3. O’Malley P, Barata I, Snow S, et al. Death of a child in the emergency department [technical report]. J Emerg Nurs. 2014;40(4):e83–e101. 4. Dudley N, Ackerman A, Brown KM, et al. Patient- and family-centered care of children in the emergency department [technical report]. Pediatrics. 2015;185(1):e255–e272. http://pediatrics.aappublications. org/content/135/1/e255.full. Accessed April 3, 2015. 5. Barata I, Brown KM, Fitzmaurice L, et al. Best practices for improving flow and care of pediatric patients in the emergency department [technical report]. Pediatrics. 2015;185(1):e278–e288. http://pediatrics. aappublications.org/content/135/1/e273.full. Accessed April 3, 2015. 6. Gausche-Hill M, Ely M, Schmuhl P, et al. National Assessment of Pediatric Readiness of Emergency Departments. [published online ahead of print April 13, 2015]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2015.138. http:// archpedi.jamanetwork.com/article.aspx?articleid=2214165&resultClick=3. Accessed April 13, 2015. 7. Gausche-Hill M, Schmitz C, Lewis RJ. Pediatric preparedness of United States emergency departments: a 2003 survey. Pediatrics. 2009;120(6):1229–1237.
VOLUME 41 • ISSUE 3
May 2015
