At Cohen Children’s Medical Center in New Hyde Park, New York, a 12-year-old girl reported to be autistic and non-verbal was admitted for potential new onset seizures. Once she got to the medical/surgical unit, she began to have behavioral outbursts that made it difficult for the team to perform tests necessary for her medical work-up.
The patient was combative, hitting, scratching and biting herself and staff members. Due to her behavioral outbursts, tests were unavoidably delayed for days. The staff became frustrated and described the patient as being in a fight or flight response whenever someone approached her.
Frustration levels continued to escalate. The leadership team called a huddle to discuss this patient’s plan of care. Jane McMahon, B.S.N., RN, CPN, medical surgical clinical nurse, expressed concern they were missing something because this patient attended school, so there must be a way she communicates.
The team then discovered the girl communicates through a school-provided electronic device, but out of concern it would be lost or broken in the hospital, the parents opted to not bring the device with them. The team contacted the patient’s school and signed out the device, so they could use it in hospital.
A magical moment occurred when the patient had the device in her hands. She began communicating with the team and didn’t appear combative or scared. There was no longer a need for constant observation or confinement to her room. She could go to the playroom, have tests performed, treatments implemented, and providers discharged her shortly thereafter.
A healing environment for all
Medical environments are a challenge for patients with special needs. In addition to their medical conditions, many of these patients also have neurobehavioral diagnoses including autism spectrum disorder, attention deficit disorder and sensory integration disorder. Medical environments are often the antithesis for the promotion of healing and wellness with this vulnerable population.
If not appropriately addressed, their needs may lead to delays in procedures, tests and treatments and increase in safety risks, restraint use, and ultimately an increase in the child’s length of stay in the hospital. A traditional health care approach for these children can result in aversions to future medical care, prompting families to avoid or wait to seek medical treatment due to poor experiences.
At Cohen Children’s, a survey revealed 96% of staff members felt the hospital could improve care provided to children with special needs; and 58% felt comfortable caring for children with special needs.
This one patient had such a significant effect on staff members that it led to the development of the BEE Mindful program. Three key components of the program include:
- E-learning modules for all staff members that include visual and auditory depictions of how a child with special needs hears and sees the world.
- A visible symbol to identify patients with special needs.
- Pediatric Neurobehavioral Assessment Tool (PNAT), an assessment and intervention tool to help provide the individual care these children deserve and need.
While there is no algorithm or formula for how to best care for a child with special needs, the team understood the importance of recognizing the needs of each patient. An interdisciplinary focus group consisting of 25 medical employees and family input created the PNAT, which is now completed for all patients.
Pause for awareness
The BEE Mindful symbol was purposefully designed so it’s not identifiable by the public. The intent of the symbol is not to stigmatize the patient but rather support the needs of the child and family while they are in the hospital. The symbol is placed outside the patient’s room and on the chart. It provides a visual pause that creates situational awareness and redirects staff members back to the medical record to review the PNAT or speak to the primary care nurse for instructions on how to best proceed.
With the use of the symbol, Cohen Children’s minimizes the amount of interruptions to the patient’s room through clustering of care. The hospital teaches patients and families their bed or room is a safe place and no harmful procedures will be conducted in
that space.
Putting it all together
After implementation of the program, length of stay (LOS) decreased by an average of two days, bringing the hospital’s once higher-than-average LOS for children with special needs to below average. This decrease may be a result of performing tests and treatments in a timely manner without delay due to effective patient management through the BEE Mindful program.
The hospital also saw an increase in Press Ganey patient experience scores related to the question, “staff addressing personal needs” by 4.3%. Families expressed gratitude and relief as they experienced the positive effects of the BEE Mindful program for their children. McMahon says the program has made a difference for everyone involved, not only for the patients
and families, but for staff members, too.
