©2013 Children's Mercy. All Rights Reserved. 09/13 David Seastrom RN, BSN Trauma Injury Prevention,...

©2013 Children's Mercy. All Rights Reserved. 09/13©2013 Children's Mercy. All Rights Reserved. 09/13

David Seastrom RN, BSNTrauma Injury Prevention, Outreach

& Education Coordinator

Patient & Family Centered Care

©2013 Children's Mercy. All Rights Reserved. 09/13


Objectives

Recognize and understand the 4 Core Concepts in Patient - Family-Centered Care

Be able to define family presence

Identify ways you can change your practice to be more patient and family centered


History

Began in 1962

Congressional address from President Kennedy

Right to safety Right to be informed Right to choose Right to be heard

1965 “Head Start” was legislated


History

1987 - Surgeon General C. Everett Koop

1991 – EMS-C National Resource CenterChildren’s National Medical Center

1992 – The Institute for Family Centered Care formed

1993 – Family Preservation & Family Support Act

1994 – The Families of Children with Disabilities Act


History

Why are these important?

Led the way for family / collaborative programs

Women started to challenge

Family advocates voiced concerns


Core Values

Respect & Dignity

Information Sharing

Participation

Collaboration


Respect & Dignity

Listening toHonoring

Planning & Deliver of Care ConsiderationsKnowledgeValuesBeliefsCultural Background

Family perspectives & choices


Information Sharing

Share complete & unbiased information

Share in ways that are useful & affirming

Receiving info in a timely, accurate & complete form

So as to participate & make decisions


Participation

Encourage & Support in participatingCareDecision Making

Level they choose

Non-judging / Opinion forming / etc.


Collaboration

Delivery of care

Facility design

Program development

Policy developmentPed Emerg Form


Core Value Overview

Listen to the patient & families

Communication is of the utmost importance

Participation at the families comfort level

Working together we can accomplish more


EMS


EMS & Family Presence

Why do we separate families from their children?

Control “Our” ambulance

Focus Multi-tasking

Time Scene times, etc.


Class Participation



Who here with EMS has a Family Presence Guideline?



Who here with a hospital has a Family Presence Guideline?



Who here supports Family Presence during invasive

procedures & resuscitation?



Who here isn’t exactly sure how they feel about Family Presence during

invasive procedures & resuscitation?



“The healthcare field is evolving from a paradigm where the patient is expected to passively comply with diagnosis and treatment to one that emphasizes patient-provider collaboration”

Guidelines for Providing Family-Centered Prehospital Care

(Consensus Panel from EMS-C, NAEMT & HRSA)


Who Supports Family Presence?


Family Presence Policy

Family Advisory Board Members (parents)ED providersSocial WorkersChaplainICU providersTrauma providersChild lifeCritical Care TransportFamily Care CoordinatorsAdministrationCode Blue Committee


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Are We Still Awake?



Family Presence

Principles behind Guidelines Consistency of Practice

– While we attempt to be fair in everything we do, we must admit that some families get to stay with their children and some don’t

Communication with Staff– Attending staff have control over what

happens, guidelines give others the right to talk openly about family presence


Family Presence

Principles behind Guidelines Evolution

– Guidelines will create a “guided evolution” of the culture of interaction between staff & families

Culture– Once we make it part of our practice,

families will expect it.


Family Presence

2000 Clinical Group Recommendations

Family members should be involved in primary training for pre-hospital emergency medical responders at all levels.

Family members should be given the option to be present and to participate in pre-hospital care, on scenes, during transport and during transfer of care to the receiving facility.


Family Presence Cont.

So What Does the Research Say?



Dingeman, et al. – 2007 JAAP

Growing trend of family members offered to be present are staying present

87% Procedures83% Resuscitations86% Right94% Repeat Decision



Sacchetti, et al. – 2005 Anals Emerg Med

7% interfered with care

None significantly alter patient management



O’Connell, et al. – 2007 JAAP

136 Trauma Team Activations197 Family Members Participated

7 asked to leave (various reasons)Evaluation/Procedure times not altered97% FMP had none or positive effect on decision-making92% Improved communication


33



What can we do?


Family Presence Overview

While some choose NOT to be present, nearly all want to be given the optionThe research is overwhelmingly in favor of family presenceVERY small percentage of families are disruptiveIf not present the option is what the families want



Many families present use their observations to conclude everything was doneFamilies who are present are less likely to litigateFamilies cannot usually differentiate between an attending physician from a fellow or a resident



Families who are given the option of family presence have a more positive bereavement outcome

Families who are given the option feel as though they have more control of their situation


37


Children’s MercyKansas City


Level I Pediatric Trauma Center

Center for Excellence in Pediatric Resuscitation

Leading Cardiac Surgery Program

Leading Hemophilia Treatment Center

Leading Sickle Cell Disease Program

International Consortium of Blood & Bone Marrow Transplant


One of a few national comprehensive liver treatment & research centers

National Leader in Specialty Critical Care Transport

Ped. Critical Care Fellowship

Ped. Emergency Medicine Fellowship

Ped. Surgery Fellowship

2007 Designated one of the top five Ped. Emergency Departments in the country

Extensive Research Activities


40


Family Centered Care Coordinators

Sheryl Chadwick DeeJo Miller

Parents on Staff -NOT MEDICAL PROVIDERS

– Provide opportunities for families to connect with other families


Children’s Mercy

Family Centered Care Coordinators

– Empower families to use the resources CMH provides

– Serve as a family voice on committees in the hospital

– Provide opportunities for families to connect with other families


42


Children’s Mercy

Family

Advisory

Board


43


Teen

Advisory

Board

Consejo de Familias Latinas/Hispanas


44


Death & Dying Workshop

Parents and family members come in and talk with staff physicians, nurses, RT, residents, etc and communicate what was helpful and what

was hurtful during their experience of loss.

We then allow the staff to ask questions dealing with their experience


45


Children’s Mercy

POPS– Parents Offering Parents Support

Primarily phone mentoring

1 on 1

Easy to do

Location not an issue


Children’s Mercy

New Journeys Guide for Families

From Families Services Guide Layout Paperwork Guide Coping Tips Hospital Guidelines


Children’s Mercy

Family Time “Open house” on the

floor so families can get away from the bedside & connect with other families


Family as Faculty

– 13 Families currently

– Focus on Resident Education PGY1 – Dinner with FAB PGY2 – Meet Family in their home PGY3 – Clinic visit with family

– GN Education

– Child Life & Music Therapy Interns

– Hem/Onc Residents


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YOU are a piece of the puzzle!

Child Life

EMS

Volunteers

Social Work

Medical Team Patient Family Chaplaincy


THE END(s)…

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