©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
©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
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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
©2013 Children's Mercy. All Rights Reserved. 09/13
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
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History
Why are these important?
Led the way for family / collaborative programs
Women started to challenge
Family advocates voiced concerns
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Core Values
Respect & Dignity
Information Sharing
Participation
Collaboration
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Respect & Dignity
Listening toHonoring
Planning & Deliver of Care ConsiderationsKnowledgeValuesBeliefsCultural Background
Family perspectives & choices
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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
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Participation
Encourage & Support in participatingCareDecision Making
Level they choose
Non-judging / Opinion forming / etc.
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Collaboration
Delivery of care
Facility design
Program development
Policy developmentPed Emerg Form
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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
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EMS
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EMS & Family Presence
Why do we separate families from their children?
Control “Our” ambulance
Focus Multi-tasking
Time Scene times, etc.
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Class Participation
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EMS & Family Presence
Who here with EMS has a Family Presence Guideline?
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EMS & Family Presence
Who here with a hospital has a Family Presence Guideline?
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EMS & Family Presence
Who here supports Family Presence during invasive
procedures & resuscitation?
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EMS & Family Presence
Who here isn’t exactly sure how they feel about Family Presence during
invasive procedures & resuscitation?
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EMS & Family Presence
“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)
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Who Supports Family Presence?
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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?
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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
©2013 Children's Mercy. All Rights Reserved. 09/13
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.
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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.
©2013 Children's Mercy. All Rights Reserved. 09/13
Family Presence Cont.
So What Does the Research Say?
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Family Presence Cont.
Dingeman, et al. – 2007 JAAP
Growing trend of family members offered to be present are staying present
87% Procedures83% Resuscitations86% Right94% Repeat Decision
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Family Presence Cont.
Sacchetti, et al. – 2005 Anals Emerg Med
7% interfered with care
None significantly alter patient management
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Family Presence Cont.
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
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Family Presence Cont.
What can we do?
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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
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Family Presence Overview
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
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Family Presence Overview
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
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Children’s MercyKansas City
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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
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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
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Family Centered Care Coordinators
Sheryl Chadwick DeeJo Miller
Parents on Staff -NOT MEDICAL PROVIDERS
– Provide opportunities for families to connect with other families
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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
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Children’s Mercy
Family
Advisory
Board
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Teen
Advisory
Board
Consejo de Familias Latinas/Hispanas
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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
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Children’s Mercy
POPS– Parents Offering Parents Support
Primarily phone mentoring
1 on 1
Easy to do
Location not an issue
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Children’s Mercy
New Journeys Guide for Families
From Families Services Guide Layout Paperwork Guide Coping Tips Hospital Guidelines
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Children’s Mercy
Family Time “Open house” on the
floor so families can get away from the bedside & connect with other families
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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
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THE END(s)…