Creating a Sensory-Friendly Pediatric Emergency Room
Meet the Team Allyson Halverson, BS, CCLS, CTP Child Life Specialist Elyssa Wood, PhD, MPH, RN, CPEN Clinical Nurse Educator Kacie Demetros, MS OTR/L CEIM Occupational Therapist Sarah Stinson, BSN, RN, CPEN Clinical Director 2
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Goals of the Project 1. Examine current data about treating children with autism spectrum disorder/sensory processing disorder (ASD/SPD) in the emergency room. 2. Identify education and community resources necessary for program success. 3. Review environment modification considerations. 4. Recognize initial and ongoing staff education needs. 5. Identify methods to measure success. 4
5 What is Sensory Processing Disorder?
6 How is SPD related to Autism?
Sensory Processing Defined Sensory Processing: Specialized receptors take in incoming information Specialized receptors then send all of these messages to different areas of the brain Unimportant information is filtered out to create a perception, behavior or motor response Children with sensory processing disorder have trouble organizing and responding to sensory stimulation 7
Response to Sensory Stimulation Sensory Modulation The brain can attend and/or ignore extraneous stimulation The brain s ability to instantly adjust the flow of stimulation to the brain This allows for us to alter our arousal states immediately Thresholds for Response Low neurological threshold = Hypersensitivity High neurological threshold = Hyposensitivity 8
Hypersensitivity Defined Hypersensitivity (Sensory Defensiveness, Sensory Avoider) Strong reactions (fight or flight response) Limit sensation Emotional or behavioral outbursts to sensory stimulation Examples: Sudden screaming or trying to hit when lightly touching their head or arms Trying to flee when attempting to tip them backwards to lie down on the mat table 9 Image credit: https://autism.lovetoknow.com
Strategies for Children with Hypersensitivities Parent/Caregiver Information They are the experts on their child s tolerances and strategies that calm them Environmental Accommodations Decrease lighting if possible Try to avoid light or unexpected touch Try to provide firm pressure when touching the child Try to provide verbal/visual warnings of transitions or touch Noise cancelling headphones Calming Strategies Weighted blanket Sensory brush Bubble tube 10
Hyposensitivity Defined Hyposensitivity (Sensory Seeking) Require more sensory stimulation than others Examples: Constantly moving May touch everything May seek out noises/make noises, etc. May not register pain sensation May smell non-edible items 11 Image credit: http://occupationaltherapyforchildren.over-blog.com
Strategies for Children with Hyposensitivities Parent/Caregiver Information They are the experts on their child s tolerances and strategies that calm them Calming Strategies Weighted blanket Sensory brush Bubble tube Vibration Chewy Tubes Tactile fidget 12
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 13
Create Team Engage Community Expert Consultation Create Team Gather Evidence Modify Environment Educate Staff Implementation 14
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 15
16 Survey Data Overview
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18 Survey Data Overview
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Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 20
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 21
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 22
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Modifying Patient Care Flow Patient Intake Form Available online Submit electronically or bring in paper copy Added to medical chart Accessible from visit to visit 24
Challenges and Considerations Obtaining Resources Budget Reusable vs. disposable Space to store resources Changing Our Environment Best Practices vs. Realistic Expectations Modifying the Patient Care Flow Who from staff needs to be involved in patient care flow decisions? How will this new flow effect our other patients and how do we prioritize? Staff Training Who needs to be trained? How do we ensure all staff is trained? Timeline for training? Needs assessment of staff knowledge and comfort levels 25
26 Resources
Resources Resource list Story boards Pictures of procedures ipads 27
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Modifying Patient Care Flow Limiting staff Limiting transitions Expediting care 29
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 30
Staff Training Understanding Autism: What Healthcare Professionals Need to Know Before the Meltdown: Strategies and Techniques for Helping Neurodiverse Hospitalized Children Assessment and Sensory Items: Finding the Best way to Support your Patients Sensory-Friendly ED: Putting it into Practice Procedural Sedation in Children with Cognitive Impairments 31
Create Team Engage Community Expert Consultation Gather Evidence Modify Environment Educate Staff Implementation 32
Outcomes Communicated a shared vision with staff and community practitioners Collaborated with community & local experts Addressed the educational needs of staff Modified care environment to create peaceful and healing space Adjusted patient flow process Supported care team so they could better communicate with the patient and deliver safe and atraumatic care 33
Sustainability Setting Expectations All new staff receive training during onboarding Focused storytelling: sharing stories of success Exposure & Transferability Identify & support opportunities in other departments Example: Pre-Op, PACU Conference attendance & presentation Publication Creating a Sensory-Friendly Children s Emergency Room guide 34
Resources - Sensory Processing If you have Occupational Therapists at your hospital, please use them as a resource. Websites: Sensory Processing Disorder- STAR Clinic www.spdstar.org Sensory Processing Foundation- www.spdnow.org Sensory Smarts- www.sensorysmarts.com Spiral Foundation (Sensory Processing Institute for Research and Learning) www.thespiralfoundation.org Books: Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD) - Lucy Jane Miller and Janice Roetenberg No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges - Doreit Bialer and Lucy Jane Miller The Out-of- Sync Child - Carol Kranowitz (There are a series of books) 35
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Contact Information Allyson Halverson, BS, CCLS, CTP Child Life Specialist Allyson.Halverson@inova.org Kacie Demetros, MS OTR/L CEIM Occupational Therapist Kacie.Demetros@inova.org Elyssa Wood, PhD, MPH, RN, CPEN Clinical Nurse Educator Elyssa.Wood@inova.org Sarah Stinson, BSN, RN, CPEN Clinical Director Sarah.Stinson@inova.org 37