An Interprofessional Approach to Manage Pain and Anxiety in Pediatric Burn Patients Paul Plowman, RN-BC, and Caitlin Dougherty, CCLS 9/25/2013 1 Conflict of Interest 9/25/2013 2 Conflict of Interest Disclosure Conflicts of Interest for ALL listed contributors. P. Plowman, RN-BC No conflict of Interest C. Dougherty, CCLS No conflict of interest A conflict of interest is a particular financial or non-financial circumstance that might compromise, or appear to compromise, professional judgment. Anything that fits this should be included. Examples are owning stock in a company whose product is being evaluated, being a consultant or employee of a company whose product is being evaluated, etc. Taken in part from On Being a Scientist: Responsible Conduct in Research. National Academies Press. 1995. 9/25/2013 3 1
Riley Burn Center Riley Burn Center Riley Hospital for Children at IU Health 705 Riley Hospital Drive Indianapolis, IN 9/25/2013 4 Objectives Discuss strategies used to treat pain at the Burn Center at Riley Hospital for Children at IU Health 9/25/2013 5 Patient Population Age Burn severity Average length of stay 9/25/2013 6 2
Challenges in Pediatric Burn Care Burns compared to other forms of trauma Depth or degree of burns Superficial burns Partial thickness burns Full thickness burns Total burn surface area 9/25/2013 7 Team Members and Roles MDs Nurses Child Life specialists Pharmacists Physical and occupational therapists Parents Sedation team Nutritionist Social workers 9/25/2013 8 Child Life: An Overview Child Life specialists work as part of the medical team to create a care plan Child Life provides: Care for each patient s developmental level Coping skills Non-pharmacologic pain management Therapeutic play Procedural preparation and support 9/25/2013 9 3
Medications Types and routes of medications used: Opioids Benzodiazepine Oral Intravenous Intranasal 9/25/2013 10 Considerations for Sedation Minimal sedation Moderate sedation 9/25/2013 11 Routine Dressing Change Patient: Molly 4 years old No allergies 20 kgs 5% TBSA partial thickness burns to bilateral hands and right arm 9/25/2013 12 4
Routine Dressing Change Select dressing change time MD Child Life PT/OT Parents Other nurses Pre-medicate With oral pain medications patient specific 9/25/2013 13 Routine Dressing Change Set up tub room for dressing change Bring patient to the tub room Appropriate mediations will be given Child Life provides developmentally appropriate distraction and strategies 9/25/2013 14 Child Life: Procedural Support Research has found that using Child Life: Helps increase coping Decreases the amount of initial pain medicine used Decreases length of hospital stay Increases overall patient and family satisfaction 9/25/2013 15 5
Child Life: Procedural Support In pediatric burn patients, preparation and distraction: Reduces the amount of pain felt during procedures Reduces the amount of time for healing Reduces the amount of emotional upset experienced by the patient 9/25/2013 16 Child Life: My Burn Journey App The Riley Burn Center developed an app to help educate and provide distraction to specifically help pediatric burn patients 9/25/2013 17 Child Life: My Burn Journey App Search My Burn Journey in the App Store to get this app on your ipad This free app was developed by Riley This app was produced with Scofield and Freedom Solutions 9/25/2013 18 6
A Look Into the Future We are starting research to investigate the effects of using Child Life during dressing changes and the potential is has to reduce benzodiazepine use. 9/25/2013 19 Contact Information Paul Plowman, RN-BC PPlowman@iuhealth.org 317-944-3927 Caitlin Dougherty, CCLS cdougherty@iuhealth.org 317-944-1852 9/25/2013 20 References American Academy of Pediatrics Child Life Council and Committee on Hospital Care. (2006). Child Life Services. Pediatrics, 118 (4), 1757-1763. American Burn Association, Advance Burn Life Support Course Provider Manual, 2007 Indiana University Health (2012). Procedural Sedation and Analgesia. MS 3.39. [report] Indianapolis: Indiana University Health, pp. 1-12. Miller, K., Rodger, S., Kipping, B., & Kimble, R.M. (2011). A novel technology approach to pain management in children with burns: A prospective randomized controlled trial. Burns, 37(3), 395-405 9/25/2013 21 7