Redefining the Perioperative Experience for Children with Neurodiversity

PROCESS

• Screening and inclusion into the BEE MINDFUL program in pre-surgical testing
• Interventions to promote a positive experience identified in pre-surgical testing
• Pre-op phone call with a review of interventions and to provide support to the patient and family
• Day of surgery- BEE PASS entry into the facility
• Situational awareness signage and individualized interventions incorporated into pre-op, intra-op, and post-op care
• BEE Cart use of sensory items

NEXT STEPS

• Continued expansion of the BEE MINDFUL™ program nationally and internationally.
• Expansion of the BEE MINDFUL.com Website to include Community-based resources

Presented at:

OR Manager Conference first place poster winner showcases impactful program from 2023

By Marisa Torrieri

From highlighting the need for better preoperative nasal decolonialization to touting the success of personalized pediatric behavioral health interventions, the posters on display at the 2023 OR Manager Conference highlighted the exceptional work of clinicians in 2023.

 

Poster: “Redefining the Perioperative Experience for Children with Neurodiversity”

Changing the narrative for the once-marginalized neurodiverse population, the BEE MINDFUL program promotes equity, inclusion, and wellness in the healthcare arena. OR Manager spoke to Sharon Goodman, DNP, RN, NPD-BC, CPNP, director, pediatric service line, quality management, at Cohen Children's Medical Center; and Jennifer Simonetti, DNP, RN, NPD-BC, CPN, Director, Magnet Program, Patient Experience, Cultural Leader at Cohen Children's Medical Center. Here’s what they had to say.

Q: Was there a moment, or a story, that inspired you to embark on making a change? 

Goodman: We had a patient in our hospital, a 12-year-old girl, who came to us from an outside facility. And the report that we got was she was nonverbal and autistic, and she unfortunately came to us in four-point restraints: she was restrained at her legs and arms when she arrived, and she was very scared and became aggressive. As were trying to do tests for her, she would escalate and became more frightened. 

The nurses on the unit huddled and said they felt they were missing something. As it turned out, she actually did communicate through a communication device that her family did not bring because they were worried it would get lost or stolen. But at that time, it was really traumatic for our staff. They felt they could have done a better job assessing the situation and intervening. That's when the program kind of took flight. That one patient sparked the whole program. 

After we got her communication device, she was a different person. She went to the playroom and was able to communicate with us. She got all of the tests done. She was able to be discharged. And then Jen and I realized, she ended up staying here much, much longer than she needed to be. So that was a metric we could improve.

Q: How do clinicians and other healthcare workers interact with patients within the program? 

Simonetti: Our program comprises three key components: education, situational awareness, and a patient neurobehavioral assessment tool. We believe education is power, and in developing the program, we ensured that all team members who have a footprint in our building, both clinical and nonclinical, were provided education.

The second component of the program is creating situational awareness. In an effort to create a safe environment for our patients and families, partnering with interprofessional colleagues and family partners, we created a symbol to identify those enrolled in the BEE Mindful program. This unique symbol was created to identify those patients in the program in a nonstigmatized manner. Creating situational awareness to all team members that the patient is enrolled in the program through the usage of the symbol on the door further creates a safe place for the patient and family, as all team members are educated to pause and speak with the patients’ nurse and/or review the patient neurobehavioral assessment tool prior to entering the room to understand the individual needs of this patient.

The third component to the program is the patient neurobehavioral assessment tool, also known as the PNAT. This validated assessment tool has been integrated in the electronic health record and provides a plan to further individualize the care to the patient. This allows all team members to understand each patient’s individual needs, so care can be provided in a safe, nontraumatic environment. 

Q: With whom did your team collaborate to achieve the results you emphasize in your poster?

Simonetti: We are very proud to share that we collaborated with nursing, medicine, child life, and creative arts therapies; physical, occupational and speech therapies; environmental services; security, social work, and hospitality teams; as well as family partners as we developed and launched the program. 

Q: What lessons did you learn based on this project? 

Goodman: What we really took home from what they told us is there's really no formula. Parents would keep saying, ‘For my child, this would be a trigger,’ ‘For my child, this would be challenging.’ I like to give the example of the hospital gown. Many children or patients hate that gown. We make alternatives and figure things out. But then we'll have a patient who loves the gown. We had this little one sitting there, rubbing the gown together and listening to it, and just enjoying it. I think that was another ‘aha’ moment. 

Simonetti: Additionally, we recognized that caring for people with neurodiversity doesn’t end when they age out of pediatric care, and the need to ensure care across the continuum was paramount to the success of the program. We partnered with our adult colleagues to ensure the program was able to be continued as they transitioned from pediatric to adult care management.