Hospital Pediatric Survey

This survey is being shared by the Southwest Florida Healthcare Coalition pediatric task force in an attempt to determine hospital pediatric gaps or needs within the Southwest Florida region 6. The individual agency results will not be shared publically and will only be used as a guide for the task force to attempt to close the noted gaps. We ask for name and agency to help with any duplications. Please work with any other coalition members within your organization to determine who best to take this survey. Hospitals with multiple facilitles should submit a survey with each emergency department.

These questions can be used as a guide for the purpose of this survey and were transcribed from this link:

https://media.emscimprovement.center/documents/NPRP_Checklist_Final_Apr2021.pdf

Question Title

* 1. Please list your name and agency contact information

Name

Facility

County

Email Address

Phone Number

Question Title

* 2. Administration and Coordination of the ED for the Care of Children

Physician Coordinator for Pediatric Emergency Care (PECC)*
•Board certified/eligible in EM or PEM (preferred but not required for resource limited hospitals)

•The Physician PECC is not board certified in EM or PEM but meets the qualifications for credentialing by the hospital as an emergency clinician specialist with special training and experience in the evaluation and management of the critically ill child.

Nurse Coordinator for Pediatric Emergency Care (PECC)*
•CPEN/CEN (preferred)•Other credentials (e.g., CPN, CCRN)

Question Title

* 3. Please check the following policies, procedures, and protocols for the emergency care of children you may have.

Illness and injury triage.

Pediatric patient assessment and reassessment.

Identification and notification of the responsible provider of abnormal pediatric vital signs.

Immunization assessment and management of the under- immunized patient.

Sedation and analgesia, for procedures including medical imaging.

Consent, including when parent or legal guardian is not immediately available.

Social and behavioral health issues.

Physical or chemical restraint of patients.

Child maltreatment reporting and assessment.

Death of the child in the ED.

Do not resuscitate (DNR) orders.

Children with special health care needs.

Family and guardian presence during all aspects of emergency care, including resuscitation.

Patient, family, guardian, and caregiver education.

Discharge planning and instruction.

Bereavement counseling.

Communication with the patient’s medical home or primary care provider as needed.

Telehealth and telecommunications.

Question Title

* 4. Healthcare providers who staff the ED have periodic pediatric-specific competency evaluations for children of all ages. Our areas of pediatric competencies include any/all of the following:

Assessment and treatment (e.g., triage)

Medication administration

Device/equipment safety

Critical procedures

Resuscitation

Trauma resuscitation and stabilization

Disaster drills that include children

Patient- and family-centered care

Team training and effective communication

Question Title

* 5. The written all-hazard disaster-preparedness plan addresses pediatric-specific needs within the core domains including:

Medications, vaccines, equipment, supplies and trained providers for children in disasters.

Pediatric surge capacity for injured and non-injured children

Decontamination, isolation, and quarantine of families and children of all ages.

Minimization of parent-child separation.

Tracking and reunification for children and families

Access to specific behavioral health therapies and social services for children..

Disaster drills include a pediatric mass casualty incident at least every two years.

Care of children with special health care needs.

Question Title

* 6. Guidelines for QI/PI in the ED

Data are collected and analyzed.

System changes are implemented based on performance.

System performance is monitored over time.

Question Title

* 7. Evidence-Based Guidelines

Evidence-based clinical pathways, order sets or decision support available to providers in real time

Question Title

* 8. Inter-facility Transfers

Written pediatric inter-facility transfer agreements

Written pediatric inter-facility transfer guidelines. These may include:
• Criteria for transfers (e.g., specialty services)
• Criteria for selection of appropriate transport service
• Process for initiation of transfer
• Plan for transfer of patient information
• Integration of family-centered care
• Integration of telehealth/telecommunications

Question Title

* 9. Guidelines for Medication, Equipment and Supplies

ED staff is educated on the location of all items.

Daily method in place to verify the proper location and function of pediatric equipment and supplies.

Medication chart, length-based tape, medical software, or other systems is readily available to ensure proper sizing of resuscitation equipment and proper dosing of medications.

Standardized chart or tool used to estimate weight in kilograms if resuscitation precludes the use of a weight scale (e.g., length-based tape)

Question Title

* 10. Guidelines for Improving Pediatric Patient Safety

Children are weighed in kilograms only

Weights are recorded in kilograms only

For children who require emergency stabilization, a standard method for estimating weight in kilograms is used (e.g., a length-based system)

Infants and children have a full set of vital signs recorded • A full set of vital signs includes temperature, heart rate, respiratory rate, pulse oximetry, blood pressure, pain, and mental status when indicated in the medical record.

CO2 monitoring for children of all ages

Process for safe medication delivery that includes:
• Prescribing
• Administration
• Disposal

Pre-calculated drug dosing and formulation guides

24/7 access to interpreter services in the ED

Timely tracking and reporting of patient safety events

Question Title

* 11. Medications

Analgesics (oral, intranasal, and parenteral)

Anesthetics (eutectic mixture of local anesthetics; lidocaine 2.5% and prilocaine 2.5%; lidocaine, epinephrine, and tetracaine; and LMX 4 [4% lidocaine])

Anticonvulsants (benzodiazepines, levetiracetam, valproate, carbamazepine, fosphenytoin, and phenobarbital)

Antidotes (common antidotes should be accessible to the ED, e.g., naloxone)

Antipyretics (acetaminophen and ibuprofen)

Antiemetics (ondansetron and prochlorperazine)

Antihypertensives (labetalol, nicardipine, and sodium nitroprusside)

Antimicrobials (parenteral and oral)

Antipsychotics (olanzapine and haloperidol)

Benzodiazepines (midazolam and lorazepam)

Bronchodilators

Calcium chloride and/or calcium gluconate

Corticosteroids (dexamethasone, methylprednisolone, and hydrocortisone)

Cardiac medications (adenosine, amiodarone, atropine, procainamide, and lidocaine)

Hypoglycemic interventions (dextrose, oral glucose)

Diphenhydramine

Epinephrine (1mg/mL [1M] and 0.1 mg/mL [IV] solutions)

Furosemide

Glucagon

Insulin

Magnesium sulfate

Intracranial hypertension medications (mannitol, 3% hypertonic saline)

Neuromuscular blockers (rocuronium and succinylcholine)

Sucrose solutions for pain control in infants

Sedation medications (midazolam, etomidate and ketamine)

Sodium bicarbonate (4.2%)

Vasopressor agents (dopamine, epinephrine and norepinephrine)

Vaccines (tetanus)

Question Title

* 12. Guidelines for ED Support Services

Medical imaging capabilities and protocols address age- or weight-appropriate dose reductions for children.

All efforts made to transfer completed images when a patient is transferred from one facility to another.

Collaboration with radiology, laboratory and other ED support services to ensure the needs of children in the community are met.

Question Title

* 13. Equipment/Supplies: General Equipment

Patient warming device (infant warmer)

IV blood and/or fluid warmer

Restraint device

Weight scale, in kilograms only (no opportunity to weigh or report in pounds), for infants and children.

Tool or chart that relies on weight (kilograms) used to assist physicians and nurses in determining equipment size and correct drug dosing (by weight and total volume)

Pain scale assessment tools that are appropriate for age.

Rigid boards for use in CPR

Pediatric-specific AED pads

Question Title

* 14. Equipment/Supplies: General Equipment

Patient warming device (infant warmer)

IV blood and/or fluid warmer

Restraint device

Weight scale, in kilograms only (no opportunity to weigh or report in pounds), for infants and children

Tool or chart that relies on weight (kilograms) used to assist physicians and nurses in determining equipment size and correct drug dosing (by weight and total volume)

Pain scale assessment tools that are appropriate for age

Rigid boards for use in CPR

Pediatric-specific AED pads

Question Title

* 15. Endotracheal Tubes

uncuffed 2.5 mm

uncuffed 3.0 mm

cuffed or uncuffed 3.5 mm

cuffed or uncuffed 4.0 mm

cuffed or uncuffed 4.5 mm

cuffed or uncuffed 5.0 mm

cuffed or uncuffed 5.5 mm

cuffed 6.0 mm

Question Title

* 16. Feeding Tubes

Question Title

* 17. Laryngoscope Blades

straight: 0

straight: 1

straight: 2

curved: 2

Question Title

* 18. Magill Forceps

pediatric

Question Title

* 19. Nasopharyngeal Airways

infant

child

Question Title

* 20. Oropharyngeal Airways

size 0

size 1

size 2

size 3

Question Title

* 21. Stylets for endotracheal tubes

pediatric

infant

Question Title

* 22. Suction Catheters

infant (6-8F)

child (10-12F)

Question Title

* 23. Rigid Suction Device

pediatric

Question Title

* 24. Bag-mask device, self-inflating

infant (250 ml)

child (450-500 ml)

Question Title

* 25. Non-rebreather masks

infant

child

Question Title

* 26. Clear Oxygen masks

infant

child

Question Title

* 27. Masks to fit bag-mask device adaptor

neonatal

infant

child

Question Title

* 28. Nasal cannula

infant

child

Question Title

* 29. Gastric tubes

infant (8F)

child (10F)

Question Title

* 30. Arm boards

infant

child

Question Title

* 31. Catheter-over-the-needle device

22 gauge

24 gauge

Question Title

* 32. Intraosseous needles or device

pediatric

IV administration sets with calibrated chambers and extension tubing and/or infusion devices with the ability to regulate the rate and volume of infusate (including low volumes)

Question Title

* 33. IV solutions

Normal saline

Dextrose 5% in 0.45% normal saline

Lactated Ringer's solution

Dextrose 10% in water

Question Title

* 34. Extremity splints (including femur splints)

pediatric

Question Title

* 35. Cervical Collar

infant

child

Question Title

* 36. Equipment/Supplies: Monitoring Equipment

Blood pressure cuffs: neonatal, infant & child

Doppler ultrasonography devices

ECG monitor and/or defibrillator with pediatric and adult capabilities, including pediatric-sized pads and/or paddles

Pulse oximeter with pediatric and adult probes

Continuous end-tidal CO2 monitoring

Alprostadil (prostaglandin E1)

Question Title

* 37. Difficult airway supplies and/or kit

supraglottic airways of all sizes

needle cricothyrotomy supplies

surgical cricothyrotomy kit

video laryngoscopy

Question Title

* 38. Newborn delivery kit (including equipment for initial resuscitation of a newborn infant)

umbilical clamp

scissors

bulb syringe

towel

Question Title

* 39. Urinary catheterization kits and urinary (indwelling) catheters

infant

child

Question Title

* 40. Central venous catheters

4.0F

5.0F

6.0F

7.0F

Question Title

* 41. Chest tubes

infant (8–12F catheter)

child (14–22F catheter)

adult (24–40F catheter) OR pigtail catheter kit (8.5–14F catheter)

Question Title

* 42. Additional Recommendations for High-Volume EDs

Hypothermia thermometer

Inotropic agents (e.g., digoxin and milrinone)

Laryngoscope blade; size 00

Tube thoracostomy tray

Video laryngoscopy

Question Title

* 43. Lumbar puncture tray, spinal needles

infant

child

Question Title

* 44. Noninvasive ventilation

continuous positive airway pressure OR high-flow nasal cannula

Question Title

* 45. Self-inflating bag-mask device

pediatric

Question Title

* 46. Tracheostomy tubes

size 0

size 1

size 2

size 3

size 4

size 5

size 6

Question Title

* 47. Umbilical vein catheters

3.5F

5.0F

Question Title

* 48. Does your agency offer Pediatric Advanced Life Support (PALS)

Yes

Other (please specify)