Staff competencies are a key concern

Joint guidelines from the American Academy of Pediatrics, the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) cover several major areas including staff competencies; improving patient safety; policies, procedures, and protocols; transfer agreements; support services; and equipment, supplies, and medications.

Satisfying nearly all of these guidelines requires an ED staff that is competent in the specialized care children need. What core competencies should be required? "The ED manager has to work in cooperation with the pediatric coordinators to identify them," says AnnMarie Papa, MSN, RN, CEN, FAEN, president-elect of ENA for 2010. "Typically, what you do when you develop competencies is you look at things like the population base, as well as the types of injuries that are common in your area, since they're all different."

However, there are some common considerations that must be taken into account, Papa says. "No. 1 is safety," she says. "That includes airway management, and recognizing a child is sick before they start getting sicker, because kids can go downhill real fast."

For nurses, there are some important certifications, such as pediatric advanced life support (PALS), Papa says. "Also, ENA has an emergency nursing pediatrics course, or ENPC, that nurses have to take every four years," she says. "It covers airway management, identifying burns, resuscitation, dehydration, and sepsis." Any nurse that cares for a child should have this course, Papa says. "Some think PALS is enough, but that only addresses airway management," she adds.

In addition, she says, it's important to have the ability to bond with parents and to listen to them. "If a parent says their kid is sick, then they are sick until proved otherwise — and you have to have people who are sensitive to that," Papa says. "You need to partner with them and trust the parent to tell you what has worked in the past, say, for Tommy's asthma."

There is no substitute for this relationship with the parents, she emphasizes. "You can have every certification, have every piece of equipment you need, and be a top clinical nurse, but if you can't develop trust and bond with the parents in the first two minutes, it'll be all downhill," Papa warns.

The pediatrics coordinator should handle all of the competency training or train the trainers, she says. "That gives nurses in the department to opportunity to grow," Papa says. The coordinator also should handle competency evaluations, she adds.

It's important when training your staff to advise them against becoming intimidated by caring for children, notes Alfred Sacchetti, MD, FACEP, chief of emergency services at Our Lady of Lourdes Medical Center, Camden, NJ; a spokesman for the American College of Emergency Physicians (ACEP); and a member of the committee that developed the guidelines. "Overall, we tend to underestimate the quality [of care we provide], and as a result, these people tend to be intimidated by children when they shouldn't be," he says. "Once you become intimidated, you basically back away from doing the right thing, and inappropriate intimidation in itself may lead to suboptimal care."