How to handle that pediatric referral
How to handle that pediatric referral
Ensuring proper patient care
In a perfect world, all pediatric patients would receive specialized pediatric care. However, that’s not always possible: Managed care or capitated contracts may call for you to accept a pediatric referral, or maybe there is not a pediatric home infusion provider available in a rural area.
Should you ever find yourself with a pediatric referral, here is how the experts say you should prepare for that very special patient.
Lydia Gonzalez Ryan, RN, MSN, PNP, a hematology/oncology/bone marrow transplant nurse practitioner at Children’s Memorial Hospital in Chicago, says there are four areas of specific training she looks for in a home infusion/home care provider before giving a referral:
1. Developmental issues.
This encompasses a wide range of topics, from understanding family dynamics to knowing the differences between how a two-year-old and a 15-year old patient will react and behave.
Ryan adds that compliance issues are unique to pediatrics.
"If you have a 52-year-old patient, that person’s choice to comply with therapy is his own," she says. "But a child is totally dependent on the family. A nurse must have an appreciation for how to work with parents in addition to working with children."
2. Fluid and electrolyte issues.
"You are going to have to be able to calculate fluid maintenance on a child, so you have to know what IV fluids you are giving and proper volumes," says Ryan.
3. Normal vital signs for pediatric patients.
"For example, you have to know what the normal blood pressure for a four-year-old is so you get a number that makes sense to you," says Ryan. While an adult’s top number will range from 120 to 170, a child may fall between 60 and 80. And the bottom number, normally 80 to 95 for an adult, will be between 30 and 50 for a child, depending on age. There will be similar drastic differences in pulses and respiratory rates.
Nurses must recognize subtle signs’
"You need a staff that knows exactly what to look for in a patient that is very stable, but also to recognize instabilities," says Catherine Prophet, RN, BSN, PHN, vice president of clinical operations for Building Blocks, a Newport Beach, CA-based pediatric home care company. "And neonatal patients get well very quickly, as well as sick very quickly, so you need a nurse who will recognize those subtle signs before you have a crisis in the home."
4. Therapeutic modalities in pediatrics.
"We are doing things in the home with children that are very different than what we are doing with adults," says Ryan. "For example, we can provide intensive, high-dose chemotherapy for a year or year and a half in the home for a child as opposed to adults, where you can’t drive their doses anywhere near what you can for pediatrics."
What if an agency is lacking in pediatric- specialized staff? It’s not a lost cause, but Ryan does expect special attention to be given to the patient.
Does agency perform specialty training?
"First, an agency must be credible and have the right accreditation, such as Joint Commission accreditation," she says.
"I also look at what training they do for their nurses if they don’t have any pediatrics. Do they require certain certification or accreditation of nurses? Do they recognize the populations they serve? If they handle respiratory and oncology patients, are nurses trained in those areas?"
Because most of the patients Ryan deals with are cancer patients, she would expect nurses to belong to the Oncology Nursing Society or the Association of Pediatric Oncology Nursing.
"This shows that they have some of the education and networking that should have provided them with current education in those specialty areas," she says.
If a staff has specialty training but not pediatric training, Ryan will consider making the referral, but only under very strict conditions.
"I put in all the demographics and what I need, and then I ask to talk to the specific nurses that will be in the field with this patient," says Ryan. "I educate them on the patient. I may tell them that this is a two-year-old, his weight is X, fluid maintenance is such and such, I’m expecting this and my parameters are this, call me for this kind of blood pressure, etc. And most of the nurses love that because they feel safer and realize what they may not have brought to the home in terms of knowledge base."
Such one-on-one training is critical should a referral fall to an agency without pediatric-experienced staff.
Judy Gay, RNC, CCRN, CRNI, pediatric service coordinator for CareSouth of Macon, GA, provides such training to field staff who must take a pediatric referral.
"We have had rural agencies accept an occasional pediatric referral," she says. "I have gone as far as 120 miles one way to make sure a nurse is adequately prepared to handle a pediatric patient. The training also will vary depending on the diagnosis and needs of the patient and his or her family."
Also, Gay carries a beeper with her 24 hours a day so every nurse in her pediatric program has almost immediate help available.
"I may not be able to render care, but I can provide guidance over the phone," she says. "Many times, this gives nurses the level of comfort and confidence needed to provide appropriate care."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.