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Download Paper Version of the Assessment - Pediatric Readiness Assessment
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Pleaseprovideuswiththefollowinginformation,incaseweneedtocontactyoutoclarifyany ofyourresponses: Name:__________________________________________________________________________________ Title/Position:_________________________________________________________________________ Phonenumber:_________________________________________________________________________ Email:____________________________________________________________________________________ Thesefirstfewquestionswilltellusabouttheinfrastructureofyourhospitalandemergency department. 1. Whatisthenameofyourhospital?_______________________________________________ 2. Inwhatcityisyourhospitallocated?_____________________________________________ 3. Zipcodeofyourhospital:__________________________________________________________ 4. Doesyourhospitalhaveanemergencydepartment(ED)thatisopen24/7? Yes No (Youdonotneedtocompletetheassessment…thankyouforyourtime.) 5. WhichoneofthefollowingisthebestdescriptionofyourEDconfigurationforthecareof children(childrenasdefinedbyyourhospital)? (Chooseone) a. b. PediatricEDinaChildren’shospital(hospitalcaresONLYforchildren) SeparatepediatricEDinageneralhospital(adultandchildrenwithinone hospital) c. GeneralED(pediatricandadultpatientsseeninsamearea) d. Stand‐byED(physicianoncall) e. Free‐standingED(EDunattachedtoahospitalwithinpatientservices) f. Other Youmarked“Other”tothepreviousquestion.PleasedescribeyourEDconfiguration forthecareofchildren:________________________________________ 2 Answerstothefollowingquestionswillhelpustobetterunderstandtheresourcesavailable forthecareofchildreninyourED. PhysicianAdministration/Coordination 6. Doesyourhospitalhaveaphysiciancoordinatorwhoisassignedtheroleofoverseeing variousadministrativeaspectsofpediatricemergencycare(e.g.,overseesquality improvement,collaborateswithnursing,ensurespediatricskillsofstaff,developsand periodicallyreviewspolicies)? Note:Thephysiciancoordinatorforpediatricemergencycaremayhaveadditional administrativerolesintheED. Yes No Goto8 7. Ifyes,isthereajobdescriptionorwrittenlistofresponsibilitiesforthisphysician coordinator? Yes No NurseAdministration/Coordination 8. Doesyourhospitalhaveanursecoordinatorwhoisassignedtheroleofoverseeing variousadministrativeaspectsofpediatricemergencycare(e.g.,facilitates continuingeducation,facilitatesqualityimprovementactivities,ensurespediatric‐ specificelementsareincludedinorientationofstaff)? Note:Thenursecoordinatorforpediatricemergencycaremayhaveadditional administrativerolesintheED. Yes No Goto10 9. Ifyes,isthereajobdescriptionorwrittenlistofresponsibilitiesforthisnursecoordinator? Yes No 3 Thefollowingassessmentquestionsrefertopersonnel,qualityimprovement,andpatient safetyintheED. 10. Doesyourhospitalrequirespecificpediatriccompetencyevaluationsofphysiciansstaffing theED(e.g.,sedationandanalgesia)? Yes No 11. Doesyourhospitalrequirespecificpediatriccompetencyevaluationsofnursesstaffingthe ED(e.g.,triage,painassessment)? Yes No QualityImprovement 12. DoesyourEDhaveapediatricpatientcare‐reviewprocess?(Thismaybeaseparate QualityImprovement/PerformanceImprovementPlanforpediatricpatientsorintegrated intotheoverallEDQualityImprovement/PerformanceImprovementPlan.) Yes No Goto14 13. Ifyes,iseachofthefollowingcomponentsincludedintheQualityImprovement/ PerformanceImprovementPlan? (CheckYesorNoforeach) a. Identificationofqualityindicatorsforchildren (e.g.,performingalumbarpunctureonfebrile neonates) No No c. Developmentofaplanforimprovementinpediatric Yes emergencycare(e.g.,processtoensurethatvariances incareareaddressedthrougheducationortraining andreassessedforevidenceofimprovement) No d. Re‐evaluationofperformanceusingoutcomes‐based measures(e.g.,howoftenwaspainrapidlycontrolled orfeverproperlytreated) No b. Collectionandanalysisofpediatricemergencycare data(e.g.,admissions,transfers,deathintheED,or returnvisits) Yes Yes Yes 4 PediatricPatientSafetyintheED 14. Areall*childrenseenintheEDweighedinkilograms(withoutconversionfrompounds)? *Note:Thisincludescriticalsituationswhenachildmightbypasstriageandhavehis/her weightestimatedinkilograms. Yes No Goto16 15. IstheweightrecordedintheEDmedicalrecordinkilogramsonly? Yes No Goto17 16. Ifno,howarechildrenintheEDweighed,andhowistheweightrecordedinthemedical record? (Chooseone) Weighedinpoundsandconvertedtokilogramsforrecordinginthemedical record b. Weighedineitherpoundsorkilogramswithanoptiontorecordineitherpounds orkilogramsinthemedicalrecord a. 17. Aretemperature,heartrate,andrespiratoryrate recordedonallchildren? Yes No 18. Isbloodpressuremonitoringavailablefor childrenofallagesbasedonseverityofillness? Yes No 19. Ispulseoximetrymonitoringavailablefor childrenofallagesbasedonseverityofillness? Yes No 20. Isawrittenprocedureinplacefornotificationofphysicians whenabnormalvitalsignsarefoundinallchildren? Yes No 21. Isaprocessinplacefortheuseofpre‐calculateddrug dosinginallchildren? Yes No 22. Isaprocessinplacethatallowsfor 24/7accesstointerpreterservicesintheED? Yes No 5 Nextwewishtoknowaboutpoliciesand/orproceduresthatyourEDhastoaddresstheneeds ofchildren.ThesepediatricpoliciesmaybeintegratedintotheoverallEDpolicymanualor maybelistedseparately.TheyshouldalsobewrittenandavailabletostaffintheED. PoliciesandProcedures 23. DoesyourEDhaveatriagepolicythatspecificallyaddressesillandinjuredchildren? Yes No Goto25 24. Ifyes,doyouuseavalidatedpediatrictriagetool?Yes No Unsure 25. DoesyourEDhaveeachofthefollowinglistedpoliciesandprocedures? (CheckYesorNoforeach) *Note:Thesemaybepartofoverallhospitalpolicies,butmustclearlycontainreferenceto childrenorincludepediatric‐specificindicators. a. Pediatricpatientassessmentandreassessment Yes No b. Immunizationassessmentandmanagement oftheunder‐immunizedchild Yes No c. Childmaltreatment Yes No d. DeathofthechildintheED Yes No e. Reduced‐doseradiationforCTandx‐rayimaging basedonpediatricageorweight Yes No 26. DoesyourEDhaveapolicyforpromotingfamily‐centeredcare?(e.g.,familypresence, familyinvolvementinclinicaldecisionmaking,etc.) Yes No 27. Doesyourhospitaldisasterplanaddressissuesspecifictothecareofchildren? Yes No 6 28. Doesyourhospitalhaveapolicyonhowtocareforchildrenwithsocialandmentalhealth issues? Yes No 29. Doesyourhospitalhaveawrittenguidelineforthetransferofchildrenwithsocialand mentalhealthissuesoutofyourfacilitytoanappropriatefacility? Yes No Nextwewouldliketoknowaboutyourhospital’sinter‐facilitytransferguidelines. 30. Doesyourhospitalormedicalfacilityhavewritteninter‐facilityguidelinesthatoutline proceduralandadministrativepolicieswithotherhospitalsforthetransferofpatientsof allagesincludingchildreninneedofcarenotavailableatyourhospital? Note:CompliancewithEMTALAdoesnotconstitutehavinginter‐facilitytransferguidelines. Theguidelinesmaybeaseparatedocumentorpartofaninter‐facilitytransferagreement document. Yes No Wecurrentlydonothavewrittenguidelines,butareintheprocessofdevelopingthem. Ifyouareintheprocessofdevelopingguidelines,whendoyouanticipatethe guidelinestobeready?Month/Year(mm/yyyy):_____________ Nowwewouldliketoknowaboutyourhospital’sinter‐facilitytransferagreements. 31. Doesyourhospitalormedicalfacilityhavewritteninter‐facilityagreement(s)withother hospitalsforthetransferofpatientsofallagesincludingchildreninneedofcarenot availableatyourhospital? Yes No Wecurrentlydonothavewrittenagreements,butareintheprocessofdeveloping them. Ifyouareintheprocessofdevelopingagreements,whendoyouanticipatethe agreementstobeready?Month/Year(mm/yyyy):_________________________ 7 WewouldliketoknowabouttheequipmentandsuppliesforchildreninyourEDandhow theyarestoredandresupplied.Ifyouhavenotalreadyprintedtheentireassessment,we recommendprintingthisportionoftheassessmentandtakingittoyourequipmentand supplyareastocompletetoensureaccuratereporting. EquipmentandSupplies 32. IstheEDstafftrainedonthelocationofallpediatricequipmentandmedications? Yes No 33. Isthereadailymethodusedtoverifytheproperlocationandfunctionofpediatric equipmentandsupplies? Yes No 34. Isamedicationchart,length‐basedtape,medicalsoftware,orothersystemreadily availabletoensurepropersizingofresuscitationequipmentandproperdosingof medications? Yes No 35. IseachofthefollowingmonitoringequipmentitemsavailableforimmediateuseintheED? (CheckYesorNoforeach) a. Neonatalbloodpressurecuff Yes No b. Infantbloodpressurecuff Yes No c. Childbloodpressurecuff Yes No Yes No e. Pulseoximeterwithpediatricandadultprobes Yes No f. Continuousend‐tidalCO2monitoringdevice Yes No d. Defibrillatorwithpediatricandadult capabilitiesincludingpads/paddles 36. Iseachofthefollowingfluidresuscitationequipmentitemsavailableforimmediateusein theED? (CheckYesorNoforeach) a. 22gaugecatheter‐over‐the‐needle Yes No b. 24gaugecatheter‐over‐the‐needle Yes No 8 c. Pediatricintra‐osseusneedles Yes No d. IVadministrationsetswithcalibratedchambers andextensiontubingand/orinfusiondeviceswith abilitytoregulaterateandvolumeofinfusate Yes No e. Umbilicalveincatheters(3.5For5.0F) Yes No f. Centralvenouscatheters (anytwosizesinrange,4F‐7F) Yes No 37. Iseachofthefollowingrespiratory/airwaymanagementequipmentitemsavailablefor immediateuseintheED? (CheckYesorNoforeach) a. Endotrachealtubes:cuffedoruncuffed2.5mm Yes No b. Endotrachealtubes:cuffedoruncuffed3.0mm Yes No c. Endotrachealtubes:cuffedoruncuffed3.5mm Yes No d. Endotrachealtubes:cuffedoruncuffed4.0mm Yes No e. Endotrachealtubes:cuffedoruncuffed4.5mm Yes No f. Endotrachealtubes:cuffedoruncuffed5.0mm Yes No g. Endotrachealtubes:cuffedoruncuffed5.5mm Yes No h. Endotrachealtubes:cuffed6.0mm Yes No i. Laryngoscopeblades:straight,size00 Yes No j. Laryngoscopeblades:straight,size0 Yes No k. Laryngoscopeblades:straight,size1 Yes No l. Yes No m. Laryngoscopeblades:curved,size2 Yes No n. Pediatric‐sizedMagillforceps Yes No o. Nasopharyngealairways:infant‐sized Yes No p. Nasopharyngealairways:child‐sized Yes No q. Oropharyngealairways:size0(50mm) Yes No r. Oropharyngealairways:size1(60mm) Yes No s. Oropharyngealairways:size2(70mm) Yes No t. Oropharyngealairways:size3(80mm) Yes No u. Styletsforpediatric/infant‐sizedendotrachealtubes Yes No v. Tracheostomytubes:size3.0mm Yes No w. Tracheostomytubes:size3.5mm Yes No Laryngoscopeblades:straight,size2 9 x. Tracheostomytubes:size4.0mm Yes No Yes No Yes No aa. Maskstofitbag‐maskdeviceadaptor:infant Yes No bb. Maskstofitbag‐maskdeviceadaptor:child Yes No cc. Clearoxygenmasks:standardinfant Yes No dd. Clearoxygenmasks:standardchild Yes No ee. Non‐rebreathermasks:infant‐sized Yes No ff. Non‐rebreathermasks:child‐sized Yes No gg. Nasalcannulas:infant Yes No hh. Nasalcannulas:child Yes No Yes No jj. Laryngealmaskairways:size:1.5 Yes No kk. Laryngealmaskairways:size:2 Yes No ll. Laryngealmaskairways:size:2.5 Yes No mm. Laryngealmaskairways:size:3 Yes No nn. Suctioncatheters:atleastoneinrange6‐8F Yes No oo. Suctioncatheters:atleastoneinrange10‐12F Yes No pp. Supplies/kitforpediatricpatientswithdifficult Yes airways(supraglotticairwaysofallsizes,needle cricothyrotomysupplies,surgicalcricothyrotomykit) No y. Bag‐maskdevice,selfinflating:infant,450ml z. Maskstofitbag‐maskdeviceadaptor:neonatal ii. Laryngealmaskairways:size1 PleaseprovideactualdataorestimationsofEDpatientvolumeforthefollowing: 38. Listthetotalnumberofpatients(adultandpediatric)seeninyourEDinthelastyear. (Numericdataonly,e.g.,5000,not“fivethousand”) NumberofTotalPatients____________________________ 39. Estimatethenumberofpediatricpatients(asdefinedbyyourhospital)seeninyourEDin thelastyear. (Chooseone) a. Low:<1,800pediatricpatients(averageof5orfeweraday) b. Medium:1,800–4,999pediatricpatients(averageof6‐13aday) 10 c. MediumtoHigh:5,000–9,999pediatricpatients(averageof14‐26aday) d. High:>=10,000pediatricpatients(averageof27ormoreaday) 40. Ifyouknowtheactualnumberoramorepreciseestimateofpediatricpatientsseenin yourEDinthelastyear,pleaserecordbelow.(Numericdataonly,e.g.,500,not“five hundred”) NumberofPediatricPatients_____________________ Finally,pleaseprovideinformationaboutyourhospital'straumadesignation. 41. Isyourhospitalverifiedordesignatedasatraumafacility? Yes No Goto42 GotoEndofSurvey 42. Atwhattraumalevelisyourfacilitydesignated? (Chooseone) LevelI LevelII LevelIII LevelIV PediatricLevelI PediatricLevelII CombinedLevelIandPediatricLevelI CombinedLevelIandPediatricLevelII CombinedLevelIIandPediatricLevelII Other:__________________________________________________________ Ifyouhaveanycomments,pleasenotethemhere: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________ 11 Pleasereturntowww.pedsready.orgtoenteryourelectronic assessmentresponsesandtoreceiveyourpediatricreadinessscore. Also,youcanreturntothewebsiteatanytimeandclick“2013‐14 NationalResults”toviewpreviousnationalaverages.
