Electronic Medical Record for Child Life

1. Electronic Medical Record for Child Life It’s EPIC! Samantha K. Garrett, MS, CCLS Senior Child Life SpecialistPatient and Family Centered Care Department

2. Nemours Children’s Hospital • Nemours Children’s Clinic of Orlando (NCCO) was established in 1997. • Nemours Children’s Hospital was granted Certificate of Need for 97 beds in 2007 by Florida legislature. • Key leaders for NCH were hired in 2011 including a Senior Child Life Specialist, who joined the team November 14, 2011. • October 22, 2012: NCH opened it’s doors for our first ED and inpatient patient.

3. Patient and Family Centered Care Department Child Life lives here. • The Patient and Family Centered Care Department is lead by our Director, who has a Social Work background. The department houses Child Life, Spiritual Care, Social Work, KidsTRACK, Service Excellence and the Advisory Councils. • This innovative departmental structure provides an umbrella and one budget for the psychosocial care team. Our department consists of 21 associates.

4. Nemours commitment to the EMR • Transforming Children’s Health Care Through Electronic Medical Records http://www.youtube.com/watch?v=V3954seCf_s&list=PL1F9C5DCDD7A2E93F • The Nemours enterprise— • the Healthcare Information and Management Systems Society (HIMSS) Davies Organizational Award of Excellence recipient for 2010 • HIMSS Stage 7 (Paperless for Improved Patient Quality) • Nemours Children’s Hospital • HIMSS Stage 6

5. Research and Information Gathering • Child Life Council (2010). The Child Life Profession. Retrieved from http://childlife.org/The%20Child%20Life%20Profession/ • Children’s Hospital of Philadelphia. (2010) Emergency Department Acuity Index • Hollen, E., & Skinner, L. (2009). Chapter 7: Assessment and Documentation in Child Life. In R. Thompson (Ed.), The Handbook of Child Life: Guide for Pediatric Care (116-136). Springfield: Charles C. Thomas, Publisher LTD. • Koller, D. (2008). Child Life Assessment: Variables Associated with a Child’s Ability to Cope with Hospitalization. Child Life Council Evidence-Based Practice Statement. • Palm, S., Skinner, L., & Wilson, J. (Eds.). (2006). Chapter Three: The Child Life Process (11-12).Guidelines for the Development of Child Life Programs in Health Care Settings. Rockville, MD: Child Life Council. • Rollins, J., Bolig, R., & Mahan, C. (2005). Meeting Children’s Psychosocial Needs Across the Health-Care Continuum. Austin, Texas: PRO-ED • Thompson, R. (2009). Chapter 7: Assessment and Documentation in Child Life. In R. Thompson (Ed.), The Handbook of Child Life: Guide for Pediatric Care (116-136). Springfield: Charles C. Thomas, Publisher LTD.

6. Bio-Psychosocial Assessment • Devised a Bio-psychosocial Assessment to decrease redundancy in establishing a baseline for care. • Introduced to PFCC members during EPIC instructor led classes. • Implemented upon opening of the facility. • Decreased incidents of repetitive questioning by staff regarding family dynamics, school status, medical stressors, coping and support systems for the family.

7. Bio-Psychosocial Assessment • Incorporated Child Life Needs Assessment Tool concepts for Family/Community Support and Medical Stressors. • Secondary assessments were completed to facilitate specific discipline based information gathering. • Document was utilized also in KidsTRACK for outpatient visits. • Is color coded for priority based on length of stay

8. Report View • Green – documentation completed • White – newly admitted patient, no documentation has been done. • Yellow – documentation not done = have 24 – 48 hours to complete documentation • Red - > 48 hours with no  documentation done

9. Family Centered Care Tab • Bio psychosocial Support • Assessment • School History • History • Contract/ Introduction • Living Situation • Family Support System • Family Strengths • Support • Medical Stressors • Family/ Community/ Spiritual Support System

10. View in EPIC Bio psychosocial

11. Family Centered Care Tab • Child Life • Contract/ Introduction • Assessment • Prep/ Distract • Education • Assessment/ Plan • Assessment Score (Provides numerical representation to the information in the Needs Assessment)

12. View in EPIC Child Life Screens

13. Family Centered Care Tab • Pastoral Care • Progress Notes • Quick Note • Needs Assessment • Progress Note • End of Life • Legacy Materials • Support • Social Work • C.A.R.E Assessment • Psychiatric Crisis

14. Case Study 4 yr old male Possible laceration Transported by Reedy Creek EMS from Blizzard Beach Mother present; sister and father on their way. EMS report: Pt was exiting the wave pool when he slipped and landed face first. With bandage over right eye. Upon exam 2 cm lac in eyebrow. Family on vacation staying at Wilderness Lodge Resort.

15. Questions? Samantha K. Garrett, MS, CCLS Samantha.Garrett@nemours.org 407-650-7499