Pediatric patient safety:
Keeping children safe in the hospital
HealthSmart! Pediatric patient safety: Keeping children safe in the hospital (PDF, 772 KB) »
Hospitals work very hard to make a child's stay safe, and safety is a top priority on every doctor's, nurse's and employee's minds. However, hospitals are very busy places and human errors can happen in spite of the staff's best intentions. The more informed and involved you are in the treatment of your children, the safer the hospital experience is likely to be.
Here are some ways you can play an active role in making your child's hospital stay as safe as possible.
Preparing for the hospital
- Learn all you can about your child's illness and scheduled treatments. This will help you participate in your child's care and increase the odds of detecting any mistakes.
- Seek credible sources for information. Your child's doctor and any specialists you are referred to should be your main sources of medical information. Make sure to ask them about any information you don't understand.
- Other possible resources include books, credible websites such as www.medlineplus.gov and medical organizations such as the American Cancer Society or the American Academy of Pediatrics. Some hospitals have patient-education libraries that are good sources for health information.
- You may also want to talk to others who have had your child's condition.
- Choose a hospital that has a lot of experience in the treatment of your child's illness. Research indicates patients do better at experienced hospitals where the staff is familiar with the disease, surgery or procedure. Ideally, choose a children's hospital, as they specialize in treating children and have facilities and equipment designed for children.
- While packing for a hospital stay, keep medications your child may need with you at all times.
- Get a notebook and write down important information about test results, medications, etc.
- Ask the doctor or his/her staff to make copies of any important information for you. Take it with you when you go to health care appointments. If you have questions, write them down so you won't forget to ask them during your next visit.
- Bring medical information with you such as any medications your child takes, how much they take and why they take it.
- If your child has any allergies to medications or food, know what they are and what kind of reaction they have.
- Ask to talk to a nutritionist about your child's diet needs.
- Bring your child's immunization record and make sure it includes the dates when the immunizations were given.
- Also, know the dates of any previous surgeries or hospitalizations and bring health insurance cards.
Know your child's caregivers
Make sure your child has been introduced to the people caring for him or her and is as comfortable as possible with them. All the staff should wear identification badges that include their pictures. If you don't see such a badge on someone caring for your child, ask to see it. Inquire about their function to learn whether they are a nurse, respiratory tech, dietitian or other hospital caregiver.
- Talk with your child's caregivers about your child's health history. Talking with caregivers gives you an opportunity to make sure they have the right information about important details such as allergic reactions, medication history and chronic illness.
- Know your child's primary nurse. Children are usually assigned to a registered nurse (RN). This registered nurse helps coordinate your child's care and should review your child's care plan of care with you each day.
- If you don't understand why something is being done, ask. It is helpful to write down your questions, especially for early morning rounds by doctors and nurses. Repeat the caregivers' answers to make sure you understand their responses and write them down. If you're not comfortable with a particular caregiver or if they seem consistently impatient or always too busy to talk with you, ask for the patient care manager for your floor. If you are still uncomfortable with how your questions are being answered, contact the hospital's customer service representative or ombudsman.
- Keep a level head. Your communication will be more effective if you carry out discussions in a calm manner.
- Remember your rights. You have a right to question anyone involved with your child's care. You have the right to ask for a second opinion or request a transfer to another hospital if you are dissatisfied with your child's care. Be assertive and don't be afraid to challenge any decisions that affect your child.
- Encourage your child to speak out. You can't be with your child every minute during hospitalization, but you can let your child know what he or she can do when you're not present. Familiarize your child with as many aspects of safety as they can reasonably understand. Your child is likely to pick up on any anxiety you may be feeling, so try to share safety tips in a matter-of-fact way. Let hospital staff know if other family members will be relieving you.
Double-check your child's identification band. While in the hospital, it's ESSENTIAL for children to wear identification bands with their names and their medical record numbers. If the band is removed or comes off, ask for it to be replaced immediately. You may want to purchase medical alert bracelets for a child with severe allergies. Make sure your child understands how important it is not to remove or change the band in any way. Check that caregivers look at the identification band before they administer any medication, draw any blood or transfuse any blood products.
Familiarize yourself with orders the doctor has written for your child as much as possible. If you think medications, food or tests should not be given to your child, speak up.
Preparing for surgery
- Choose a surgeon who is board certified as a pediatric surgeon. These surgeons have special training beyond the requirements of general surgeons.
- Choose an anesthesiologist who is board certified in pediatric anesthesiology if possible.
- Take a tour. Ask for a presurgery visit during which you can meet the staff and see the waiting area and recovery room. Find out whether a child life specialist (a health care professional who helps children cope with the adjustments of being in a hospital by providing a variety of play experiences) is available to help reduce your child's stress and fear of the unknown.
- In the presurgery interview with your child's anesthesiologist, mention all health conditions your child has, medications he or she takes, any allergic reactions as well as any problems your child or a blood relative has had with any medication. Any of these could seriously affect your child's reaction to an anesthetic (medication used to put your child to sleep).
- Discuss pain control with your doctor prior to surgery. Ask about usual methods and discuss what works best for your child. Ask how this information will be passed on to all who need it.
- Ask whether the anesthesia professional who conducts your child's presurgery interview is the same one who will perform the anesthesia duties in the operating room. If not, ask how they'll make sure that person receives the above information.
- Make sure you and your doctor agree and are clear on exactly what the surgery will include. While you are present, have the surgeon clearly mark the area being operated on.
- Try to be with your child immediately before and after surgery so you can observe whether your child's pain is being controlled and whether other problems are receiving attention.
- After surgery, find out whether your child had any unusual reactions to the anesthetic and write down the information. This could be important for possible future surgeries.
Preparing for emergency care
Some hospital visits are not planned. Taking your child to the emergency department may be a frightening experience. Preparing for a visit in advance can reduce your anxiety and keep your child safe.
Carry a wallet card listing your child's health conditions, medications, allergies, doctors' names and phone numbers, and health insurance information. Also include the name and phone number of someone to call if you are unable to respond. Keep this information updated.
Reducing medication errors
- Tell caregivers about all medications your child takes (including over-the-counter medications such as cold medicines and vitamins) and any allergies he or she may have. Even if you've written these down on a form, remind your child's doctor, especially at the time he or she prescribes new medications. Adverse drug reactions can be very serious. Ask your nurse to leave medications in packets or to show you the packets so you may double-check it.
- Tell your doctor if you have given your child any other medications, including herbal or homeopathic medications, or drugstore items such as vitamins or over-the-counter medications. If you have any reason to suspect your child may be taking illegal drugs, please share this too (the information is protected). Any of these could cause dangerous interactions with drugs that caregivers might give your child.
- If a caregiver is prescribing a new medication for your child, learn its name, what it is used for, the dosage, possible side effects and what it looks like. This applies to intravenous (IV) medications, medications given by mouth, suppositories and creams.
- Double-check to make sure your child's exact weight and height is marked on the chart. Most medication doses given to children are calculated based on the child's weight, and some on both weight and height, so it is essential that these be marked accurately.
- Know what time of day your child is supposed to receive various medications so you can tell someone if the medications are late. Also, make sure different caregivers don't mistakenly repeat a medication after your child has already had a dose.
- Tell a nurse immediately if you notice your child having an unexpected reaction to a medication. Alert the nurse if your child reports any pain or burning sensation, shortness of breath, trouble breathing, dizziness, confusion, tightness in the chest, numbness, or itching after receiving medication.
The spread of germs is a major hazard in hospitals and is believed to cause thousands of infections every year.
- Monitor hand washing. Parents and child should wash their hands frequently, particularly after every trip to the bathroom or playroom, after visiting with other sick children, and before eating. Also watch that caregivers wash their hands before touching your child. Hands may be washed in the restrooms with warm water and soap or by using waterless cleansers from hand-wash dispensers, usually located throughout the floor and in each room.
- Alert the caregiver if bedclothes or linens become soiled.
- Ask friends and family who may have colds, respiratory infections or other infectious illnesses (such as flu, diarrhea, fever and rash) to not visit your child in the hospital. Minimize visits from young children who frequently carry germs that can infect others. Remind all visitors to wash their hands and use the disinfectant gel upon entering and leaving your child's room.
It is important to continue safe practices after your child is discharged from the hospital.
- Understand your child's treatment plan for going home, including any medications he or she will need to continue to take, how quickly the child may return to normal activities and what signs or symptoms require a quick call to the doctor. If you need to learn to do a special treatment for your child at home, make sure you practice it with your nurse until you are comfortable performing it.
- Bring home contact information. Make sure you have the phone numbers you should call if you have any questions following discharge.
- Ask when you should bring your child in for a follow-up visit.
Facts about Kentucky Children's Hospital
Kentucky Children's Hospital was established in 1997 and was renamed in 2005 to more clearly define its role as the hospital for all children of Kentucky. The building features children's play and activity rooms, expanded family consultation rooms, a family resource center, waiting rooms, conference rooms, and a pediatric staff library.
- KCH has 101 beds including a 44-bed inpatient center, a 50-bed Level IV neonatal intensive care unit, a 12-bed state-of-the-art pediatric intensive care unit and 11 beds for 23-hour admissions/observation.
- Inpatient admissions each year number about 5,500 with about 4,250 floor admissions, 570 PICU admissions, 720 NICU admissions and 1,610 admissions to the newborn nursery.
- UK Hospital/KCH was the 38th hospital in the nation to receive Magnet® designation, the nation's highest honor for excellence in nursing services, awarded by the American Nurses Credentialing Center of the American Nurses Association. Only 145 of the 7,569 hospitals in the nation have achieved this prestigious designation.
UK Hospital Health Information Library: 859-323-7808, Room C104, 1st Floor.
Hours 10 a.m. - 3 p.m.
UK HealthCare Web site: ukhealthcare.uky.edu
UK Health Connection information line: 859-257-1000
UK HealthCare Customer Service: 859-257-2178
Kentucky Children's Child Life Office: 859-323-6551
Kids Korner HealthSmart!
Safety tips for kids going to the hospital
Going to the hospital isn't much fun, but your doctor and parents have decided it's the best place for you to get help for your illness or injury. At least you'll meet some nice people and have some interesting experiences you can describe to your friends. While in the hospital, you and your family can help the doctors, nurses and other people who will be taking care of you.
Here are some things you can do to make sure you get the best care possible:
Wear identification and allergy bands or bracelets. When you first go to the hospital, you will get an identification bracelet that contains your name and some important information. This bracelet is called an ID band. It's how the people taking care of you can make sure they give you the right medicine or the right treatment. Make sure you keep this on your wrist or ankle all the time. If something happens to it, let the people taking care of you know right away and ask them to get you a new one.
Ask about tests and treatments. You may need to have tests or treatments while you're in the hospital. If you don't understand why someone is doing something, ask them to explain or ask your parents to help you find out what the test or treatment is supposed to do for you.
Ask about medicine. When the nurse gives you medicine to take, ask him or her what the medicine will do. If it's different from the pills you usually take, ask why. Sometimes medicine you take at home will look different from the same medicine at the hospital, but you should never be afraid to ask what it is or why it looks different.
Avoid infections. Wash your hands with warm water and soap whenever you visit the playroom or another child's room. You may also use the hand-wash gel that kills germs; it is in a container on the wall in your room. Clean your hands after you go to the bathroom and before you eat. If you are not able to get out of bed, ask the people taking care of you to help you wash your hands. If you can't get to a sink, ask for the hand-wash that you can use in your hospital bed.
Talk to the people who take care of you. If you're hurt or are uncomfortable or frightened, tell your nurse. He or she may be able to help you feel better. Try to do everything your nurse and doctors ask you to do, but if you are worried they are asking you to do something that doesn't seem right, speak up. Don't be afraid to ask questions; they won't be angry with you.
If you are still worried or don't understand their answers, talk to your parents. If you know a certain medication or food makes you sick, make sure you tell someone. If they forget and bring you that food or medicine, tell them they may have made a mistake.