Hospital Play Service can Decrease Sedation Use for Children Undergoing Echocardiography in Tseung Kwan O Hospital

Abstract Description

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Authors (including presenting author) :

Ng HY1 Law VYH1 Chui T2 Kong P2 Tse FSY3 Lui MMW1 Chan LTW1

Affiliation :

1 Department of Paediatrics & Adolescent Medicine, Tseung Kwan O Hospital 2 Playright Children’s Play Association 3 Electrographic Diagnostic Unit, Tseung Kwan O Hospital

Introduction :

Children may present with signs and symptoms suggestive of acquired or congenital heart disease. Echocardiography is a crucial evaluation tool. Most local units or overseas paediatric echocardiography laboratories require sedation in infants and young children for adequate examination. Chloral hydrate has been the medication of choice because of its low cost and high safety profile. However, it is not without risk and it may fail too. Some parents are also skeptical about the sedative drug. Recent researches showed therapeutic play can help children cope better and be positive in the medical procedure.

Objectives :

A CQI initiative was developed by a multidisciplinary team comprising paediatricians, nurses and hospital play specialists (HPS) aiming at reducing the use of sedation (chloral hydrate) in young children (below 5-year-old) who underwent echocardiography.

Methodology :

HPS designed therapeutic play activities and playful reward scheme for preparing children and parents for echocardiography. Using child-friendly pamphlets and medical play tools, children could have better psychological preparation. During the scan, HPS would accompany the children, using distraction technique, toys, music, sound machine, cartoon to alleviate anxiety. Small rewards were offered to them as positive experience. Moreover, the echocardiography laboratory was refurnished to become child-friendly using cartoons decoration. Administrative arrangement was also modified to allow longer scanning time and higher priority for young children. Parents were fully informed of our HPS service and were given written information for appropriate clothing and accessories needed (toys/ pacifier / milk / nappies etc.)

Result & Outcome :

The use of chloral hydrate markedly reduced from 100 episodes a year (2011/12) to zero episode (2017/18). All parents appreciated this change in practice and the workload of nursing staff was also reduced as there was no longer a need for post-sedation monitoring. Conclusion Hospital Play Service successfully decreased the use of sedation for children undergoing echocardiography in Tseung Kwan O Hospital. This multidisciplinary service model involving paediatricians, nurses and HPS could reduce the fear and anxiety experienced by the sick children. Responses from parents and health-care providers were all positive. Risk related to sedation was reduced to zero. HPS should be promulgated among local hospital paediatric service.