Precautions and Protocols For Pediatric Acute Care By: Judi Smerilson, PT

What are the current protocols in pediatric acute care? What is the time frame post-op before a patient can be placed in sitting or prone? What are the precautions for orthopedic injuries? When are patients on contact precautions allowed out of their rooms with therapy?

How do we make sure all acute care staff are following the proper precautions and protocols? Where are the precautions and protocols posted? What format can we use to get the information to all staff so that it is easily accessible?

Who should determine the precautions and protocols? Doctors have specific protocols based on surgeries performed Nurse Practitioners are aware of protocols and precautions that the doctors want followed

Procedure There are currently no written guidelines for post surgical precautions and protocols. I gathered information from various doctors and nurse practitioners throughout the hospital to ensure that proper precautions and protocols were being followed. I compiled a chart that each therapist can carry with them to reference when needed.

Summary A chart was created that therapists could carry with them to look up precautions and protocols. References were included.

Procedure/condition Precautions Trach Placement Bedrest until first trach change Contact Isolation May leave the room with OT/PT. Gown and glove for pt when leaving room. Therapist should remove their gown and gloves when exiting the room. Pt should not touch environmental objects while participating in therapy outside the room. C-collarNo cervical flexion or twisting. No UE ROM restrictions as long as it does not affect cervical flexion, twisting or pain. G-tube PlacementProne when pt tolerates usually 2-3 days post op ensuring that g-tube is securely taped down Clavicle fracture-closed treatmentMovement as soon as pt tolerates usually 2 weeks post injury. Return to normal activities when pt can perform a push up pain free.

Clavicle fracture-surgical treatmentNo abduction or forward flexion above 90 degrees for 3 weeks PICC line No vigorous exercise with repetitive jerking motions. No weights above 10 pounds. Cystic Fibrosis Same as contact isolation but requires surgical mask to leave room. History of Cepacia can not leave the room. Droplet Precautions Pt needs to wear a surgical mask to leave the room Airborne Precautions Pt is unable to leave the room Lumbar PunctureMust lay flat for 2 hours post procedure

Cardiac CatheterizationMust lay flat for 6 hours post procedure Norwood and Glenn Cardiac Procedures Can be on abdomen when Dermabond comes off usually 7-14 days post-op. Can be placed in sitting when medically stable Heart Transplant Can be placed on abdomen when Dermabond comes off usually 7-14 days post-op. Can be placed in sitting when medically stable. Proceed to OOB when medically stable. Cardiac Surgery Shoulder ROM limited to 90 degrees flexion/abduction for 3 months, no lifting under the arms for 3 months, no lifting greater than 10 pounds, no pushing and no pulling for 3 months. No retrograde massage.

References Orthopedic protocols received via from Dr. Gregory Mencio, orthopedic surgeon Surgical Protocols received via from Amy Gann, ARNP General Surgery Trach Protocal received via from Kimberly Huffman, ARNP ENT Surgery Infection Control Protocols received via from Tracy Louis, ARNP Infection Control per CDC recommendations and Vanderbilt Policy PICC line protocol received via from Kathleen Polis, ARNP PICC Services Cardiac Protocols received via from Judy Berger, ARNP Cardiac Surgery and verbally from Dr. Debra Dodd, cardiac surgeon Cardiac Catheterization Protocol received verbally from Dr. Debra Dodd, cardiac surgeon Lumbar Puncture Protocol received verbally from Dr. Avery Mixon, oncology

Assessment In reviewing current operating procedures all staff were not aware of all precautions and protocols. There was no written reference for specific surgical protocols. I developed a tool that could be used and accessed by all acute care therapists.

Recommendation and Plan All acute care therapists will be provided with a copy of the chart of precautions and protocols for easy reference. A copy will be placed in the Acute Care Orientation Manual.