BC Children’s Hospital is in a very nice suburb of Vancouver and is due for a total overhaul as a new hospital is being built just nearby to replace the current one which should be ready in 2017. The PICU should see a big change when they move as they will be going from open bays with a few side room to only single rooms. It is a mixed cardiac and med/surg ICU with a smaller transitional care unit attached.
Family centred care is a clear part of practice in the PICU here. I met the family advisor for the hospital who has been working closely with the unit. Her role is to help bridge the gap between the families and the hospital, support families and to ensure the family voice is heard throughout the hospital, including getting parent advisors involved in decision making. She has also been getting parents in to help with educating staff on FCC, by telling their stories, both the highs and lows s this really helps staff understand the importance of good FCC. She has been working with the PICU ward manager to look at creating family satisfaction questionnaires and how improve the family areas in the unit.
I was also lucky enough to talk to the mother of one of the patients on the unit (who gave me consent to publish her comments anonymously). She was complimentary of the nursing staff, saying that they had all been very supportive and that they had been taken care of almost as much as their child. She had particularly appreciated the support of the social worker who came and checked in with them every day, providing both emotional and practical support and had been very helpful in sorting out paperwork to help her husband get time off work. She was also appreciative of being given time on ward round to give her opinion and ask questions. Her one criticism however, was the number of people who came into the bed space looked at her child and gave her information without actually telling her who they were or what their role was. The child was being seen by several different services so the parents were meeting too many people to be expected to remember everyone and was always uncertain what to do with the information they was given when they didn’t know what perspective it was coming from.
The social worker felt one of her main strengths was working out what the real concerns were for the family and working with them from there, however big or small. She also does a lot of work containing and managing family dynamics. She always tries to be present with the family for bad news so she can help them understand what the situation is afterwards and she liases with the organ donation team. Lots of families stay in touch with her after their discharge, whether their child has survived or died, sometimes just for advice or to update her, others get in contact if they aren’t coping well and she provides support. She also tries to follow the families through the hospital where possible, the families always appreciate the continuity where possible, otherwise she will give a thorough hand over to the ward social worker.
The unit is also doing some very interesting work surrounding patient safety. One of the senior nurses is running a program called Patient View. This is where she, or trained volunteers, visit families 24/48 hours post discharge from PICU and/or 24/48 hours pre hospital discharge. If the child is able, they will ask them, otherwise they talk to the caregivers, and give them examples of safety events, such as a medication error or equipment failure and ask them if anything like this happened to them during their admission from one of the following categories – staff-staff communication, staff- family communication, complication of care, medication or equipment. They listen to the families and extend an apology if something negative has happened. They also ask the families what they think is working and if they noticed anything that the staff did to promote their child’s safety. In doing this, they have identified some trends and issues and have put intervention in place to prevent reoccurrence. They have also received some really positive feedback from families who are grateful to be given the opportunity to talk about these things and to be listened to.