Don’t worry, this won’t hurt, “Ouch-less ED” has pain-free pediatric emergency care as its goal

Michelle Tracy, RN, MA, CEN Assistant Vice President of Nursing, Emergency and Trauma Services

Ouch! A small but instantly understandable word, used when we experience sudden pain such as with a bee sting or when we stub a toe.

In the Emergency Department (ED) where I work, we typically hear it from kids when we have to administer pain medication or when we’re treating a burn, fracture or a cut. Emergency care can be scary, and many times painful, for children, and parents, too.

It doesn’t have to be that way, however. Specialized equipment and supplies, medication tailored to children, a staff trained in pediatric emergency care, a kid-friendly environment — all are now part of the standards for pediatric emergency care and have resulted in “ouch-less” EDs in hospitals across the country.

This kind of sensitive care, tailored to the whole child, and taking in the needs and feelings of parents, has been a dream and a goal of mine for some time. It began when my daughter and I were severely injured in a car accident in 1992, in Rochester, New York. Assuming I was somehow at fault, the staff and even the physician treated me badly, offering me no sympathy or access to her even though my daughter had suffered a brain injury and wasn’t expected to make it through the night. Later exonerated and my daughter safely out of the hospital and into rehab, I decided to put my anger to positive use.

I was working as a pediatric nurse at a hospital in New York and transferred to the Emergency Department team. I wanted to find ways to ensure the ED experience would be more positive for children and their families. I became an advocate for parents and pediatric care, focusing on brain injuries and their aftermath. My advocacy resulted in many changes in pediatric care, especially pediatric emergency care.

In 2012, I moved to Marin County and started working at Marin General Hospital as the Director of the Emergency Department, a job I dearly love. I didn’t leave my vision for pediatric emergency care back on the East Coast, and recently I have been fortunate to be joined by two wonderful women, and an organization open to new and innovative approaches to care in our community. One is Cathy Taylor, a mom who proposed changes in ED care to the Marin General Hospital Board of Directors after experiencing a mother’s typical anxiety when bringing her own child in for care. Cathy also reached out to me with an offer to help make our ED an “ouch-less” ED. The other woman is a Marin General Hospital Board Member, Andrea Schultz, who heard about the project and provided the seed money for training, supplies and equipment through the Schultz Foundation..

With their help and the support of Marin General leadership, I am pleased to announce that in November of this year, Marin General Hospital’s Emergency Department will have established the only “ouch-less ED” in our area, offering the families of Marin County a standard of pediatric emergency care as recommended by the American Academy of Pediatrics and the Joint Commission. Within 1-2 years, we expect to be EDAP certified (Emergency Department Approved for Pediatrics) by the county of Marin.

The goal of an “ouch-less ED” is to provide family centric care and minimize the pain and anxiety children typically feel when coming to the ED as much as possible. Our nurses have undergone a four-hour training course in pediatric emergency care with help from the experts at UCSF Benioff Children’s Hospital. All staff have gone through special sensitivity training in order to be prepared for the special needs of children and families during an emergency. We will offer new medications and equipment to administer pain medications. Medical carts will be stocked with color coded supplies and equipment to correspond to the child’s size and stage of development. Pediatric patients will have 3 dedicated, cheerfully decorated rooms. The Emergency Department will be supplied with distractions to help engage the child in fun activities, shifting his/her focus away from the treatment. These include iPads to play games, dolls, including “medi-dolls” used to teach the child about an upcoming procedure, books and other toys. Parent participation will be encouraged.

As an emergency nurse, I am often called upon to talk with families, some often hysterical, about the crisis they are experiencing. Some tell me, “You can’t imagine what I’m going through.”

The truth is, I can. “I’ve been in your shoes,” I say as I recount my ordeal and how my daughter’s injury has affected our lives even to this day. I want to make sure that what happened to me never happens to any other parent. I am confident that with the “ouch-less ED” now in full swing at Marin General Hospital’s ED, we will be able to deliver the best of care to parents and children in our community and genuinely be able to say “don’t worry, this won’t hurt.”