Children's Hospitals Today - Fall 2024 - 16

FEATURE / IMPROVEMENT
team created the BMSCH Emotional
Harm Severity Scale, defining four
levels of harm.
A rating of one represents severe emotional
harm while four indicates no apparent
harm. " It is a self-developed scale,
but it is grounded in child development
and family systems theory, " Romito said.
Previously, safety events received
only a physical harm classification.
In January 2022, the hospital began
something larger, " Romito said.
For instance, the team found that a
labeling inconsistency requiring a second
blood draw from patients was the
root cause for an increase in moderate
emotional harm reports. " We addressed
the issue and significantly decreased
the number of moderate emotional
safety events, " Handel said.
The BMSCH Emotional Harm Severity
Scale is being studied for validity. In the
There is a theory that emotional harm has more of an impact on
patients and their families than physical harm. -Barbara Romito
classifying emotional harm events as
well. Physical and emotional events
sometimes mirror one another, but often
there's no connection. For example,
a patient did not experience physical
harm due to slower-than-normal lab
results, but the delay may have caused
emotional harm.
Romito said staff are increasingly
reporting
emotional
harm events
without any associated physical harm.
" We're proud because people are really
understanding events can potentially
cause no physical harm but can have
severe emotional harm. "
Brandi Handel, MSN-FNP,
meantime, the hospital continues to
make emotional safety a focus.
" We've really seen it emerge as a value
for BMSCH, " Romito said. " Everyone
owns physical safety. Everyone owns
emotional safety. That's the care we expect
for our patients and families. "
director
of children's hospital outcomes at
BMSCH, said the hospital's safety event
classification system helps identify areas
for improvement. " Every month, a
multidisciplinary committee made up
of nursing directors, medical directors,
educators,
child life specialists, administrators,
and pharmacy staff talk
through each safety event. We come
to consensus on classifying both the
physical and emotional harm of these
events, " Handel said.
After classification, the team considers
how to address the harm. " Everyone
is accountable to know what harm
happened to that patient and to take
care of it, whether it's a conversation,
an apology, a child life intervention, or
Hitting the bullseye
No two days look the same for music
therapists at children's hospitals. The
modality encompasses much more
than playing music in a patient's room,
which makes it difficult to create productivity
targets.
During any given week, a therapist
may play music to calm an anxious child
or comfort a drug-exposed newborn.
They may spend hours writing a song
for the family of a patient in hospice
care or incorporating the heartbeat of
a child having an organ transplant into
a song. The neurology team can utilize
music therapy treatments to induce
brain plasticity, resulting in cognitive,
motor, speech, language, and sensory
improvements following a neurologic
injury; others may use music to help
children develop gross motor skills.
Despite the diversity of tasks, leaders
of the music therapy department
at Kentucky Children's Hospital sought
to create a productivity target for the
team. " We suspected we should be
touching more patients and needed a
way to gauge productivity, " said Kelsey
Rahenkamp, a clinical administrator
who assumed leadership of the department
in 2023.
Identifying a target required research
and observation. " It was really
complex trying to figure out the level of
work involved, especially since there's
a good deal behind the scenes that supports
hands-on patient interactions, "
said Amanda Biddle, practice manager.
Biddle and Rahenkamp started by
looking at benchmarks for modalities
like physical and occupational therapy.
The pair also looked to a workforce
analysis created by the American Music
Therapist Association and had one-onone
conversations with music therapists
to better understand their work.
" We did a pretty extensive time study
where someone shadowed therapists
for full shifts. They tracked their time
in the room and average session length
and identified the things that might
require time outside of time with patients, "
Biddle said.
That information laid the groundwork
for a target. Tracking the productivity
measures was another matter.
The team initially used a simple Excel
file but went on a " lengthy journey "
to find a way to pull some tracking
information from the Epic EHR. Music
therapists track individual, group, and
attempted sessions, each with different
weights. Administrators pull each therapist's
totals from Epic and calculate a
weighted number. Unblinded scores are
shared with the team.
Managing the change in expectations
was difficult, but worthwhile.
" There were some really tough conversations,
and we had to balance being
sensitive to the team's needs while
pushing for progress, " Rahenkamp said.
" Six months later, the data has shown
we have a bigger impact on our patients
with the same number of FTEs, and
therapists recognize they have more
autonomy in their schedules. "
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CHILDREN'S HOSPITALS TODAY Fall 2024
Children's Hospitals Today - Fall 2024

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