REACHing All Kids

Nemours Children’s Hospital Orlando soothes the ED experience for patients with autism

For any parent, a trip to the emergency department is a harrowing experience. For parents of children on the autism spectrum, it is even more nerve-wracking. Even a basic visit can be fraught with anxiety.

Cara Harwell, ARNP, CPNP, PMHS, emergency department nurse practitioner at Nemours Children’s Hospital Orlando, explained, “A lot of emergency rooms can be quite crowded and loud. Sometimes the seats are uncomfortable. Unfortunately, you have long waits, and that can be one of the biggest challenges for kids with autism.” The brightly colored walls of the emergency department at Nemours Children’s, which were designed to be attractive to children, can be overstimulating to those on the autism spectrum.

Children with autism often have sensory processing issues and are sometimes averse to the texture of the hospital gowns and the feel of the wristband IDs. Between the noise of the other patients and the beeping monitors and strangers coming in and out to examine the kids, the ED can send some young patients into a frenzy.

Proactive Communication

“We needed to do something different to make it easier for them,” Harwell said. The hospital developed REACH-Respecting Each Awesome Child Here-to create a better experience for kids on the autism spectrum and with various developmental delays. Harwell presented to the nursing staff on autism and how to care for such patients in the ED.

“The nurses really took the concept and ran with it,” she recalled.

The main thing the nurse can do is communicate with the family, Harwell explained. Nurses ask the parents what past experiences in the emergency department were like and find out the child’s likes and dislikes.

The nurses write REACH on the patient track board, which is visible to everyone. A REACH sign is also placed on the patient room door as an indication that staff members should approach the child gently and consult the nursing staff or child life team with any questions. Nurses should be hypervigiliant about sensory experiences by responding to alarms quickly and removing blood pressure cuffs as soon as possible.

Sensory Processing Solutions

Emily Bradley and Cara Harwell display some of the sensory equipment used in the autism-friendly ED at Nemours Children's Hospital Orlando. Photo courtesy Nemours
Emily Bradley and Cara Harwell display some of the sensory equipment used in the autism-friendly ED at Nemours Children’s Hospital Orlando. Photo courtesy Nemours

“Just slowing down is a big part,” Harwell explained. Talking to them and providing distraction objects is beneficial. To that end, a box of sensory objects is positioned at the nurses’ station. It includes items such as noise-cancelling headphones, weighted lap pads and sensory balls.

The Child Life team is a key collaborator in REACH. Emily Bradley, MA, CCLS, certified child life specialist, explained, “We empower all staff to make sure it’s a good experience.” Together with the nurses and the families, they create a coping plan for upcoming procedures so that everyone is on the same page.

“The best thing a parent can do is prepare the child,” Harwell said. Bringing familiar objects from home can go a long way in soothing the anxious child. Most importantly, if the parents remain calm, the child is more likely to remain calm.

Once they recognize its importance, hospitals don’t need a lot of funds to start autism-friendly projects. Screening all patients for autism and developmental delays upon admittance to the ED, then communicating that knowledge to fellow staff, is both the first and most important step in creating an autism-friendly ED.

The emergency department is a scary place for anyone. With a little help and attention, the experience can be less frightening for vulnerable children and their parents.