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## Complete Summary

#### GUIDELINE TITLE

Facilities and equipment for the care of pediatric patients in a
community hospital.

#### BIBLIOGRAPHIC SOURCE(S)

Sigrest TD. Facilities and equipment for the care of pediatric patients
in a community hospital. Pediatrics 2003 May;111(5 Pt 1):1120-2. \[7
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12728103)

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Facilities and equipment for
care of pediatric patients in a community hospital. Pediatrics. 1998 Jun
1;101(6):1089.

AAP Policies are reviewed every 3 years by the authoring body, at which
time a recommendation is made that the policy be retired, revised, or
reaffirmed without change. Until the Board of Directors approves a
revision or reaffirmation, or retires a statement, the current policy
remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Pediatric diseases or conditions resulting in community hospitalization

#### GUIDELINE CATEGORY

Diagnosis\
Management\
Treatment

#### CLINICAL SPECIALTY

Pediatrics

#### INTENDED USERS

Hospitals\
Nurses\
Occupational Therapists\
Pharmacists\
Physical Therapists\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Respiratory Care Practitioners\
Social Workers\
Speech-Language Pathologists

#### GUIDELINE OBJECTIVE(S)

To provide guidelines for the basic facilities and equipment needed to
adequately care for children in community hospitals with the realization
that there are significant budgetary constraints to be acknowledged in
the provision of these services

#### TARGET POPULATION

Pediatric patients from birth to 18 years of age in a community hospital

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Provision of basic facilities including single- or double-occupancy
    rooms, age-appropriate furniture such as cribs, area for play and
    other child activities, separate treatment room for patient
    assessment and procedures

2.  Provision of essential medical equipment including resuscitation
    cart containing pediatric-specific supplies, intravenous catheters,
    phlebotomy equipment, and lumbar puncture trays of appropriate size,
    common neonatal and pediatric intravenous solutions, scales,
    pediatric-appropriate dietary supplies. (For more details on
    equipment refer to the original guideline document)

3.  Provision of support services including routine radiograph imaging,
    computed tomography, clinical laboratory services appropriate for
    neonatal and pediatric needs, pharmacy services with age- and
    size-appropriate drug administration and dosing. (For more
    information on support services refer to the original guideline
    document)

4.  Continuing education of all health care professionals in a pediatric
    area

5.  Establishment of referral network

6.  Establishment of admission and transfer criteria

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not applicable

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**The Facility**

In addition to recommendations of the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) for facilities used in the provision
of care to hospitalized patients, the following is a list of basic
facility needs for the care of children from birth to 18 years of age:

-   Single- or double-occupancy rooms that comply with guidelines for
    prevention of nosocomial infections and that are large enough to
    accommodate parents who stay with their children.

-   Patient room configuration and bed positioning that allow convenient
    observation and supervision of patients by nursing staff, especially
    if parents are not available.

-   Covered electrical outlets, childproof window locks and door
    latches, padding of sharp edges, and nonslip, easily maintained
    floor surfaces.

-   Age-appropriate furniture, including cribs equipped with safe
    overhead restraints and beds with covered mechanical or electrical
    controls.\
    Beds, cribs, and other furniture should meet Consumer Product Safety
    Commission standards ([www.cpsc.gov](http://www.cpsc.gov/)).

-   Area set aside for play, entertainment, education, and other child
    life activities.

-   Separate treatment room for patient assessment and procedures.

Interior design and decor are not addressed in this statement.
Information about child-friendly, developmentally appropriate
environments may be obtained from the Institute for Family-Centered Care
(see \"Resources\" section).

**Equipment**

Essential medical equipment for pediatric care is included in the
following list. Additional information on pediatric resuscitation
equipment is included in the AAP policy statement \"Guidelines for
Pediatric Emergency Care Facilities\" and in standard pediatric
emergency care textbooks.

-   Resuscitation cart containing pediatric-specific supplies:

    -   Common pediatric emergency drugs should be readily accessible
        and plainly labeled. Drug dosing by weight or length should be
        easily referenced.

    -   The resuscitation cart should also have an appropriate
        assortment of the various sizes of pediatric oxygen masks,
        endotracheal tubes, laryngoscope blades, oropharyngeal and
        nasopharyngeal airways, and self-inflating bags (ie, Ambu bags
        \[Ambu International, Linthicum, MD\]) with various sizes of
        masks. A size-appropriate backboard for resuscitation should be
        available.

        -   A cardiac defibrillator designed for pediatric use with
            paddles for infants and children.\
            A chart for appropriate joule dosages for weight should be
            readily available.

        -   Cardiorespiratory monitors appropriate for the level of
            pediatric care provided.

        -   Respiratory equipment in appropriate sizes for infants and
            children.\
            Necessary items include oxygen masks, nasal cannulas,
            tubing, self-inflating (Ambu) bags and masks, oropharyngeal
            and nasopharyngeal airways, suctioning equipment and
            catheters, nebulizers with pediatric-sized face masks,
            spacer devices and masks for metered-dose inhalers, pulse
            oximeters with appropriate infant and pediatric probes, and
            infant and pediatric tracheostomy supplies.

-   Intravenous catheters, phlebotomy equipment, and lumbar puncture
    trays that are size appropriate; extremity warmers, such as chemical
    packs that warm via exothermic reaction, for improving peripheral
    blood flow and facilitating blood sampling in infants; papoose
    boards, adequately padded, of at least 2 sizes for immobilization of
    infants and children.

-   Common neonatal and pediatric intravenous solutions, such as small
    vials of 10% dextrose, 100 and 250 mL bags of common pediatric
    intravenous solutions such as 5% dextrose with one-half normal
    saline or lactated Ringer\'s solution, 5% dextrose with one-quarter
    normal saline or lactated Ringer\'s solution, and intravenous
    infusion pumps designed for pediatric use with precise
    administration of small infusion rates.

-   Scales and stadiometers for infants and older children.

-   Pediatric-appropriate dietary supplies, such as common newborn
    formulas, pediatric nutritional supplements, and dietary choices
    that appeal to children; appropriately sized assortment of
    orogastric and nasogastric feeding tubes and enteral feeding pumps
    designed for precise administration of small infusion rates.

-   Pediatric urine collection devices and appropriately sized urinary
    catheters.

-   Mercury-free thermometers and blood pressure devices (various sizes
    of blood pressure cuffs).

-   Pediatric orthopedic equipment, including wheelchairs, crutches,
    slings, and splints.

-   Infant incubators for small infants with temperature control
    problems.

-   Portable lamps for bedside procedures.

-   Developmentally appropriate books, toys, games, and when
    economically feasible, electronic media such as videocassette
    players and computers.

    -   Toys and equipment should be safe for use by children with
        impaired mobility.

    -   Infection control should be a priority, with all toys,
        equipment, and play surfaces regularly cleaned with appropriate
        germicidal solutions.

    -   Computers that are available for pediatric patient use should
        have Internet access limited to child-appropriate sites.

**Support Services**

The following therapeutic and diagnostic facilities should be available
on a 24-hour basis:

-   Routine radiograph imaging, with a radiologist available for reading
    of emergency films.

    -   Availability of computed tomography is strongly recommended.

-   Clinical laboratory services appropriate for neonatal and pediatric
    needs, including hematologic profiles, blood chemistries, blood gas
    studies, microbiologic profiles, and standard urine studies.

    -   Equipment should be available to process all commonly ordered
        tests such as complete blood cell counts and renal and hepatic
        function tests using samples of less than 1 mL (\"micro\"
        samples).

    -   Minimum amounts of blood, urine, and cerebrospinal fluid
        required for tests should be obtained and posted in the hospital
        laboratory and pediatric areas.

    -   Response times should be appropriate for timely diagnosis and
        treatment of the child\'s condition.

    -   Topical anesthetics should be available and used before
        obtaining blood samples whenever possible.

-   Pharmacy services providing age- and size-appropriate drug
    administration and dosing.

    -   Commonly used oral suspensions should be immediately available.
        The equipment necessary to create pediatric liquid formulations,
        including pill crushers, suspension agents, and flavoring
        solutions, should be available. Pediatric oral suspension
        delivery devices, such as oral medication syringes and pacifiers
        that deliver liquid medications, should be available.

    -   Doses of antibiotics that are known to cause ototoxicity or
        nephrotoxicity, such as vancomycin, tobramycin, and gentamycin,
        should be calculated using computer programs or calculations
        based on appropriate neonatal or pediatric pharmacokinetic
        models. Serum drug concentrations should be obtained to optimize
        dosage amounts and intervals. Clinical judgment should be used
        before ordering multiple serum concentrations if the antibiotic
        is to be discontinued with negative cultures or oral antibiotics
        are to be started as soon as the patient is afebrile.

    -   Current references for pediatric drug dosing and drug
        interactions should be easily available. A liaison with a
        tertiary care children\'s hospital pharmacy is advised to help
        minimize the possibility of adverse consequences in off-label
        use of drugs and drug dosing.

The following services should be available as needed: social work
services; pastoral services; sign and foreign language interpretation;
and respiratory, physical, occupational, and speech therapy.
Professionals providing these services should have adequate training and
continuing education provided in the pediatric applications of their
respective fields. If a child is hospitalized for more than 2 school
days, a designated hospital employee, such as nurse, social worker, or
child life specialist, should serve as a liaison with the child\'s
school to assist the parents in providing for the child\'s educational
needs.

Child life services are recommended whenever feasible. These specialists
provide a valuable service in addressing the psychosocial concerns of
children and families during hospitalization and provide support for the
concept of family-centered care in the medical setting.

**Continuing Education**

All health care professionals in a pediatric area should be familiar
with the unique and changing physical and psychosocial needs of
children. Continuing education should be provided to reinforce these
concepts. Nurses and physicians should have current certification in
pediatric life support techniques. All should know the location of carts
and equipment for cardiopulmonary resuscitation and mock codes should be
conducted on a regular basis. Instruction on the use of
cardiorespiratory monitors and their alarms should be provided on an
ongoing basis. If patients are provided with monitors that feature
electrocardiogram readouts, appropriate training should be provided.
Education sessions and mock codes should be documented for review by
hospital quality assurance committees and the JCAHO.

**Referral Networks**

Community hospitals and physicians providing care for children must have
well-established referral networks for timely consultation by pediatric
subspecialists and, when necessary, for transfer of patients to a
pediatric center that offers more advanced levels of care. This includes
access to an air and ground transportation system that is responsive and
appropriately equipped and staffed to care for children of all ages.
Guidelines for regionalization of care and transfer of injured patients
have been published by the American Academy of Pediatrics (AAP) and the
American College of Surgeons.

**Admission and Transfer Criteria**

Because community hospitals vary significantly in their resources for
providing pediatric care, there is no single set of criteria for
admission and transfer of pediatric patients that has universal
applicability. Each institution must assess its own capabilities and
limitations in light of its mission and then formulate guidelines. Once
guidelines for transfer of patients have been established, those for
admission become less difficult to define. This challenging process
requires input from all members of the health care team, including
hospital administration. The goal is to ensure that each patient in the
facility receives the optimal care that is most appropriate for his or
her medical and psychosocial needs.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate facilities, equipment, and conditions for the care of
pediatric patients in community hospitals

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in the guideline does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Sigrest TD. Facilities and equipment for the care of pediatric patients
in a community hospital. Pediatrics 2003 May;111(5 Pt 1):1120-2. \[7
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12728103)

#### ADAPTATION

Not applicable: Guideline was not adapted from another source.

#### DATE RELEASED

2003 May

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Hospital Care

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Members of the Committee on Hospital Care, 2002-2003*: John M. Neff, MD
(Chairperson); Jerrold M. Eichner, MD; David R. Hardy, MD; Michael
Klein, MD; Jack M. Percelay, MD, MPH; Ted D. Sigrest, MD; Erin R.
Stucky, MD;

*Liaisons*: Susan Dull, RN, MSN, MBA (National Association of
Children\'s Hospitals and Related Institutions); Mary T. Perkins, RN,
DNSc (American Hospital Association); Jerriann M. Wilson, CCLS, MEd
(Child Life Council)

*Consultant*: Timothy E. Corden, MD

*Staff*: Sephanie Mucha, MPH

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Facilities and equipment for
care of pediatric patients in a community hospital. Pediatrics. 1998 Jun
1;101(6):1089.

AAP Policies are reviewed every 3 years by the authoring body, at which
time a recommendation is made that the policy be retired, revised, or
reaffirmed without change. Until the Board of Directors approves a
revision or reaffirmation, or retires a statement, the current policy
remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/5/1120).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on December 11, 2003. The information
was verified by the guideline developer on February 5, 2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008