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Parents/Support Person Present with Child at Induction of Anesthesia (1.15)

Parents/Support Person Present with Child at Induction of Anesthesia (1.15) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Administrative

1.15

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

March 1992
ORIGINAL
 REVISION

April 2016
PAGE 1
OF 4
POLICY #

1.15
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
PARENTS/SUPPORT PERSON PRESENT WITH CHILD AT
INDUCTION AND IN RECOVERY PHASE OF ANESTHESIA



I. PURPOSE

To provide a guideline that allows a pediatric patient’s support person (includes parent, guardian, other family
member, or another person) to support the child during induction of anesthesia. All patients under 18 and over
the age of 6 months are identified and Child Life contacted about possible “parental” presence at induction of
anesthesia (PPI) for the inpatient operating rooms and non-O.R. locations.

II. POLICY

Ideally, a calm, comforting environment should be provided for pediatric patients and their family. The patient
and family may, if it does not place the child at increased risk, participate in their surgical experience. The goal
is to reduce stress caused by separation anxiety and an unfamiliar environment. When appropriate, PPI is
permitted. However, this is not an “invitation”, nor a requirement.

III. PROCEDURE

A. Confirm with faculty anesthesiologist that the child’s support person (as defined in purpose statement)
wishes to be present during induction of anesthesia. Assess appropriateness of his/her attendance at
induction of anesthesia.

Cases with anticipated difficult airway or medical conditions that preclude PPI are determined by
faculty anesthesiologist. Children less than 6 months old are unlikely to have separation anxiety. In
these cases, PPI is for the parent’s benefit. Surgical Services and/or Child Life should not promise
PPI until discussed with anesthesiologist.
1. Possible contraindications for PPI include:
a. Child’s medical condition, age, or difficult airway: issues are determined by faculty
anesthesiologist.
b. Support person unable to tolerate viewing medical procedures or environment.
c. Known infections/illness of support person.
d. Support person not able to attend induction due to presence of patient’s siblings without other
caregivers.
2. Surgical and Anesthesiology personnel must be informed of support person’s presence at the
induction room.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

March 1992
ORIGINAL
 REVISION

April 2016
PAGE 2
OF 4
POLICY #

1.15
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
PARENTS/SUPPORT PERSON PRESENT WITH CHILD AT
INDUCTION AND IN RECOVERY PHASE OF ANESTHESIA



B. Educate/orient support person about what to expect at PPI, brief orientation to room, their role in the
OR and proper time to be escorted out. This will be performed prior to the child entering the OR.

A calm and quiet environment is essential during anesthesia induction. Support person may not use
their cell phone or camera when accompanying their child back to the operating room. Unnecessary
conversations by surgical or other personnel should be postponed until the child is anesthetized. Avoid
loud noises, such as pagers, phone ringers, and equipment rattling.
1. Educate/orient support person with verbal and written explanations about what to expect at
induction. Include information on transportation to the induction room, positioning of child and
support person, and monitoring and equipment. Inform support person about expected events during
induction of anesthesia: restlessness followed by sedation, irregular breathing, possible movement
during “Stage II”, and appearance of child as asleep or “limp”.
2. Nursing staff will provide support person with access to written documentation on “Information
for Parents About Anesthesia for Your Children” during admission process.
3 Educate/orient support person about equipment, alarms, and sounds often heard in induction room.
4. Support person’s role at induction is to provide reassurance to child. This may include talking,
touching, or other comfort measures.
C. Street attire worn by parent must be covered in restricted areas in order to maintain an aseptic/sterile
environment. Scalp hair should be covered by a cap. Parents street clothes will be entirely covered by
disposable attire including shoe covers.. Masks are required.
D. A Child Life representative or a member of the nursing staff is required for a support person to be
present at induction.
1. Child Life and/or RN, ORSA, or NA is responsible for escorting the support person.
2. The escort will be in attendance during the anesthesia induction. She/he will facilitate proper
positioning of the parent and child and provide assistance to the anesthesia team.
3. A Child Life representative or a member of the nursing staff is required for a support person to be
present at induction.
E. The pediatric patient may walk to the induction room (if not premedicated) or be transported by cart,
crib, wagon, or carried by family or medical personnel.
1. If not premedicated, pediatric patients may choose to walk to the induction room. Otherwise, they
may arrive in a cart, wagon, crib, or they may choose to be carried by family or medical personnel.

F. Pre-induction, the child may be positioned on a table/bed or held by the support person. The
anesthesiologist determines the positioning of the child during induction. If the child is to be held
during the induction, a stable chair should be provided for the support person.
1. During the pre-induction period the safety of the support person and child should be foremost.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

March 1992
ORIGINAL
 REVISION

April 2016
PAGE 3
OF 4
POLICY #

1.15
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
PARENTS/SUPPORT PERSON PRESENT WITH CHILD AT
INDUCTION AND IN RECOVERY PHASE OF ANESTHESIA


2. A chair may be provided for the support person. (The anesthesiologist decides if the child should
be held or be placed on the bed during induction.)
3. The position of the child during induction should provide comfort, security, and safe airway
management.
G. In case of difficult induction or unexpected change in patient condition, the support person should be
expeditiously escorted out of the induction room. When the child is stable, medical personnel should
inform the family about the child’s condition.
1.- In case of an unexpected adverse change in the child’s condition, the support person should be
expeditiously escorted out (during difficult situations, medical personnel provide the best care
when not distracted) of the room by medical staff and, as soon as possible, provided with
information and support.
H. The support person should be escorted back to the child’s room, preoperative preparation area, or
surgical waiting area after the patient is anesthetized, or at the order of the faculty anesthesiologist.
Family should be informed about the estimated length of procedure, given information about the
child’s condition and what events to expect.
1. The support person should usually be escorted out of the induction room before invasive
procedures are initiated. Medical personnel should provide comfort, answers to questions and
concerns, reassurance regarding the child’s condition, and estimates of procedure’s duration.
2. - Family should be informed that one or two support persons may be allowed at their child’s side
when she/he is stable in PACU. .
I. Family (includes parents, guardians, other family member, or other support persons) should be
informed about the child’s condition if the operative procedure is longer than anticipated.
1. The circulating nurse should inform appropriate medical staff about any procedural delays or
problems. Medical personnel should then inform and reassure the family.
J. PACU staff should be informed that the child’s 2 support persons desire to be present in the PACU
during Stage I recovery. All patients under 18 are identified and Child Life should be contacted to
prepare support persons for the PACU.
1. Inform PACU staff that support persons wish to be present during recovery in the PACU.
2. PACU staff or Child Life Specialist should notify support persons when they can visit the patient
in the PACU. A Child Life Specialist or medical personnel should escort the family to the PACU
3. Two support persons may be allowed to be with the child in the PACU if the child is stable, or at the
discretion of the faculty anesthesiologist.






UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

March 1992
ORIGINAL
 REVISION

April 2016
PAGE 4
OF 4
POLICY #

1.15
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
PARENTS/SUPPORT PERSON PRESENT WITH CHILD AT
INDUCTION AND IN RECOVERY PHASE OF ANESTHESIA



REVIEWED BY

Policy and Procedure Committee 4/16
Julie Auenson, Child Life Services Manager AFCH 4/16
Deborah Rusy MD, Director of Perioperative Services – AFCH 4/2016
Christopher Turner, MD, Director of Perioperative Services, 4/16
Sandy Schoenmann, Interim Director of Surgical Services, 4/16

SIGNED BY
Cathy Madsen, Director
Surgical Services Department AFCH