By Lisa A. Clark, MSN, RN, PCCN
There is a saying frequently heard about autism: “If you have met a person with autism, that’s all you have done is met one person.”
Realizing that each autistic person having surgery at the Asheville Surgery Center (ASC) needs individualized care, a multidisciplinary team recently implemented the evidence-based Linked Program.
Nurses, anesthesiologists, registration staff, Child Life Specialists and Certified Nurse Anesthetists collaborate to reduce stress and anxiety for autistic children and their families/caregivers, when surgery is required. The Linked Program implements strategies to improve the entire process from scheduling, registration, preparation, recovery, discharge and follow up.
The strategies assist autistic children in their lifelong challenges with social communication and the way they make sense of their environment. Our perioperative areas intensify the great difficulty experienced by those with autism spectrum disorders (ASD)* related to changes in routine, noisy or busy environments, medical procedures and typical methods of communication.
This Linked Program pilot is designed for children with ASD, but we foresee the possibility of expanding it to all children with special needs across Mission Health.
Strategies in the program include the following steps:
Prior to Visit
- Phone interview to include “All About Me” Passport and assessment of ASD functional level
- This allows for an individualized plan of care
- Linked program information pamphlet emailed to parents/caregivers
- Invitation to visit the surgery center before surgery
- Availability of completing consents/paperwork ahead of time
Day of Surgery Registration
- Availability of quiet room while waiting
- Electronics or toys for distraction if needed
- Schedule first case of day if possible
- Rapid or early registration process
- “All About Me” Passport shared with all caregivers prior to care
- Child Life Specialist support
- Linked Program magnet at patient’s door to highlight need for communication of plan of care
- Allow patient to remain in their clothes, have comfort items
- Use of story boards or electronic devices to help communication
- Adequate antiemetics and intravenous fluids
- Caregiver at bedside while patient awakening
- Keep lights and noise to a minimum–recover in private room once awake
- Remove monitors and intravenous lines as soon as possible to avoid stress
- Provide discharge instructions prior to patient waking if possible
- Follow-up phone call with brief survey:
- Evaluation of time to discharge, time to return to baseline behavior
- Any feedback about healthcare experience
*Autism spectrum disorders (ASD) are a group of disorders including autism, childhood disintegrative disorder, persuasive-developmental disorder/not otherwise specified (PDD-NOS) and Asperger syndrome. Reference: Shah, S.P. (2014, March). Perioperative Management of a Patient with Autism. Austin Journal of Anesthesia and Analgesia, 2(2), 1015.