Poster - #UCDH25 - Best Patient Experience Innovation

Providing a non-sedated lumbar puncture option for families at the Pediatric Cancer Center during the COVID-19 Pandemic

Janeen Anderson, MSN, RN, Mackenzi Lee, MA, CCLS, and Deborah Woods, MSN, CPNP
UC Davis Health of Pediatric Oncology

ABSTRACT
Background: In children with Leukemias or specific types of Lymphomas, frequent lumbar punctures (LP) are required for both diagnostic and therapeutic purposes; in some cases, as many as 23 procedures may be performed during course of treatment. Standard of care for the last two decades included general anesthesia or conscious sedation when performing these procedures. In March 2020, the onset of COVID-19 forced practice changes surrounding anesthesia and use of surgical suites. COVID testing was required for all patients prior to potentially aerosol generating procedure, including LPs with anesthesia. This process of frequent COVID swabs created parental anxiety and patient distress. Not surprisingly, younger patients seem to struggle the most, although distress was observed in all age groups. Purpose/Objective: The primary goal of this project was to create an option for non-sedated LP procedures for school-aged and younger patients with leukemia/lymphoma during the COVID-19 pandemic. Design/Methods: A multidisciplinary approach was used to create a new workflow within the Pediatric Cancer Center Clinic and Infusion Room. Major stakeholders within the clinic and infusion room were identified—including nursing, physicians, pharmacy and Child Life. Meetings were held to discuss how to accommodate non-sedated LPs for school-aged and younger patients. A fish-bone diagram was utilized to identify barriers within each profession, and solutions were created to address each barrier. Thus, a new workflow was created and implemented. Results: The success of this project is defined by the having a non-sedated LP option for school aged and younger patients. New appointment times were created to accommodate non-sedated LP procedures, along with changes in nursing workflow. As of December 2020, 37% of LP procedures are performed in clinic. Family satisfaction is high based on continued support for the option of non-sedate LPs. Conclusion: The workflow was created with interdisciplinary partnership at the Pediatric Cancer Center. It was observed that Child Life was instrumental to help identify appropriate patients and as well as educate families. A challenge of this project was having pediatric patients take oral versed as an anxiolytic agent, as well as having adequate nursing staff for increase patient appointments. Further investigation is needed to explore other viable non-sedative options as an alternative to oral versed. Providing non-sedated LPs for children offer many benefits, including decreased exposure to general anesthesia, decreased time in clinical areas, better financial stewardship, and increased overall patient satisfaction. This also demonstrated the importance and feasibility of partnering with our patients and families to individualize care and minimize the variety of stressors patients experience related to the COVID-19 pandemic.