Planning Pays Off with Aggressive Patients
By Holly DeLorme, RN, MSN
Managing a child on the autism spectrum can be difficult, particularly if the child is aggressive when confronted with an interruption in routine. Parents may fear that the only way to manage their autistic child in a health care setting is with brute force. How can we, as a sedation team, create an environment that can ease this fear?

Start with an empathetic telephone screening conversation, in advance of the appointment, to better understand what the child’s autism looks like. Discuss triggers that could result in aggressive behaviors, as well as calming strategies. Complete the history, discuss a sedation plan, and obtain consent by phone. On procedure day, instruct the parent to call the unit on arrival to the hospital campus in case of schedule delays. Identify the shortest, least stimulating route to your unit, and minimize time between arrival and procedure (as the history and consent will already be done!). Try to avoid the waiting room completely, as well as other behavioral triggers.

When possible, reach out to your Child Life Specialist for support during the encounter, and have back up in place from your security and/or aggressive patient management team. Take advantage of the calming techniques identified in the screening call (if the patient likes the movie “Cars”, by all means have it cued up on the TV or IPad!).
Our team has developed a triage assessment tool to screen patients for aggressive behaviors and assist us with personalizing our Autism Safety Plan (ASP), to be presented in more detail at the SPS Annual Meeting in May. This process must be collaborative, between staff and family, to ensure safe, effective care in a family-centered environment. The ASP is denoted in the appointment notes with a notifier going out to security, registration associates, APN’s and the sedation/anesthesia physicians. Thoughtful preparation can mitigate the potential for harm to patient or staff, and lead to a better outcome.
Society for Pediatric Sedation | sps@ societyhq .com | (804) 565-6354 |