Innovative care model for children with ASD reduces use of behavioral drugs in ED

An innovative care model developed by Nemours Children's Hospital for children with autism spectrum disorders (ASD) in the emergency department (ED) reduces the use of medication administered to kids who are prone to stress and sensory overload in this care setting. Information about this care model was presented today at the Institute for Healthcare Improvement's National Forum.

"Our program was designed to help prevent escalation of anxiety and agitation in children with ASD, therefore leading to the reduced use of sedatives and restraints," said Cara Harwell, ARNP, CPNP, PMHS, lead researcher and a Nurse Practitioner at Nemours Children's Hospital. "Sedative medications do have side effects, and if we can manage kids' stress in other ways, we create a better experience for them and their families."

In their evaluation of the program, Harwell and her colleagues reviewed two years of electronic health records and identified 860 pediatric emergency department visits in which this model, known as the REACH (Respecting Each Awesome Child Here) Program, was used for patients with ASD or similar conditions. With this approach, fewer than six percent of these patients needed an anxiolytic (anxiety medication). None needed an antipsychotic (for aggressive behavior) or an alpha-agonist (for hyperactivity and anxiety). Fewer than one percent needed physical restraints.

There is limited comparative research, but one study, not employing the REACH model, found that sedation or restraints were used in nearly one-fourth of ED visits by children and adults with ASD.

Nemours' REACH Program, now in its third year, accommodates children with ASD, sensory disorders, mental health disorders and similar conditions. Staff receive ongoing training regarding ASD, REACH concepts, procedure planning, and recognizing and managing anxiety and agitation. Distraction objects and rewards are placed throughout the ED, which includes a sensory-friendly exam room. Harwell, along with Emily Bradley MA, Certified Child Life Specialist, developed and instituted the program at Nemours Children's Hospital, which was one of the first in the nation to adapt care to the needs of children in the ED.

Beyond the reduced use of restraints and sedatives, patient satisfaction survey results show the program has led to improved patient experiences and a survey of providers found improved comfort and knowledge for treating children with ASD.

"The noise and pace of the ED environment can greatly increase stress for children with ASD, leading to the need for medications or restraints to help manage irritability, anxiety or harmful behavior. Avoiding these stimuli provides better, more positive care experiences for these kids," said Harwell.