Allied health professionals
Interprofessional team care planning occurs with multidisciplinary teams throughout a child's visit, relative to their specific needs. This team includes: dietetics, physiotherapy, pharmacy, social work, chaplaincy, infection control, medical engineering, audiology, speech language pathology, research staff, occupational therapists, the information systems team and more.
There are two registered dietitians (RD) in the CCCU and PICU who are considered the experts in nutrition management. With medical directives in enteral and parenteral nutrition, they tailor plans to the individual needs of each child.
The RD will focus on the most effective form of nutritional support for the critically ill child. Your RD will take in to account medical conditions and the resultant impact on a child nutritional status and growth. Through participation in research, the dietitians are able to contribute to an expanding body of knowledge to support the improvement of nutritional outcomes in critical care. RDs facilitate education by mentoring dietetic interns, as well as providing education to the multidisciplinary team.
Physiotherapists (PT) in the Department of Critical Care Medicine provide assessment, treatment incorporating the principles of family-centered care. They consult children with movement dysfunction related to cardiorespiratory, neurological or musculoskeletal conditions.
Three PTs have a portion of their clinical caseloads within the department. An evening/weekend service exists within the PT department to treat patients with urgent cardiorespiratory needs. One of the exciting aspects of working in critical care is the complexity of the patients that we see (e.g. a spinal cord injured patient may need a PT plan that involves chest treatment, an exercise plan for range of movement, muscle strengthening and mobility while taking into consideration the developmental stage of the child).
As a team, one of our goals is to identify the impact of emerging medical therapies and technologies (e.g. Novalung on the functional outcome of our patients). Recently, the renewed interest in early mobility for children in the PICU has provided opportunities to use new approaches to address movement for increasingly fragile children with multiple challenges.
The Department of Critical Care Medicine is staffed by five pharmacists, on a rotational basis, who address pharmacotherapy needs for patients admitted to the Paediatric Intensive Care Unit (two pharmacists on weekdays) and Cardiac Critical Care Unit (one pharmacist on weekdays). One pharmacy technician supports the preparation and delivery of medication infusions for patients in both units on a daily basis.
Provision of pharmaceutical care by pharmacists included medication reconciliation, identification and resolution of actual and potential drug-therapy problems for patients with the team. In addition, pharmacists practice medical directives for the following:
- Ordering of dose adjustment and therapeutic drug monitoring levels for patients with altered renal or hepatic function.
- Ordering of antibiotics for sternal closure in post-operative cardiac patients.
Pharmacists provide Therapeutic Drug Monitoring for patients including: review of doses for renal or hepatic function, age, weight, diagnosis and therapeutic plan. They will recommend serum drug concentrations when appropriate, and review and interpret each serum drug concentration. Based on serum drug concentrations, the patients' diagnosis, and therapeutic plan, pharmacists make recommendations for dose changes or further monitoring.
Pharmacists also provide drug information to the physicians, nurses and other health care providers, are fully integrated with the medical, nursing and multidisciplinary teams and are involved in care conferences for long term patients and their families.
Pharmacists also precept pharmacy residents and pharmacy students from University of Toronto and participate in the orientation tutorials for new critical care physicians and nurses.
Pharmacists are actively engaged in clinical research activities in collaboration with other researchers and critical care staff.
Working from a family-centered perspective, social workers in the PICU/CCCU employ a variety of models to assess and provide supportive clinical intervention regarding the needs of patients, family members and staff.
We recognize how profoundly stressful it can be to have a critically-ill child and each patient and family brings with them a unique set of coping mechanisms. Our psychosocial interventions are tailored to the specific needs of each family. Each of the skills we teach, and interventions we provide, respect these individuals and are optimized to meet their specific needs.
While not an exhaustive list, social workers provide:
- counselling to strengthen parents through their adjustment to change, illness, grief and bereavement
- crisis intervention for families and staff; locating and arranging resources
- consultation with hospital staff and/or community agencies and advocacy for patients and families
PICU/CCCU social workers also provide clinical and academic placements to students from a variety of accredited Canadian and selected American universities.
Child Life Specialists use play activities to help children feel more comfortable about being in the Hospital. Through the use of play we are able to offer children choice in an environment where choice is extremely limited. The use of play also helps children ask questions and encourages understanding and acceptance of their feelings.
Medical play offers children the opportunity to address their fears and develop coping skills and strategies to use while in the hospital and throughout the illness process. Child Life also works with siblings and other family members and whenever, possible, supports children and families during treatment and procedures.
The Critical Care Unit offers a variety of supports in attempt to provide holistic care for body, mind and spirit. A chaplain offers a spiritual presence in the unit and is available for immediate care or to refer to a faith community of the family’s choice. The chaplain is able to offer prayer, consultation, response to sacramental needs and support and advocacy in the challenging circumstances of Intensive Care. Staff in the CCU can make a referral to the chaplain for patients, families or for themselves. The on-call chaplain may be reached through Locating at 7500 or by pager at 416-232-4597.
Religious or Pastoral Care, sometimes referred to as Spiritual Care, is provided by hospital chaplains, community clergy and leaders in religious communities. Religious and Spiritual Care is provided in a respectful manner. Hospital chaplains have received special training to provide support and assistance to people facing a health crisis in a clinical setting. Community religious leaders are well-versed in their respective traditions and ceremonies.
Religious and Spiritual Care is offered to and in a multi-faith setting. It will be requested when someone wants the support of their particular religious faith community, through specific prayer, ritual, ceremony or celebration. The illness of a child raises a lot of questions and concerns in the minds of family members. There are moral and ethical challenges that may emerge during protocols and treatments. You may want to contact pastoral care services directly or with the assistance of your doctor or nurse.
The Infection Prevention and Control Program at SickKids is a multi-faceted program. Its directly responsible for ensuring that mechanisms, policies, procedures and practices are in place to prevent and control the transmission and acquisition of infection within the institution.
The Infection Control Practitioner meets daily with the CSNs to ensure that appropriate precautions are in place for the patients in the PICU and CCCU. Rounding in the CCU facilitates education and consultation opportunities with staff to review patients and practices related to infection prevention and control.
The program vision to strive to be recognized as world leaders in providing the best technical and clinical support in paediatric health care. We acknowledge and commit to the need for continuing education, innovation, collaboration, and discovery that will allow us to contribute to SickKids' vision of becoming the best paediatric health care centre in the world.
The Department of Medical Engineering is responsible for the management and application of all health care technology within the hospital, which includes Lab Services and the Research Institute. We provide the following services:
- Technical and clinical support at the bedside for equipment related problems
- Installations, pre-operation testing and calibration (certification)
- Corrective and preventive maintenance
- Conduct and/or assist in clinical/technical evaluation of new devices
- Consult and provide professional advice in the acquisition of new equipment
- Equipment modification to meet acceptable electrical safety standards
- In-service education programs for hospital staff relating to medical devices
- Consult in clinical accident investigations where a medical device/system is used
- Medical equipment related Hazard Alerts & Recalls processing
- Arranging and managing equipment service contracts
For more information, please contact: Kathyrn Howarth