Burn Care: The New Immersive Approach at Children's Mercy

During his most recent visit for a dressing change on his right foot, Johnathan Diercks chose to have the Burn Clinic filled with animated images of hummingbirds, a green background and ukulele music.

On a previous visit, the 10-year-old chose owls, piano music and a blue background; he’s also chosen eagles, guitar music and an orange background for dressing changes.

The calming, relaxing atmosphere is made possible by an audio/visual projection system installed in the new Burn Clinic on 1 West near the Surgery Clinic, Adele Hall Campus at Children's Mercy Kansas City. Patients pick the lighting (rainbow or combinations of green, teal, pink, orange and purple); music (piano, guitar, chimes, ukulele or violin); and animations (owls, eagles, hummingbirds, macaws or Lorikeet parrots) to set the environment during their burn treatments.

“Blank, white walls come to life,” said Daniel Marx, MHSA, MSN, RN, CPN, Nurse Manager of the Burn Specialty Team and Burn Clinic. “The whole idea is to provide distraction and decrease the fear, anxiety stress and pain patients may experience during burn treatments. It can help to decrease or eliminate the amount of narcotic/controlled medications we have to give.

“Pain is unavoidable with burns, but with distraction technology, instead of patients focusing on a caregiver coming at them with a pair of scissors and thinking ‘this is going to hurt!’ we now have all of these other options to draw their attention away from the treatment procedure,” Daniel added.

For example, especially with younger patients, the caregiver can ask the patient to count the number of birds they see or what color they like best.

“It’s an immersive environment that follows the patient from room to room and even in the hallways,” Daniel said.

Katie Schmuke, RN, CPN, Burn Specialty Team Nurse, said, “It is no surprise that burn care is painful … typically with burns, nobody is excited to see us nurses! But it has been amazing to have this technology to help distract patients from that. Returning to our clinic for follow-up care can cause a lot of anxiety for our patients.  We now have kids who are eager to return so they can pick their bird and music!”

Some patients pick their favorite sights and sounds at every visit; Johnathan, like others, said, “I like picking different ones every time.” He said his favorites have been piano music (he plays the piano), owls and a teal green and orange background.

Johnathan got second degree burns on his foot (“I burned my foot with boiling water while I was making mac and cheese,” he explained), and he said dressing changes hurt “a little bit,” but the worst part was when he heard the initial treatment plan. “When they said they were going to cut it open…WHOA!,” he remembered.

But his mother, Jackie, said the distraction therapy eased the fears and dread of treatment visits and has “absolutely” made a difference in his attitude about visits to the Burn Clinic.

“Johnny really enjoys the ability to pick those things for the environment,” she said. “It puts things more in his control, which is great for kids going through something as difficult as a burn.”

Jackie added, “I was extremely impressed with the facility. My husband is military, so we’ve been to hospitals all over the country. This, by far, has been one of the most accommodating for children. The consideration they’ve put into making this experience as un-traumatizing as possible is tremendous.”

Creativity from necessity

The creativity that has gone into the design of the Burn Clinic resulted from rethinking Children's Mercy’s whole approach to burn care when the Pediatric Intensive Care Unit (PICU) on 2 Henson was expanded to include the Cardiac Intensive Care Unit (CICU). The expansion absorbed space that included seven beds for burn patients.

“It gave us an opportunity to shake things up,” Daniel said. “There really wasn’t room on 4 West (where burn care has four beds) to build treatment room. We had to throw all our cards in the air and adapt while still providing high quality burn care and increasing staff satisfaction.”

Instead of trying to find space for the seven beds and treatment space lost due to the PICU expansion, Daniel and Pablo Aguayo, MD, FACS, FAAP, Director-Burns and Associate Director, Trauma and Critical Care brainstormed a different model.

Previously the Children's Mercy burn unit was connected to the 2 Henson Med/Surg unit. Burn care was transitioned from a unit-based to a team-based approach. The nine-member Burn Specialty Team (BST) was created and the new Burn Clinic on 1 West was built with distraction technology. The BST manages and completes all burn debridements/treatments and ambulatory burn clinic visits.

“With the Burn Team approach, our organization has experienced increased staff collaboration, improved care coordination and increased burn nurse availability leading to decreased time from arrival to initial debridement, all of which improves patient care and experience,” Daniel said. “This is a non-traditional clinic; to my knowledge, this structure doesn’t exist in the pediatric burn world; this is a unique team for a pediatric setting and we’re the only pediatric burn center between St. Louis and Denver.”

The Burn Clinic has attracted attention from other pediatric burn centers; Daniel has met with five who wanted to learn more about Children's Mercy’s burn care model.

Dr. Aguayo said, “This project has been over seven years in the making and has come to fruition through the tireless efforts of so many individuals from within and outside of the walls of Children’s Mercy. These people, from administrators, construction specialists, architects to nurses and doctors, have whole-heartedly embraced the work that is being performed for pediatric burn survivors at Children's Mercy. All of us truly believe that this new outpatient treatment space for burns will improve the care and the lives of so many of our patients and their families. This is a huge win for our city and for our region as we continually strive to improve care of the entire person here at Children’s Mercy.”
 

Learn more about Burn and Trauma Care at Children's Mercy.