Proposal to enhance the current Starship Hospital’s Pet Programme By Lindy Lely & Veni Oliveros, ADHB Volunteers Centre 1 September 2017 Updated December 2017 I. Objective a. To gain ADHB approval to enhance the current Starship Hospital Pet Programme. b. The proposal is to move the pet visits from the Atrium to a designated room on the wards. A wealth of supporting evidence (please see attached research schedule) for allowing Pet Therapy trained and groomed pets onto the wards and on the beds of patients come from similar (Children’s) hospitals in the Western world, i.e. UK, Canada, Australia, Italy, USA and The Netherlands. c. The pets as described in this proposal are especially trained, groomed and monitored therapy pets that belong to Pet Therapy organisations that are contracted by Auckland DHB Volunteers Services. d. The therapy pets will initially be a dog. e. If, one year after satisfactory implementation, the Volunteers wish to expand the programme to include small animals other than dogs, a new proposal will be formulated. II. Timeline & Budget The roll-out of the proposed process is 2018 February and to increase the visits to twice or three times a week, depending on the agreed time with (currently Wednesdays between 13.30 and 15.00 hrs). III. Background Auckland DHB has had a Pet Programme running at Starship Children’s Hospital in the past six years. It involves an Auckland DHB volunteer and SPCA volunteers who bring their specially trained and groomed therapy dog into the atrium of Starship so patients and families can visit. Both volunteer parties are responsible for making sure that all safety and hygiene requirements are met. Visits occur every Wednesday from 1.30 pm to 3pm with children being accompanied by a nurse (if clinically required) and a family member. There are problems with the atrium as a venue. The atrium can be cold with draughts and is therefore not a suitable place for sick children. It can be hard, if not impossible, to transport sick children from their ward to the atrium. As a result numbers attending the Pet Programme have been lower than expected, and many of the visits have been from siblings rather than the child who is in hospital. IV. The proposal for an enhanced programme The proposed process is based on the Pet Programme used by the Children’s Hospital of the Academic Medical Centre (AMC), Amsterdam, Netherlands which has been running since February 2010. The detail of the AMC model is very similar to the work process flow currently used at Starship Hospital. a. Pet visits are allowed on most wards, excluding (by concession only) Intensive Care Units and the Haematology Unit, with the Clinical Charge Nurse (CCN) or Charge Nurse (CN) or Nurse Unit Manager (NUM) authorisation. b. The signed visit checklist and proof of vaccination are to be submitted by the ADHB volunteer-Pet Manager to the Hospital. The ADHB volunteer has a copy of each document available during the visit. c. The proposal extends the current once-a-week regime to two to three times a week. d. Every child must have CCN or CN or NUM and care giver approval granted for a pet visit. The requests for pet therapy will be as per process. e. Patients with open wounds or burns, allergies to pets, or immune deficiencies or compromise will not be allowed pet visits. f. Pets are supervised at all times by their handler/owner and accompanied by an ADHB Pet Volunteer while being transported through the hospital For individual patient/pet contact, ADHB volunteers can take the role of transport and security guide. g. Each ward has an identified room (see table) which can be used one hour in a day to be used by the pet, its owner and the patient. h. In cases where a patient can’t leave their bed, the pet will be brought to the room. i. The child will wear a disposable gown or the gown and/or one will be placed on the bed while interacting with the animal. j. After the pet visit, ADHB volunteers will tidy up the room and remove the disposable gown from the child. Page | 1 k. A nurse (or Healthcare Assistant (HCA)) will wheel the patient back to their room while the volunteer guides the pet and owner out of the hospital. l. Before leaving the family room, everyone will perform appropriate hand hygiene (for both visual and non-visual grease). m. Any child with medical equipment such as an IV stand should be accompanied by a Staff member. Table: Designated Pet Areas in Starship Hospital PICU Individual bed spaces Ward 23 Family or teaching room Ward 24A & B Family room between the two wards Ward 25 One of the quiet rooms Ward 26A Quiet room Ward 26B Large Quiet room Ward 27 Adolescent lounge on 27B DSU No room Recommendations Volunteers_Pet Programme in SSH.doc V. Roles and Responsibilities a. CCN or CN or NUM Approval of pet visits to patients on the ward to be decided as per process. Ensure parental/caregiver’s consent b. Volunteer Manager Organisation of pet visitation program ADHB Pet Volunteer’s performance of duties/tasks c. ADHB Volunteer ADHB pet programme volunteers facilitate the visits of SPCA pets into the Starship Hospital. Support Outreach Therapy Pets volunteers and staff with the coordination of visits Ensure hospital protocols are followed Ensure pet enclosure, furniture and all equipment are cleaned before and after pet visits Escort and signing of pet handler/owner in and out of Starship Hospital Transport of pet to and from L1 entrance to designated room in the ward Supervision of pet visit Preparation and cleaning of designated room before and after visit Page | 2 Conduct hand hygiene procedure (Microshield) for everyone in the Family Room before and after pet visit Immediate notification of CCN, CN, NUM in cases of bites, scratches or any incident relating to the pet visit which is then noted in DATIX Submission/return of visitation list to the Volunteer Manager 27B patients who have been granted (through CCN or NUM approval only) a therapy pet visit will have first access to the animals before they are moved on to other wards. d. Nurse of HCA Transport of Patient to and from designated areas. Provision of single use disposable gown for the child. e. SPCA Outreach Therapy Pets Volunteers (Pet Handlers/Owners) as outlined by SPCA Abide by ADHB health and safety regulations and by SPCA Therapy Pets guidelines o Only ever use our own approved animal for visits at approved establishments that have been allocated to the SPCA volunteer o The approval to use a specific animal as a therapy pet is not transferrable to a different animal owned or handler o All animals are subject to individual assessment which will be maintained at least every two years. Animals must always be humanely handled so as to minimise stress and any risk to the welfare and well-being of the animal and clients o Visits shall not be longer than one hour without a suitable break for the animal in which it can rest or burn off steam as appropriate o Approved animals must be healthy (e.g. not lame, no internal or external parasites), in good condition (e.g. not obese or under- weight), well presented (e.g. clean and well groomed), with up to date training and assessments. IX Complaints process and managing risks Not every family or staff member will be happy to see animals within an acute hospital facility. Animals may initially be associated with dirt and disease or as dangerous or frightening. For this reason it is essential that people opposed to the Pet Programme or who are fearful of animals be able to discuss their concerns with the CCN, CN or NUM of the area. The following process will help to manage likely criticisms and complaints: All families are informed about the Pet Programme on admission during orientation, using the information sheet. How to provide feedback and how to opt out of The Pet Programme will also be clearly indicated at admission time. A sheet with Frequently Asked Question may also be useful (see the final page). Page | 3 No child will engage with pets without explicit approval of the medical team and the caregiver. This proposal has addressed the many risks identified to date. Constant monitoring will be required as the programme expands to identify any risks and ensure these are managed promptly. It is important to note that no scratches or any bites have occurred to date in the current programme available at Starship Hospital. VI. Benefits of this Proposal a. More children will have the opportunity to interact with the pets. Bringing the pets to family rooms on the wards will shorten the physical distance between the Pet Programme and its intended beneficiaries. With the current process, only 2-15 children are able to go down to the cold and windy Atrium. The number of children (and families) benefitting from the programme is just a tiny fraction of those eligible, especially considering that the hospital has nine wards and a capacity of 219 beds. b. There will be a more comfortable space for child-dog interaction. Anyone visiting the Atrium during the cold months will notice the draught in the area. A possible solution involving a sail cover for the enclosure was explored but was not pursued due to its prohibitive cost. c. Programme continuity. With ADHB’s plan to re-allocate hospital spaces and renovate the Atrium, there is a possibility that the Programme will lose the enclosure.