adult patients admitted to a pediatric hospital

umcRN, BSN, RN · Apr 22, 2012

That said, I do still think it's a disservice to some of these patients to keep them in a pediatric hospital for EVERYTHING.

Not all adult patients feel that way though. There is a 40ish frequent flyer at my hospital and he'll tell anyone who asks that he'd rather be at the children's hospital than the adult hospital across the street. He feels he gets better care, the "amenities" are nicer and that being an old TOF pt people know what they're doing with him & his heart.

CloudySue · Apr 22, 2012

I work with a 19 year old girl w SMA, and now that she's off to college in a major city, her nurses/aides and even her closest friends are on strict orders to be sure that if she needs to go to a hospital, it's the local children's hospital. They would be well-versed on SMA since it's a pediatric disease. The family is convinced that an adult hospital would be dangerous for her.

pedshemoncRN:) · Apr 25, 2012

The hospital I work at has an AYA (adolescent/young adult) oncology/bone marrow transplant program and we often take care of adults up to their mid 20's with "pediatric" oncology diagnoses. Studies have proven that if these patients are treated on pediatric protocols in pediatric hospitals, their outcomes tend to be much greater and long-term morbidity/mortality lower. I personally love the diversity of being able to take care of a 2 year old, a school-age child and a young adult all in one assignment. The creativity and critical thinking it takes to be a pediatric nurse, working with many different ages of patients and their families makes us better nurses... taking care of young adults just broadens that experience.

KelRN215, BSN, RN · Apr 25, 2012

The hospital I work at has an AYA (adolescent/young adult) oncology/bone marrow transplant program and we often take care of adults up to their mid 20's with "pediatric" oncology diagnoses. Studies have proven that if these patients are treated on pediatric protocols in pediatric hospitals, their outcomes tend to be much greater and long-term morbidity/mortality lower. I personally love the diversity of being able to take care of a 2 year old, a school-age child and a young adult all in one assignment. The creativity and critical thinking it takes to be a pediatric nurse, working with many different ages of patients and their families makes us better nurses... taking care of young adults just broadens that experience.

I have heard before that young adults (up to 24ish) with cancer treated at pediatric institutions tend to do better. Your screen name, however, reminded me of a patient I encountered before I left my job at the hospital.

This patient was 21 years old- alert and oriented, developmentally appropriate and her own legal guardian. She had some kind of end stage rhabdoid tumor and her prognosis was less than a few months. Her team, however, had been discussing all of this- prognosis, end of life issues, etc- with her parents only and because her parents didn't want her to know she was dying, no one on the medical team discussed this with the patient. I think what happens often is that providers at a pediatric institution are so of the mindset that they talk to the parents about the patient, that they don't even realize what they're doing when they talk to the parents of an adult patient without the patient's specific consent. My colleagues and I were all extremely distraught over this when she came to my floor (she was primarily a patient on heme/onc but was admitted to my floor after spinal surgery) because it is both unethical and illegal to discuss these issues with family only and not involve the adult patient in the conversation. I realize that at some point in her treatment, the patient probably did agree that her parents could be involved in her care but that does not mean that her parents can make decisions for her or withhold information from her. Not to mention, she can revoke her consent for them to receive information at any time yet she was never given the option to do that since the providers were talking exclusively with the parents.

I can't even count how many times I've had to have a resident re-do a surgical consent form because they- out of habit- had a 19 year old's parent sign consent for surgery. And then they'd get confused when I'd bring it back to them and say, "this is not a valid consent." Just like my mother cannot consent to surgery for me, this 19 year old's mother cannot consent to surgery for her. I'd also come across nurses who would think that it was ok for a 20 year old's mother to sign their discharge paper work or who wouldn't understand what I was talking about when I mentioned that the mother's signature meant nothing for their 19 year old daughter's elective surgery. For what it's worth, we did have a fair amount of adult patients whose parents were their legal guardians but I just found that inappropriate lines were often crossed when we had developmentally appropriate adults admitted to that hospital.

Pediatric Critical Care Columnist · Apr 26, 2012

KelRN215, I've seen similar situations in the past, even though our facility manages many adults with chronic health issues as adults. One sticks with me. The patient was an adult with congenital heart disease. Didn't want any more surgery, didn't want a transplant, didn't want anything invasive done at all. Content with the life the patient had been given but not eager to extend it at all/any cost. On admission to the adult cardiac ICU, these wishes were made plain to anybody who would listen. When the inevitable arrived and the patient required intubation, the parents took over. Intubation was followed by VAD (ventricular assist device) placement. The nurses on the adult unit were angry and upset that their patient's wishes had been ignored and made their views well-known. Next thing we know, the patient was now a peds patient. The handful of days of "life" gained were agony for all concerned. The peds nurses were told to do their jobs and keep their opinions to themselves.

Another situation involved an adult patient who had a degenerative disorder, in need of a VAD and under a lot of pressure from family, who had been turned away by every other program in the country. Not ours. Several weeks of complication after complication ensued with the patient finally saying that had all the drawbacks been explained up front, the VAD would have stayed in the box. And the inevitable happened, and the family was filled with regret for having gone forward. Terribly sad.

umcRN, BSN, RN · Apr 26, 2012

Horribly frustrating! Similar thing had happened with my 26 year old BMT patient, one day the patient said he didn't want to do this anymore, next thing you know moms getting papers signed to be his POA and making him "incompetent" to make decisions

I also had a similarly frustrating situation happen to myself, not as severe obviously and not at a children's hospital, but I was awaiting a call from a doctors office to make an appointment after a biopsy confirmed I may need radiation/chemo and when the woman couldn't get a hold of me (sorry I showered) she immediately called my dad. She only told him she was calling from "such and such CANCER center" but couldn't tell him why else she was calling, only that I needed to call back and make an appointment. Ok I though the "in case of emergency" contact was for a medical EMERGENCY, not making a doctors appointment. In any case I didn't need treatment at the time but I think my dad lost ten years off his life. HIPPA violation anyone?

Pediatric Critical Care Columnist · Apr 26, 2012

Wow... Just wow. Very unprofessional. Did you call her on it?

KelRN215, BSN, RN · Apr 26, 2012

Horribly frustrating! Similar thing had happened with my 26 year old BMT patient, one day the patient said he didn't want to do this anymore, next thing you know moms getting papers signed to be his POA and making him "incompetent" to make decisions
I also had a similarly frustrating situation happen to myself, not as severe obviously and not at a children's hospital, but I was awaiting a call from a doctors office to make an appointment after a biopsy confirmed I may need radiation/chemo and when the woman couldn't get a hold of me (sorry I showered) she immediately called my dad. She only told him she was calling from "such and such CANCER center" but couldn't tell him why else she was calling, only that I needed to call back and make an appointment. Ok I though the "in case of emergency" contact was for a medical EMERGENCY, not making a doctors appointment. In any case I didn't need treatment at the time but I think my dad lost ten years off his life. HIPPA violation anyone?

I had almost forgotten that something like that happened to me before too! When I was in nursing school, I had a syncopal episode at the pediatric hospital in which I was doing clinical and was sent to their ER (much to my dismay). I have been in control of my medical problems since I was 19 and I don't discuss things with my mother unless absolutely necessary. I didn't tell her this because there was no need to. Next time I see her, she tells me that someone from the hospital called her house and left a message on her answering machine that said something like, "We're calling to check on Kel, because she was seen in the ER due to fainting on Wednesday." Um, hello? They didn't even try to call me on my cell phone or at college- went right to calling my mother's house. I was 23 years old at the time. If I hadn't been trying to get a job there at the time, I would have called and pitched quite the fit.

umcRN, BSN, RN · Apr 26, 2012

Wow... Just wow. Very unprofessional. Did you call her on it?

Yes I did actually. I was very upset. Especially since I had yet to even tell my family that I had gotten the biopsy results, and I'm 25, not a child. She was a little taken aback on the phone when I talked to her but she did apologize,she just didn't want me to not get the memo.

~PedsRN~, BSN, RN · Apr 30, 2012

We get patients up to age 24 in our hospital.... most of these are CP, CF, Cardiac kids, etc.

imaginations · May 9, 2012

The oldest patient I've nursed in a paediatric setting has been a 20 year-old CF patient on their last admission for tune-up prior to transition to adults (next door).

Interestingly, I've seen a lot of children nursed in complex adult settings. The leading cardiac ICU in the state very often treats congenital cardiac adults and almost equally as often, takes teenagers (I think some of the younger ones have just broken 14 years of age) on ECMO, transferred from either of the paediatric ICUs in the state, who've suddenly jumped to the top of the transplant list. They typically become extremely unwell, extremely quickly in the paediatric hospitals, end up on ECMO and at the top of the transplant list and are (obviously) to unwell to be transported to the only state in the country that actually does paediatric transplants in a paediatric hospitals. They stay in the adult ICU until the organ becomes available, are transplanted in the adult hospital, cared for post-operatively until stable enough to be transferred back to the PICU and transitioned out onto the wards in the paediatric hospital.

wooh, BSN, RN · May 11, 2012

Ahh, my favorite soap box...

I know some of these adults have pediatric diagnoses but this is the reason i chose to do pediatrics because i cannot stand adult patients that act like this.

I drive an HOUR to work peds. If I wanted to take care of adults, I'd have an 8 minute commute.

The patients we get, there are services for them in the adult world. They just do not want to transition. We're nicer than the adult hospitals. Because we have a bunch of bleeding heart sweet young girls that never worked adult care and have a complete inability to put their foot down and tell the patient that they need to start acting like a grown-up and take responsibility for their own health.

It's one thing when there truly is no other alternative, and the congenital cardiac stuff? Fine. The young adults with oncology, until the adult oncologists get up to date on what will work better for them? Fine. But sickle cell? Cystic fibrosis? There are adult programs now. Various handicaps since young? The adult hospitals have people that can take care of them.

The most irritating thing is that the only time our hospital actually WILL refuse a patient is if it's a young woman that's given birth. So we'll refuse to take a 12 year old that's had a baby, but a 23 year old guy that has multiple kids by multiple women? We'll take him. Even if he's spending the entire hospitalization hitting on every staff member with boobs under the age of 30.

We have to do mg per kg math. We've got to be up on the developmental processes. We shouldn't have to deal with adult patient drama on top of it.