Over 21 but not an adult - adult or peds ICU?

[webdwarf40]

I am a Peds ICU nurse for the most part and have noticed a recent issue at the facility that I am a traveler. What matters most in your facility when caring for a developmentally delayed patient - CHRONOLOGICAL AGE OR DEVELOPMENTAL AGE?

For instance, at this facility, the chronological age limit for Peds ICU admission or floor admission under the Peds teaching team is 18 years. Despite this we have recently admitted a 24 year old that functions at a 3-5 year old level but weighs 75kg and takes adult dosed meds. My patient tonight is a 19 year old with a chronic seizure disorder - again >50kg and on adult dosages.

With technological advances, children with chronic needs are living much longer and although they are of adult size - they are still, and always will be children.

There are centers for Adult with Congenital Heart Defects around the country to deal with a small portion of special needs patients that fall in between the standard care models.

Anybody have an example of an existing solution that has worked in their community? Any thoughts appreciated.

Thanks

Mary

[wooh, BSN, RN]

At least they're developmentally kids. On our peds floor, we get 19 year olds that can work the system like any 45 year old. And we've had 16 year old girls with GYN problems admitted at the same time as their kid.

IMO, It depends on the patient. Personally, I don't mind the developmentally delayed adult patients. It's the sexually active teenagers that want to be treated like an adult but then whine if I don't find them the video games quick enough. And I'm really tired of teenage boys not closing the lid of their laptop that they're surfing for Media on when staff walks in the room.

[webdwarf40]

What city are you in? I'm a travel RN and really want to stay away from there! :lol2

[november17, ASN, RN]

As long as there are open beds, patient placement will find a reason to stick the patient anywhere. This sounds like a bit of the bending of the criteria to suit the placement, but I don't work peds. I just know that they do that stuff on our unit all the time.

I work ortho and patient placement will give us a patient with MRSA or something just because they had a knee replacement a few years ago. Silly.

[Quickbeam, BSN, RN]

My pediatric hospital took anyone who they could even vaguely categorize as a child or someone with a childhood illness. That meant that we got anyone of any age who was developmentally delayed as well as adults with chronic pediatric conditions (e.g. CF). I believe that is changing now that CFs are aging out of pediatrics and demanding to be treated in an adult setting. But we routinely got the 45 year old severely delayed patients, especially if they were non/never ambulatory.

[RN1989]

The hospitals that I have worked for usually went by chronological age.

The peds nurses know the correct interventions/meds/dosages for children, the adult nurses know the correct stuff for adults. These interventions have nothing to do with whether or not their brain functions as an adult - they go by size/wt. I think it is asking for errors to go by developmental age.

[MB37]

I'm not in Peds, but when I rotated there at my current employer in school they accepted young adult non-delayed patients based on census/need for beds. We had several 18-21 year olds, which made it tough to learn as much from a pediatric clinical as I would have liked! We also sent up a >21 patient with mental age of 4from neuro ICU when I was rotating there - but he had been a regular on that unit growing up and needed a floor bed, so we asked permission to send him to Peds since the neuro floor was full. Peds had room so they took him, but it wasn't standard practice.

[RNsRWe, ASN, RN]

We seem to have the reverse problem: our facility takes kids onto our adult unit as long as they're physically big! Kid you not, we'll get an 11 year old with whatever (we're a surgical floor) as long as the kid's big enough to use our adult equipment on. Which means, of course, that he's obese. And we have to put him in a private room so Mom and perhaps the whole family can stay there, because he's a kid. And WHY can't he go to the peds floor? Because of his SIZE! LOL...

[ChristineN, BSN, RN]

I work at a peds hospital, and if they're 21 or younger, we admit them, regardless of condition. If they are over 21, they generally only get admitted if it is something congenital that peds dr's know better than adult dr's (ie congenital heart defects). I take care of 18-21 year old pts on a daily basis.

[Katie82, RN]

Most of my Pediatricians refer MR patients to me when they are 21 because they want me to find them and adult medicine PCP. They feel that they are treating the body, not the mind, and an adult body has different needs than a child's. Makes sense to me.

[rn/writer, RN]

Maybe, at least in the cases where there is developmental delay, there needs to be a new specialty--adult peds.

I'm not entirely kidding (no pun intended). Such caregivers need adult A&P, med and treatment knowledge coupled with the understanding of pediatric cognitive, mental and emotional responses.

Aside from mental capabilities, as more kids survive diseases and conditions that used to end their lives in childhood or adolescence, we're going to see a growing number of practitioners having to stretch into areas where they may not feel all that comfortable.

I really do see some new sub-specialties arising out of the fact that medical miracles have created a whole new population. CF and congenital cardiac kids have been mentioned. I'm sure there are others. Demand will eventually call forth supply.

In the meantime, we just have to punt--i.e. do the best we can for each individual patient.