Charting

Importance of Charting

While Game Techs are not providing direct medical care for patients and families, it can be argued that providing documentation of interactions is an important aspect of the profession. Not only can this provide an easy source of trackable metrics, but can help provide continuity of care for long term or frequent admission patients. Documentation can remind staff to provide formal referrals at re-admission, help carry over coping/socialization plans, and increase exposure of the role to other team members. Each hospital program has different philosophies on what is considered "chart worthy" information so you may need to advocate to have this access granted for your role. Reaching out to other social/emotional support teams such as Child Life or Creative Arts can give insight into their process and can be used as starting template. As the Game Tech profession grows, exploring and creating standards of care will become increasingly important and which may include standardization of charting.

Potential Content to Chart

- Services Provided

- Time Spent (both with patient and working on projects tied to them)

- Response to interventions (change in mood/affect, verbal gratitude/excitement, increase movement/tolerances, pain levels [will need to be verbally prompted before and after intervention to effectively track])

- Intervention/Game preferences

- Presence during co-treat sessions

- VR screening results (if they pass/fail established guidelines)

- Future and Long term goals

- Source of referral

Examples from Established Programs

Ann & Robert H Lurie Children's Hospital of Chicago

Lurie Children's charts using EPIC and game techs use a combination of flowcharts and narrative notes. All interactions are documented using drop down menus in the flowchart and if interactions are more complex (co-treat, long term goals, etc), the data is pulled into a narrative note, where the game tech provides more detail as needed. Examples used under Provided Service include: introduction, normalization, socialization, co-treat, procedure support, education, and troubleshooting.

Epic Flow Sheet

Upstate Golisano Children's Hospital

Upstate Golisano Children's Hospital charts using EPIC and game techs use a combination of manual charting and smart notes. All interactions are documented using drop down menus, or fill in the blanks. If interactions are more complex, a detailed manually written note is included in the session summary section.

(optional notes are in italic, choices are in parenthesis)

Gaming & Technology Specialist Progress Note:

Session Type: (Introduction and overview of services / Offer of game play session / Playstation game play session / Xbox game play session / Nintendo Switch game play session / Technology Assistance/Maintenance).

Session Length: ___ minutes.

Patient was (alone / with ___) (in room / in playroom / other).

Prior to session start, patient appeared (comfortable / in pain / upset / anxious / fatigued / other), as evidenced by ___.

Session Summary: [will be one of the three options below]

• Game Session: Gaming and Technology Specialist was referred to patient by (Child Life Specialist / Other) ___. Gaming and Technology Specialist met patient and ___ at the bedside (to provide introduction and overview of services) (Patient known to this writer from previous admissions) Patient chose to play ___ (competitively / cooperatively) with this writer (continuing from previous session). This writer spent approximately ___ minutes with patient in session. Patient was (not very / somewhat / very) talkative and engaging throughout session. Session paused to allow for medical team to speak with patient and ___. (play continued / session ended) afterwards.

• Patient Declined: This writer offered services, patient politely declined at this time. (Patient stated they were not interested in video games / other reasoning)

• Technical Issues: Gaming & Technology Specialist was asked to visit patient room to assist with the gaming system. Patient was having trouble getting the (system / controller) working. This writer resolved the issues (and replaced the (system / controller) with a working one.) This writer confirmed the system was working correctly before leaving the room. This writer will continue to assist for any future needs.

Patient continued playing after this writer left the room.

Patient and ___ thanked this writer for (game session / game delivery).

Plans:

(Anticipate that patient will be discharged prior to additional follow-up / Will continue to follow throughout inpatient hospital course / Will continue to be available for any future needs)