Charting
Importance of Documentation in Game Tech Practice/Charting
While Game Techs may not directly administer medical care to patients and families, the significance of documenting interactions cannot be overstated in this profession. Documentation serves as a vital component, not only for tracking metrics but also for ensuring continuity of care, particularly for long-term or frequently admitted patients. The act of charting can prompt formal referrals upon re-admission, facilitate the transition of coping and socialization plans, and raise awareness of the Game Tech role among other team members. Since each hospital program has unique perspectives on what qualifies as "chart-worthy" information, advocacy may be necessary to gain access to this aspect of the role. Consulting with other social and emotional support teams, such as Child Life or Creative Arts, can offer insights into their processes and serve as a starting point for creating templates. As the Game Tech profession evolves, establishing and adhering to standards of care, including standardized charting practices, becomes increasingly crucial.
Potential Content to Chart
- Services Provided
- Time Spent:
- Breakdown of time with patients and time dedicated to projects related to them.
- Response to Interventions:
- Observations on changes in mood/affect, verbal expressions of gratitude/excitement, increased movement/tolerances, and pain levels (prompted verbally before and after interventions for effective tracking).
- Intervention/Game Preferences:
- Noting preferences expressed by the patient during interactions.
- Presence During Co-Treat Sessions:
- Documenting participation in co-treatment sessions with other healthcare professionals.
- VR Screening Results:
- Indicating whether the patient passed or failed established guidelines during virtual reality screenings.
- Future and Long-Term Goals:
- Outlining aspirations and objectives for ongoing care.
- Source of Referral:
- Identifying the origin of the referral for the Game Tech services.
By systematically recording these elements, Game Techs contribute to comprehensive and informed patient care, fostering a well-documented narrative that benefits both patients and the healthcare team.
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.
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.
(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.
Optional: Patient and ___ thanked this writer for (game session / game delivery / technical assistance).
Optional: Patient continued playing after this writer left the room.
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)
Connecticut Children's
Connecticut Children's Child Life Gaming and Technology Specialist (GTS) utilizes narrative chart notes on EPIC to document their interventions with patients. The purpose of these narrative notes is to tell a story about the impact that the GTS has on the patient's care plan. These notes can be reviewed by other professionals on the patient's care team, as well as the patient's family.
Actions to hit in nearly every chart note at Connecticut Children's are:
- Target(s)/goal(s) of intervention (normalization, socialization, coping, diversion, boredom, co-treat with physical/occupational therapies, assistive technology support, sibling support, etc.)
- Where the patient was engaged (bedside, unit playroom, Family Resource Center, etc.)
- How the patient was engaged, brief explanation of equipment used or provided throughout engagement, collaborative/co-op, or competitive session
- Patient's history with gaming and technology (teaching or orientation required prior to session?)
- Patient's affect/demeanor prior to engagement
- Patient's affect/demeanor during engagement
- Patient's affect/demeanor following engagement
- Challenges/successes experienced throughout
- Intentions of further GTS intervention throughout remainder of admission
This GTS also utilizes EPIC SmartPhrases, where possible, to aid in the efficiency and consistency of documenting patient interventions. SmartPhrases will not tell the whole story and the note will typically require additional details specific to each patient for the intervention to be described. Below are examples of SmartPhrases that can be used:
Tips
- If using EPIC, create SmartPhrases for common interactions (introductions, bedsides etc) that allows you to just fill in specifics for that session and in turn saves a lot of time.