Emergency Department PECC Commitment Form - Children's Health Alliance of Wisconsin

Emergency Department Pediatric Emergency Care Coordinator (PECC) Commitment and Memorandum of Understanding

Emergency Department Name *

RTAC Region *

County *

Contact Name *

Provider Level

(It is recommended that each ED has a Nurse PECC and Physician PECC)

Mailing Address *

Country

City

State

Zip code

Phone *

Email *

Who will serve as the PECC for this ED? *

PECC Contact Information (if different from above)

Statement of Commitment

This service commits to the establishment and ongoing support of an ED PECC. Ideally, the ED PECC shall strive to:

• Ensure the pediatric perspective is included in the development of emergency department (ED) protocols
• Ensure fellow ED providers follow pediatric clinical practice guidelines
• Promote pediatric continuing education opportunities
• Oversee pediatric process improvement
• Ensure the availability of pediatric medications, equipment and supplies
• Promote ED participation in pediatric quality improvement programs
• Promote ED participation in pediatric research efforts
• Liaise with the EMS agency PECC
• Promote family-centered care at the ED

Within this ED, the PECC shall ensure pediatric perspectives are included in ED protocols and that fellow providers follow pediatric clinical practice guidelines and have access to pediatric-specific training. The goal of this newly-established ED PECC is to benefit pediatric emergency care by overseeing pediatric process improvement efforts and ensuring pediatric equipment and medication are available to this ED henceforth.

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Date *

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