Royal Surrey’s support for patient with autism makes surgery possible
A recent operation was made possible for a young patient with autism thanks to the efforts of Royal Surrey NHS Foundation Trust staff, allowing her assistance dog to stay with her until just before and after surgery.
Kiera, 16, who has a brain injury from birth that affects her balance, as well as autism, was due to have three teeth removed under general anaesthetic three years ago. Because she suffers from high levels of anxiety and sensory overload when entering hospital, Kiera had put the operation on hold despite suffering pain from teeth growing into the roof of her mouth.
Anxiety has had a huge impact on Kiera’s life, making it difficult for her to attend school, leave the house and sometimes even her bedroom, as well as making healthcare visits extremely challenging. But three years ago, Kiera received life-changing help from the charity Autism Dogs in the shape of Noodle, a working yellow Labrador.
Noodle is a highly skilled autism assistance dog, specially trained to give reassurance and security for Kiera and support her in managing her anxiety.
Kiera said: “Noodle has made a massive difference to me, he means everything to me and I really struggled before I met him.
“He can tell if I’m upset and helps keep me grounded. He applies deep pressure therapy by lowering his weight onto me if I’m distressed. He helps wake me up in the morning and he’s made it possible for me to leave my house and have a life.”
After an urgent warning from her dentist about the need to have her impacted teeth removed, Kiera decided that if Noodle could accompany her to hospital and stay with her until just before surgery, her long-postponed operation might be possible.
Vicki Ward, Royal Surrey’s Learning Disabilities and Autism Nurse, was asked by the Trust’s admissions team to look at how this operation could be made possible, given Kiera’s fear of hospital and the importance of Noodle’s presence. Vicki set up virtual meetings with Kiera and her mum Jac to find out what could be done to help.
She said: “Kiera and Jac were very open-minded and recognised some of the possible limitations and challenges with the hospital around infection control, the impact on staff and other patients.
“I approached the hospital’s decision makers and talked to our senior nursing staff, the Infection Control Team and our Head of Service for theatres, anaesthetic and critical care to find out if Noodle could be present in the anaesthetic room with Kiera and next to her when she recovered after her operation. The response was very positive, a ‘yes, we just need to work out how to do this’ response.”
Vicki was careful also to make sure Noodle’s presence in the hospital would still respect the views of both patients and staff in regard to potential phobias, allergies, religious and cultural needs.
Vicki added: “We obviously had to be mindful of other patients’ feelings and staff, as well as look at the clinical considerations such as hygiene, safety and infection control but we are essentially here for patients and we need to make our healthcare accessible to all patients.
“We looked at what reasonable adjustments we could make and, for Kiera, Noodle is that reasonable adjustment.”
Once the go-ahead was given for Kiera’s admission for day surgery accompanied by Noodle, Vicki and the theatres team invited Kiera and Noodle to visit the hospital and familiarise themselves with the environment and the route from the anaesthetic room to theatre.
Vicki also compiled an information sheet to share with staff and patients, with photos of Noodle, explaining that an autism awareness dog would be accompanying a patient admitted for surgery.
She said: “We planned the surgery so that Kiera would be last on the morning list, which meant the anaesthetic room could be thoroughly cleaned before the afternoon list started. We arranged for Kiera to return to the same room for recovery after the operation to minimise stress and disruption for her.
“Noodle stayed with Kiera until she’d had the general anaesthetic. We then encouraged him to hop off the bed and come outside for a run. As soon as she came back from theatre, he couldn’t wait to get back on the bed with her and make sure she was ok. It was lovely to see the interaction between the two of them.”
Kiera’s mum, Jac, who also has autism, said: “We are so grateful to Vicki and all the staff at Royal Surrey who made it possible for Noodle to help Kiera.
“When Kiera was starting to come round after her surgery, a machine was beeping because her heart rate was very high but as soon as Noodle got onto the bed and she saw his face and he applied his weight on her, it came right down. Soon afterwards she was laughing and giggling with the amazing student nurse who was with her, it was just incredible to see.
“Kiera normally hates the smell, the noises, the lighting in the hospital, and hates being touched by healthcare workers, so this is just a huge step and she is no longer in pain with her teeth, which is brilliant.
“She has a very special connection with Noodle. He has absolutely given her back her life. They bonded as soon as they met through the charity three years ago and that relationship has developed even more because just five months after we got Noodle he was diagnosed with cancer. He’s now cancer free but the two of them are incredibly close. He has made a massive difference in our family and the world of difference to Kiera.”
The Learning Disabilities and Autism Team are working with Kiera on guidance to support other patients with autism who have Autism Assistance Dogs when accessing their healthcare at the Royal Surrey.