The aims and expected benefits of providing the children's ...

Policy Title:Guidelines for Children’s Community teamOperational PolicyExecutive Summary: The aims and expected benefits of providing the children’scommunity nursing service are; to reduce the number ofchildren admitted to hospital, reduce the length of in-patientstay when admission is unavoidable, and promote child andfamily satisfaction with children's health services as a whole.This policy sets out the criteria required for admission to theservice and it clarifies who holds responsibility for the childwhilst they are a patient of the CCNT.Supersedes: Hospital at Home Operational Policy 2005Description ofAmendment(s):This policy has been updated and amended taking into accountcomments obtained throughout the consultation.This policy will impact on: The Children’s Ward, CCNTFinancial Implications: Non KnownPolicy Area: Children’s Services DocumentReference:Version Number: 1 Effective Date: November 2009Issued By:Authors:Women’s & Children’sServicesReview Date: October 2012Impact AssessmentDate:Consultation Phase:APPROVAL RECORDCommittees / GroupPaediatricians, Children’s Nurses,Modern Matron / CNM –Paediatrics, Associate DirectorW&CBU, A&E ConsultantDate4/11/09 – 11/11/09Director Women andChildren’sMr V Hall…………………..Associate DirectorMrs G Hopps……………….Received for information:Children’s Community TeamOperational Policy CA 2009-10-15Review 20121

Children’s Community teamOperational PolicyIntroductionThe Children’s Community Nursing (CCN) Team provides family centred,acute/chronic nursing care in the child's own homeAlthough the majority of families prefer home-based care, the psychological,sociological and economic reasons why families may prefer hospital admission arenot underestimated and the theme of supportive collaboration underpins thephilosophy of the CCN Service.The aims and expected benefits of the service are; to reduce the number of children admitted to hospital reduce the length of in-patient stay when admission is unavoidable promote child and family satisfaction with children's health services as a wholeAlthough the majority of families prefer home-based care the psychological,sociological and economic reasons why families may prefer hospital admission arenot underestimated and the theme of supportive collaboration underpins thephilosophy of the CCN Service.Service Accommodation and ManagementThe CCN team's office is located on the Children's Unit. Members of the team reportto and obtain their work allocation from this office on a daily basis.The team has one master diary in which all planned visits and phone calls arerecorded, this diary is utilised to record data of daily activity.All relevant admission details and nursing records are filed and stored securely in thisoffice and are filed accordingly in the patients medical notes at the end of the episodeof illness. (See Guidelines on Notes storage)Members of the CCN team report directly to the Clinical Manager - Children'sServices who in turn reports to the Clinical Lead for Paediatrics and the AssociateDirector, Women and Children's Business Unit.The day to day management of the team's caseload is the responsibility of theChildren’s Community Team Leader.Children’s Community TeamOperational Policy CA 2009-10-15Review 20122

Nursing visits are planned between the hours of 07:30 and 20:00. Visits are plannedaccording to clinical need, to a maximum of three per day / per patient. Nurses willundertake approximately 6 – 10 visits per shift depending on the nursing workloadand patient dependency.During operational hours nursing staff are available via mobile phone and officephone contact for parents. Parents are also given the inpatient unit's contact detailsshould they need to seek help or advice outside these hours.All staff adhere to the ECT Lone Worker policy and are provided with panic alarmsalong with a mobile phone. Community staff contact the children's ward at the end ofeach shift and it is the responsibility of the night staff to ensure that the communitystaff has phoned to say they arrived home safely at the end of their shift.Due to the nature of the service team members in main work independently inpatients homes Clinical Supervision is available and should be accessed on amonthly basis as a minimum.Safeguarding supervision is available on an as needed basis for all members of thecommunity team. The team leader should meet with the Named Nurse forSafeguarding Children at least three monthly for Safeguarding SupervisionAdmission CriteriaChildren can be admitted under the care of the CCN team after being an inpatient onthe children’s unit if:- Home based care is appropriate for the child’s condition- A Consultant or relevant middle grade doctor has examined thechild and documented the plan of care in the integrated medicalnotes- A member of the CCN team has carried out a nursing assessmentof the child and agrees that the plan of care is appropriate for homenursing.- At discharge the child's clinical condition meets the relevantdischarge criteria (see Appendix 2).- Adequate visiting time is available to complete the prescribed planof care.- The child's GP is informed of the transfer of care.Once care has been transferred to the CCN team from the children’s unit:- The Consultant Paediatrician retains overall clinical responsibility forchildren whose care has been transferred to the CCN team.- Electronic monitoring equipment and consumables will be providedby the Children's Unit, Consumables will either be provided throughGP prescription or from the CCNT budget as appropriate.Children’s Community TeamOperational Policy CA 2009-10-15Review 20123

- Referrals to relevant Allied Healthcare Professionals/SpecialistNurses and other community services will be made as appropriateby the CCN.- All patients receiving care from the CCN team will have OpenAccess to the Children's Unit and direct access to a paediatrician.- All in- patient referrals receiving input from the CCN team wouldhave open access to the children’s Unit and direct access to aPaediatrician.- If the need for medical attention is urgent the CCN has the right toarrange admission to the ward directly.-Under no circumstances will staff transport patients in their own cars.DocumentationA comprehensive plan of care will be discussed and agreed with the medical staffand family prior to transfer home. This plan of care will be evaluated at regularintervals and amended as required.A written nursing evaluation and record of care will be completed at each visit. This,along with any clinical observations, will be recorded in the CCN care record. Thenursing care record will be filed and securely stored in the CCN team office whilst thechild is receiving care from the CCN team. (See notes storage guidelines).A CCN information booklet with contact details and times of arranged visits will be leftat the child's home; parents are encouraged to write notes and observations to aidthe CCN team in evaluating their child's progress.An up to date reference list of all patients receiving input from the team will be kepton the Children's Unit.Discharge from the CCN serviceNursing visits will continue until the prescribed plan of care is complete. At this pointthe member of the CCN team directly responsible for the child's care will:- Complete a discharge summary and distribute accordingly.- Inform the relevant Consultant Paediatrician of the discharge.- Inform the child's GP of the discharge.- Inform the Health Visitor / School Nurse as appropriate.- Ensure that any planned outpatient follow up is arranged.- Ensure that all documentation is filed appropriately in the child’smedical records.- Return the medical notes to the Children's Unit ward clerk fordischarge.Children’s Community TeamOperational Policy CA 2009-10-15Review 20124

Appendix 1MedicalAcute conditions e.g. IV antibiotics,D&V, dehydration and pyrexia.Endocrine conditions.Asthma, o2 dependentchildren,neonate, feeding issuesDiabetes ViralGeneralSurgeryHernia repairOrchidopexyAppendicectomyCircumcision, Wound CareDay Surgery follow-upOrthopaedicsExternal fixationPerthes diseaseComplexneedsTrachestomy careGastrostomy careOxygen dependentTertiaryCareOncologyCystic FibrosisRheumatologyCardiologyGastroenterologyDermotologyAtopic EczemaAllergy testingPsoriasisOpthalmologyAdministration of eye dropsFollow up of day surgeryChildren’s Community TeamOperational Policy CA 2009-10-15Review 20126

Appendix 2 CCN Team Clinical GuidelinesClinical GuidelineDischarge Criteria Viral or bacterial infection Focus of infection identified and documented. No rash evident on referral. Less than 5% dehydrated. Tolerating a minimum of 10ml/kg/hr. Have shown evidence of urine output. Parents are competent at giving medication.Clinical GuidelineDischarge Criteria Gastroenteritis Child must be less than 5% dehydrated. Be tolerating a minimum of 10ml/kg/hr. Have shown some evidence of urine output.Clinical Guideline Asthma or viral associatedwheezeDischarge Criteria A diagnosis is established and documented in the relevantnotes. Clinical observations must be stable post broncodilator(i.e. respiration rate within normal limits for age. Tolerating fluids. Parents and child educated in the use of inhalers (andaccompanying devices) and deemed competent in theiruse. Information (verbal and written) on the effects of secondhand smoke given to parents.Clinical Guideline Intravenous Antibiotic Therapy(IVAB)Discharge Criteria Focus of infection identified and documented Clinical observations must be stable for a minimum of 4hours prior to discharge) All known allergies documented. Appropriate intravenous access is established prior todischarge (e.g. peripheral cannula, peripheral long line,central line, portocath) Intravenous antibiotic therapy (type, frequency and duration)and anaphylaxis drugs are prescribed prior to discharge. The first dose of antibiotic therapy regime is given on theChildren’s Unit- any adverse reactions are documented andchanges to the regime made as indicated. Antipyretic therapy should have been commenced and beeffective. Up to three nursing visits per day Parents are given written instructions on how to care for thedevice used for intravenous access prior to dischargeChildren’s Community TeamOperational Policy CA 2009-10-15Review 20127

Appendix 3 Clinical CompetenciesNursing grade Skills and Competencies Qualification / LevelBand 6 Children's Nursing Qualification. RSCN / RN - child / relevant 1 st leveldegree Specialist Practitioner Children’sCommunity Nursing 1 St Level DegreeChild protection training.VenepunctureIV antibiotic administration viaperipheral and central lines Level 3Administration of cytotoxic drugsWound dressingsPaediatric Life SupportMentorship and assessingClinical supervisionAPLS Level 3Band 5 Children's Nursing Qualification.RSCN / RN - child / relevantChild protection training.VenepunctureIV antibiotic administration viaperipheral and central linesAdministration of cytotoxic drugsWound dressings Level 2Paediatric Life SupportPLSMentorship and assessingClinical supervision Level 3Appendix 2 –Equality and Human Rights Policy Screening ToolChildren’s Community TeamOperational Policy CA 2009-10-15Review 20128

Policy Title: Children’s Community team Operational PolicyDirectorate: Women & Children’sBusiness UnitName of person/s auditing / authoring policy: Sr Claire AndrewsPolicy Content:For each of the following check whether the policy under consideration is sensitive to people of adifferent age, ethnicity, gender, disability, religion or belief, and sexual orientation?The checklist below will help you to identify any strengths and weaknesses of the policy and tocheck whether it is compliant with equality legislation.1. Check for DIRECT discrimination against any minority group of PATIENTS:Question: Does the policy contain any statements whichmay disadvantage people from the following groups?ResponseActionrequiredResourceimplicationYes No Yes No Yes No1.0 Age? X1.1 Gender (Male, Female and Transsexual)? X1.2 Learning Difficulties / Disability or CognitiveXImpairment?1.3 Mental Health Need? X1.4 Sensory Impairment? X1.5 Physical Disability? X1.6 Race or Ethnicity? X1.7 Religious Belief? X1.8 Sexual Orientation? x2. Check for DIRECT discrimination against any minority group relating to EMPLOYEES:Question: Does the policy contain any statements whichmay disadvantage employees or potential employees fromany of the following groups?ResponseActionrequiredResourceimplicationYes No Yes No Yes No2.0 Age? X2.1 Gender (Male, Female and Transsexual)? X2.2 Learning Difficulties / Disability or CognitiveXImpairment?2.3 Mental Health Need? X2.4 Sensory Impairment? X2.5 Physical Disability? X2.6 Race or Ethnicity? X2.7 Religious Belief? x2.8 Sexual Orientation? xTOTAL NUMBER OF ITEMS ANSWERED ‘YES’ INDICATING DIRECT DISCRIMINATION = 0Children’s Community TeamOperational Policy CA 2009-10-15Review 20129

3. Check for INDIRECT discrimination against any minority group of PATIENTS:ActionQuestion: Does the policy contain any conditions or Responserequired Resourcerequirements which are applied equally to everyone, butimplicationdisadvantage particular people because they cannotcomply due to: Yes No Yes No Yes No3.0 Age? X3.1 Gender (Male, Female and Transsexual)? X3.2 Learning Difficulties / Disability or CognitiveXImpairment?3.3 Mental Health Need? X3.4 Sensory Impairment? X3.5 Physical Disability? X3.6 Race or Ethnicity? X3.7 Religious, Spiritual belief (including other belief)? X3.8 Sexual Orientation? X4. Check for INDIRECT discrimination against any minority group relating to EMPLOYEES:Question: Does the policy contain any statements whichmay disadvantage employees or potential employees fromany of the following groups?ResponseActionrequiredResourceimplicationYes No Yes No Yes No4.0 Age? X4.1 Gender (Male, Female and Transsexual)? X4.2 Learning Difficulties / Disability or CognitiveXImpairment?4.3 Mental Health Need? X4.4 Sensory Impairment? X4.5 Physical Disability? X4.6 Race or Ethnicity? X4.7 Religious, Spiritual belief (including other belief)? X4.8 Sexual Orientation? XTOTAL NUMBER OF ITEMS ANSWERED ‘YES’ INDICATING INDIRECT DISCRIMINATION = 0Signatures of authors / auditors: Date: 17/11/09Equality and Human Rights Compliance / Percentage CalculationNumber of ‘Yes’ answers for DIRECT discrimination. 0Number of ‘Yes’ for INDIRECT discrimination. 0Total answers for POLICY CONTENTS discrimination. 0Percentage content non compliant 0Children’s Community TeamOperational Policy CA 2009-10-15Review 201210