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1 tljbkûpeb^iqe j^qbokfqvrkfq ^ÇãáëëáçåíçíÜÉkÉçå~í~äråáí ^ãéåçãéåíë Date Page(s) Comments Approved by July 2012 Whole Document Document Reviewed Women s Health Guidelines Group Jan 2013 Admission to SCU criteria added and audit tool adjusted Women s Health Guideline Group `çãéáäéçäów qê~åéói~ïëçå `çåëìäí~åíkéçå~íçäçöáëí få`çåëìäí~íáçåïáíüwtçãéåûëeé~äíüdìáçéäáåédêçìé~åçi~äçìêt~êçcçêìãié~éçá~íêáåá~åë o~íáñáéçäów j~íéêåáíódìáçéäáåéëöêçìé a~íéo~íáñáéçw gìäóomno a~íéfëëìéçw gìäóomno kéñíoéîáéïa~íéw gìäóomnr q~êöéí^ìçáéååéw j~íéêåáíó~åçkéçå~í~äpí~ññ fãé~åí^ëëéëëãéåí`~êêáéç lìí_ów ^äáëçåeçïâéê `çããéåíëçåíüáëççåìãéåííçw ^äáëçåeçïâéêjj~íéêåáíój~íêçå o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öénçñnn

2 See also; Resuscitation at birth on Labour Ward guideline Extreme prematurity-threshold-of-viability guideline Transfer between Neonatal Unit and Ash ward guideline Homebirth Guideline Introduction This guideline is intended to cover the transfer of neonates between areas at St Peter s Hospital and admission to the neonatal unit. Communication process and duties of staff: When it becomes likely that a baby will need admission to the Neonatal Intensive Care Unit (NICU), the Labour Ward shift leader will liaise with NICU staff as soon as possible to check bed availability. A member of the paediatric medical team will endeavour to speak with the parents prior to the birth, particularly in the case of preterm babies. The mother and baby folder (purple folder on NICU) contains details of pending births where the baby may require admission to NICU and wherever possible a management plan will be filed in the mother and baby folder. When a midwife has concerns about a baby after the birth, whether on the postnatal ward or labour ward the midwife will ask for a paediatric review of the baby and the neonatal paediatrician will make the decision whether a baby needs admission to Special care or NICU. On a daily basis, the Labour Ward shift leader will liaise with the NICU nurse in charge in order to establish bed availability on NICU, and inform him/her of any anticipated admissions. They will liaise more frequently if there is a relevant change in clinical activity in either area. NICU documents on the NICU board. o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öéoçñnn

3 NICU admission criteria Admission to NICU should be routine for the following babies: Less than 34 weeks Less than 1.7kg Respiratory distress Poor condition at birth requiring resuscitation (consider admission if the cord ph is less than 7.0) Congenital abnormalities likely to threaten immediate survival Seizures Cyanosis Sepsis Jaundice, requiring intensive phototherapy Any other babies where there are substantial concerns Special care The 9 bedded Special care unit (SCU) is part of the neonatal Unit, and is staffed by neonatal nurses. The decision to admit to SCU is the responsibility of the Neonatal team, in discussion with the nurses in charge of SCU and the neonatal shift leader. There are slightly different admission criteria for transitional and special care, and availability will depend on the current admissions on the unit. The admission criteria below are not exhaustive please discuss with a senior colleague if you are unsure whether a baby should be admitted to SCU or NICU. Consideration for admission to SCU Transitional care (6 beds) Special care (3 beds) Preterm babies 35 weeks Preterm babies 34/40 Low birth weight babies 1.8kg Babies requiring nasogastric feeding (3 hourly) Babies on intravenous antibiotics:- Babies previously admitted to NICU who are completing a course of antibiotics Low risk babies e.g. GBS positive mothers with inadequate antibiotics in labour Neonatal Abstinence Syndrome Jaundiced babies requiring double phototherapy or monitoring than could not be managed on Joan Booker Ward (JBW) Low birth weight babies 1.7kg Babies requiring nasogastric feeding (2 hourly or less frequent) Babies on intravenous fluids e.g. for hypoglycaemia or establishing feeds. Babies with MILD respiratory distress that have been admitted to NICU for the first hours and need monitoring and less that 30% incubator oxygen. Infants with congenital abnormalities / syndromes Well babies < 10 days old o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öépçñnn

4 readmitted for poor feeding All babies admitted to SCU are the responsibility of the neonatal unit and therefore, admission is through liaising with the neonatal SHO who must discuss with the nurse in charge of SCU and the nurse in charge of NICU before agreeing admission. The baby must be accompanied by its mother in SCU. If mother is too unwell to be transferred to SCU, the baby must be admitted to NICU for observation, and should not be left on labour ward. Thermal care/monitoring during transfer: Babies on Labour Ward who require ongoing cardio-respiratory support should be transferred to NICU on a resuscitaire which has a ventilator, oxygen saturation and heart rate monitoring. Babies transferred from the postnatal ward where there is concern, may be transferred on the resuscitaire as above. Babies requiring transfer from other locations (i.e. A & E) to NICU should be transported in the transport incubator. An alternative NICU incubator may also be appropriate for transfer depending on the clinical circumstances. Babies transferred from the NICU to SCU, Joan Booker or Labour Ward, are usually stable babies who can be transferred in a cot. Babies who are transferred from NICU to other departments for investigations should be discussed with the transport team/attending consultant. Depending on the condition of the baby, it may be necessary to use the transport incubator, a NICU incubator or a pram depending on the clinical circumstances. Transfer between home and hospital: (see also homebirth guideline) If a baby born at home requires admission to hospital, the community midwife will arrange for an ambulance to attend and transport the baby to hospital she must accompany the baby in the ambulance. The ambulance team will notify ambulance control when a baby and/or mother is being transferred to hospital. The baby and mother should be transferred to Abbey Wing and if the baby is requiring the immediate attention of the neonatal team, the attending midwife should notify the Labour Ward shift leader and NICU in advance of their arrival so that they can make the neonatal paediatricians aware that a sick baby is being transferred in and the nature of the problem. The baby may be transferred in on the ambulance trolley when there are concerns. If the baby is on the trolley it should have a blanket on both sides and a strap across the trolley to keep the baby secure. Duties of staff during transfer from homebirth: The midwife is responsible for the care of the newborn baby until this is handed over to the neonatal medical staff. She is responsible for ensuring all midwifery paperwork is complete including the urgent generation of a hospital number for the baby and that the baby has identity labels. Reporting & learning lessons from unanticipated admissions to NICU All unanticipated admissions to the NICU will be notified via an incident reporting form. The Women s Health Risk Group will review all cases and agree any further investigations required. Admissions to NICU are also reviewed at the multidisciplinary perinatal morbidity meeting as appropriate. Any learning from these cases will be discussed at, unit staff meetings the perinatal morbidity meeting and disseminated via the communication bulletin or newsletter as appropriate. References NICE, 2007 Intraprtum care; care of women and their babies during childbirth: London Safer Childbirth: Minimum standards for the organisation and delivery of care in labour (2007) London: RCOG CESDI 5 th annual report: London, o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öéqçñnn

5 Monitoring Compliance with this with this guideline will be monitored by 3 yearly audit as detailed in the table below. Unanticipated admissions to NICU will be reviewed at the monthly perinatal meeting or case review Element to be monitored Lead Tool Frequency Reporting arrangement a. criteria for the admission of a sick newborn to LNU/NICU/SCU b. transport arrangements for the movement of a sick newborn from the labour ward or postnatal ward to LNU/NICU/SCU c. transport arrangements for the movement of a sick newborn into hospital from either a home birth or midwifery led unit when problems have been identified at birth d. process by which the maternity unit and neonatal professionals share information about activity on a daily basis e. process for reporting and learning the lessons from unanticipated admissions to LNU/NICU/SCU Alison Howker Audit tool attached 1% or 10 sets of admission to NICU/SCU Datix reporting 3 yearly Monthly CG meeting Perinatal meeting Risk meetings Acting on recommendations and Lead(s) Alison Howker matron Labour ward manager Neonatal consultants Change in practice and lessons to be shared Communication Bulletins, newsletters, staff meetings, individuals as appropriate. o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öérçñnn

6 Appendix1 Admission to the Neonatal Unit Audit Tool Where was the admission from? Labour Ward Joan Booker Ward A&E Home Criteria Reasons for admission to NICU <34 weeks <1.7 kg Respiratory distress Congenital abnormalities Cyanosis Jaundice, requiring intensive phototherapy Poor condition Seizures Sepsis Substantial concerns Other, please specify If transferred from Labour Ward or Joan Booker Ward to NICU Paediatrician reviewed the baby Decision to admit Complied with the admission criteria (as above) How was the baby transferred to NICU? Baby transferred from Labour Ward in a: Resuscitaire Cot Other, please specify Baby transferred from Joan Booker Ward in a: Resuscitaire Cot Other, please specify Transferred from A&E in transport incubator Transferred from home birth by ambulance, accompanied by Community Midwife &: Labour Ward notified Neonatal Team notified Was this baby an unanticipated admission? No If YES, was an incident form completed Incident form number o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öésçñnn

7 >>>PTO>>> Were the transport arrangements appropriate? No If NO, please specify here. Appendix1 Admission to the SCU Audit Tool Where was the admission from? Labour Ward Joan Booker Ward A&E /Home NICU Criteria Reasons for admission to SCU >34 weeks >1.7 kg Mild respiratory distress after 12-24hrs in NICU Nasogastric feeding required Neonatal abstinence syndrome Jaundice requiring double phototherapy IV antibiotics IV fluids e.g for hypoglycaemia Congenital abnormalities Readmission for feeding problems Other, please specify If transferred from Labour Ward or Joan Booker Ward to SCU Paediatrician reviewed the baby Decision to admit complied with the admission criteria (as above) How was the baby transferred toscu? Baby transferred from Labour Ward in a: Resuscitaire Cot Other, please specify Baby transferred from Joan Booker Ward in a: Resuscitaire Cot Other, please specify Transferred from A&E in transport incubator Transferred from home birth by ambulance, accompanied by Community Midwife &: Labour Ward notified Neonatal Team notified o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öétçñnn

8 Was this baby an unanticipated admission? No If YES, was an incident form completed Incident form number Were the transport arrangements appropriate? No If NO, please specify here. o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öéuçñnn

9 bnr^ifqvfjm^`q^ppbppjbkqqlli k~ãéw ^ÇãáëëáçåíçíÜÉåÉçå~í~äìåáí mçäáåólpéêîáåéwj~íéêåáíóëéêîáåéë _~ÅâÖêçìåÇ tüçï~ëáåîçäîéçáåíüébèì~äáíófãé~åí^ëëéëëãéåí qçéåëìêéåçåëáëíéåí~åçüáöüëí~åç~êçëçñå~êéïáíüáåíüéã~íéêåáíóëéêîáåék bëí~ääáëüéëíüéåêáíéêá~~åçéêçåéëëñçê~çãáííáåö~ä~äóíçkf`rçêíê~åëáíáçå~äå~êé ~åçíüéë~ñéíê~åëñéêçñíüéä~äóíçíüé~ééêçéêá~íé~êé~k j~íéêåáíópéêîáåéëä~äçìêå~êé j~íéêåáíódìáçéäáåéöêçìé jéíüçççäçöó ^ÄêáÉÑ~ÅÅçìåíçÑÜçïíÜÉäáâÉäóÉÑÑÉÅíëçÑíÜÉéçäáÅóï~ë~ëëÉëëÉÇEíçáåÅäìÇÉê~ÅÉ ~åçéíüåáåçêáöáåiçáë~äáäáíóiöéåçéêiåìäíìêéiêéäáöáçåçêäéäáéñiëéñì~äçêáéåí~íáçåi~öéf qüéç~í~ëçìêåéë~åç~åóçíüéêáåñçêã~íáçåìëéç qüéåçåëìäí~íáçåíü~íï~ëå~êêáéççìíeïüçiïüó~åçüçï\f fãé~åí~ëëéëëãéåíêéîé~äéçåççäîáçìëáãé~åíáçéåíáñáéç kl^ qüéãìäíáçáëåáéäáå~êóíé~ãçéäáîéêáåöã~íéêåáíóå~êéü~çíüéçééçêíìåáíóíç ÅçåíêáÄìíÉíçÇÉîÉäçéãÉåíçÑíÜÉéçäáÅóK héócáåçáåöë aéëåêáäéíüéêéëìäíëçñíüé~ëëéëëãéåí fçéåíáñóáñíüéêéáë~çîéêëéçê~éçíéåíá~ääó~çîéêëéáãé~åíëñçê~åóéèì~äáíáéë Öêçìéë kçáãé~åíáçéåíáñáéç `çååäìëáçå mêçîáçé~ëìãã~êóçñíüéçîéê~ääåçååäìëáçåë kçáãé~åí oéåçããéåç~íáçåë pí~íéêéåçããéåçéçåü~åöéëíçíüééêçéçëéçéçäáåó~ë~êéëìäíçñíüéáãé~åí ~ëëéëëãéåí tüéêéáíü~ëåçíäééåéçëëáääéíç~ãéåçíüééçäáåóiéêçîáçéíüéçéí~áäçñ~åó ~ÅíáçåëíÜ~íÜ~îÉÄÉÉåáÇÉåíáÑáÉÇ aéëåêáäéíüééä~åëñçêêéîáéïáåöíüé~ëëéëëãéåí fãé~åí~ëëéëëãéåíïáäääéêéîáéïéç~íåéñíéçäáåóêéîáéï o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öévçñnn

10 o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öénmçñnn dìáç~ååéçåbèì~äáíáéëdêçìéë o~åé~åçbíüåáåçêáöáåeáååäìçéëöóéëáéë~åç íê~îéääéêëfeåçåëáçéêåçããìåáå~íáçåi~ååéëëíç áåñçêã~íáçåçåëéêîáåéë~åçéãéäçóãéåíi ~åçé~ëéçñ~ååéëëíçëéêîáåéë~åç ÉãéäçóãÉåíF oéäáöáçåçêäéäáéñeáååäìçéçêéëëiáåçáîáçì~ä Å~êÉåÉÉÇëIÑ~ãáäóêÉä~íáçåëÜáéëIÇáÉí~êó êéèìáêéãéåíë~åçëéáêáíì~äåééçëñçê ÅçåëáÇÉê~íáçåF aáë~äáäáíóeåçåëáçéêåçããìåáå~íáçåáëëìéëi ~ÅÅÉëëíçÉãéäçóãÉåí~åÇëÉêîáÅÉëIïÜÉíÜÉê áåçáîáçì~äå~êéåééçë~êéäéáåöãéí~åç ïüéíüéêíüééçäáåóéêçãçíéëíüéáåîçäîéãéåí çñçáë~ääéçééçéäéf péñì~äçêáéåí~íáçåáååäìçáåöäéëäá~åiö~ó~åç ÄáëÉñì~äéÉçéäÉEÅçåëáÇÉêïÜÉíÜÉêíÜÉ éçäáåólëéêîáåééêçãçíéë~åìäíìêéçñçééååéëë ~åçí~âéë~ååçìåíçñáåçáîáçì~äåééçë déåçéêeåçåëáçéêå~êéåééçë~åçéãéäçóãéåí áëëìéëiáçéåíáñó~åçêéãçîéçêàìëíáñóíéêãë ïüáåü~êéöéåçéêëééåáñáåf ^ÖÉEÅçåëáÇÉê~åóÄ~êêáÉêëíç~ÅÅÉëëáåÖ ëéêîáåéëçêéãéäçóãéåíiáçéåíáñó~åçêéãçîé çêàìëíáñóíéêãëïüáåüåçìäçäé~öéáëíiñçê Éñ~ãéäÉIìëáåÖíáíäÉëçÑëÉåáçêçêàìåáçêF `ìäíìêéeåçåëáçéêçáéí~êóêéèìáêéãéåíëi Ñ~ãáäóêÉä~íáçåëÜáéë~åÇáåÇáîáÇì~äÅ~êÉ åééçëf pçåá~äåä~ëëeåçåëáçéê~äáäáíóíç~ååéëëëéêîáåéë ~åçáåñçêã~íáçåiñçêéñ~ãéäéiáëáåñçêã~íáçå éêçîáçéçáåéä~áåbåöäáëü\f fññìêíüéê~ëëéëëãéåíáëêéèìáêéçéäé~ëéëééíüéfåíéöê~íéçpáåöäébèì~äáíópåüéãék cçê~çîáåéáåêéëééåíçñ~åëïéêáåöíüé~äçîéèìéëíáçåëiéäé~ëéåçåí~åíj~êá~`êçëäáéieoj~å~öéêiçåéñíéåëáçåorrok

11 PROFORMA FOR RATIFICATION OF POLICIES AND GUIDELINES BY RATIFYING COMMITTEE Policy/Guidelines Name: Name of Person completing form: Admission to Neonatal Unit Alison Howker Date: July 2012 Author(s) Alison Howker (Principle contact) Name of author or sponsor to attend ratifying Alison Howker committee when policy/guideline is discussed Date of final draft July 2012 Has this policy/guideline been thoroughly proof-read to check for errors in spelling, typing, grammar and consistency? By whom: Women's Health Guidelines Group Is this a new or revised policy/guideline? Describe the development process used to generate this policy/guideline. Who was involved, which groups met, how often etc.? Women s Health Guidelines Group, Labour Ward Forum, Obs & Gynae Consultants; Paediatricians Who is the policy/guideline primarily for? Health Professionals working within the maternity service New Is this policy/guideline relevant across the Trust or in limited areas? Maternity Services How will the information be disseminated and how will you ensure that relevant staff are aware of this policy/guideline? Intranet, newsletters, staff notice boards Describe the process by which adherence to this policy/guideline will be monitored. (This needs to be explicit and documented for example audit, survey, questionnaire) See monitoring section of policy Is there a NICE or other national guideline relevant to this topic? If so, which one and how does it relate to this policy/guideline? See reference section of policy What (other) information sources have been used to produce this policy/guideline? See reference section of policy Has the policy/guideline been impact assessed with regard to disability, race, gender, age, religion, sexual orientation? No impact Other than the authors, which other groups or individuals have been given a draft for comment?(e.g. staff, unions, human resources, finance dept., external stakeholders and service users) All obstetric Consultants, Women's Health Guidelines Group, Labour Ward Forum, Paediatricians Which groups or individuals submitted written or verbal comments on earlier drafts? Any comments received considered by Women s Health Guidelines Group and consultant paediatrician Who considered those comments and to what extent have they been incorporated into the final draft? All comments considered Have financial implications been considered? o~íáñáéç gìäóommv gìäóomno i~ëíoéîáéïéç gìäóomno fëëìé O m~öénnçñnn