SOUTHERN WEST MIDLANDS NEWBORN NETWORK Hereford, Worcester, Birmingham, Sandwell & Solihull Staffordshire, Shropshire & Black Country Newborn Network

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1 SOUTHERN WEST MIDLANDS NEWBORN NETWORK Hereford, Worcester, Birmingham, Sandwell & Solihull Staffordshire, Shropshire & Black Country Newborn Network TRANSPORT USER GROUP Minutes of meeting held on Friday 27 April 2012 Seminar Room, Education Resource Centre Birmingham Women s Hospital B15 2TG Present: Jackie Harrison, Nurse Consultant, WM Neonatal Transfer Service (Chair) Mary Passant, Network Manager, SWM Newborn Network Ruth Moore, Network Manager, SSBC Newborn Network Alex Philpott, Transport Consultant, WM Neonatal Transfer Service Amrit Dhillon, Transport Consultant, WM Neonatal Transfer Service Alison Bedford Russell, Consultant Neonatologist, BWH Melody Bridges, West Midlands Specialised Commissioning Team Carol Edwards, Senior Neonatal Nurse, Hereford Hospital Kate Palmer, Consultant, UHNS Vidya Garikapati, Heartlands Hospital Andrew Short, Consultant, Worcester Royal Hospital Imran Ahmed, ST7 Registrar, Heartlands Hospital Kath Fradley, ANNP, WM Neonatal Transfer Service Julie Crabtree, Sister, UHNS Jenny Lamb, ANNP, Royal Shrewsbury Hospital Anju Singh, ST7 Registrar, Birmingham Women s Hospital Jyoti Kapur, Registrar, Birmingham Women s Hospital Nikki Baker, Transport Nurse, WM Neonatal Transfer Service Maria Francis, Transport Nurse, WM Neonatal Transfer Service Dianne Catli, Transport Nurse, WM Neonatal Transfer Service Sarah Cormack, ANNP, WM Neonatal Transfer Service Joan Taylor, Sister, City Hospital Dudley Road Jane Edwards, Administrator, WM Neonatal Transfer Service Apologies: Alyson Skinner, Consultant, Royal Wolverhampton Hospital Julia Uffindell, UHNS Jo Mills, Transport Nurse, WM Neonatal Transfer Service Maxine Vincent, Transport Nurse, WM Neonatal Transfer Service Debbie Tompkins, ANNP, WM Neonatal Transfer Service Catherine O Connor, Transport Nurse, WM Neonatal Transfer Service Wendy Tyler, Royal Shrewsbury Hospital Judith Forbes, Cot Locator, WM Neonatal Transfer Service Gail Lloyd, Sister, Walsall Manor Hospital Collette Harvey, Russells Hall Hospital Julie Harcourt, Birmingham Women s Hospital 1

2 2. 3. Minutes of meeting held on 10 October 2011 The previous minutes were read and agreed: Actions - Parents travelling in the back of the ambulance ongoing guideline currently being drawn up by Maria Francis, Transport Nurse - Terms of reference comments have been included in document - AP confirmed that units must contact WMNTS in advance to give notification of any possible gastroschisis transfers (during normal working hours) - Stabilisation time audit to be presented in this meeting - Refusals audit to be presented in this meeting - Service information has been given to the Commissioning team - Transport Medicine Study Day flyer was re-circulated - MP confirmed she circulated electronic copies of contact information for surgical and PICU transfer requests (Appendix 8) - Feedback from parent questionnaires carried forward, more replies are required JH confirmed that all new transport guidelines put forward to Birmingham Women s Hospital for approval and automatically forwarded to both networks Transfer Activities TRANSFERS JH presented information for 2010/12 (Appendix 1, 1a and 1b) A total of 1,074 transfers were performed for the year by WMNTS. Transfer data for each unit is available via Jane Edwards if required. JH commented that the number of back transfers for Worcester, New Cross and Heartlands has increased this year. Royal Shrewsbury and UHNS (Stoke) surgical activity has also increased. MP said that due to staffing issues at Birmingham Women s Hospital it was necessary to transfer babies out for cot management purposes this year. 5 YEAR ACTIVITY Total number of WMNTS transfers dropped 2011/12, to coincide with both CenTre and BCH PICU teams being fully operational from September WMNTS are now the 3 rd busiest neonatal transfer team in the country. JH presented a map (Appendix 1a) indicating the scope and distance of WMNTS transfers in the UK. TRANSPORT INTEREST GROUP MEETING MARCH categories of time critical transfers were agreed for the CQUINS appraisal, data to be collected from April Gastroschisis - Ventilated TOF - Perforated NEC - Cardiac not responding to prostin Overall transfer and response times will be reviewed. Andrew Short enquired about the definition not responding to prostin. JH said the UK TIG are currently drawing up a paper to clarify the categories Anju Singh recently completed a prostin guideline for the SWM network which includes this aspect. Action MF JA 2

3 OTHER TIME CRITICAL TRANSFERS Birmingham Children s Hospital is formulating a gastroschisis guideline and is conducting an audit to see whether the babies are transferred within a 2 hour time period. KP asked who does the Liverpool transfers, JH said to call Alder Hey The KIDS team are to be contacted if beds are required at Birmingham Children s Hospital. CDH babies should be delivered at Birmingham Women s Hospital. RM/MP to take back to the surgical board for discussion. ABR commented that gastroschisis babies are not meeting the 2 hour surgical requirement target; any delay may compromise the gut. The target can be met if the unit is well organised and both the WMNTS and surgical ward are called in advance. Other babies could then be transferred to create space if required. AP commented that whilst WMNTS are waiting for gastroschisis babies to be born they may have to perform other ITU calls (some calls may be at UHNS ie 1 hour away). The KIDS team can be contacted and assistance requested if WMNTS are on another call. WMNTS said that occasionally the surgeon at the receiving unit is not available to accept the gastroschisis baby thus delaying the transfer time. ABR said the prospective audit should pick up this information but asked staff to complete a form highlighting any delays/areas for improvement, and this can be analysed by the Birmingham Children s Hospital surgeon. ABR said there should be albumin available on the units for gastroschisis babies (do not routinely give normal saline). However if non-availability of albumin is delaying the transfer, WMNTS staff must speak to the surgical ward so they can get albumin ready for when the baby arrives. ABR stressed the importance of photocopying the antenatal diagnosis / counselling / in the maternity and baby s notes ready for the transfer team as the surgeon requires a copy. OUT OF REGION SURGICAL TRANSFERS There were 3 appropriate surgical transfers out of region during 2011/12 (cases that required external intervention) and 3 inappropriate transfers due to no cot availability at Birmingham Children s Hospital The above information is based on transfers performed by WMNTS. Any transfers carried out by KIDS or individual neonatal units need to be reported to obtain the whole picture. JH reviewed 5 years surgical data and confirmed the out of region transfers had significantly decreased. RM/MP 4. Clarification of Escalation Policy / Cot Management If units need to transfer babies out due to overcapacity or staff shortages, a senior member of staff must contact the WMNTS who will then triage the call. CQUINS state it is the neonatal unit s responsibility to ensure babies are back on their own unit as soon as possible. Units are reminded it is costly to employ the WMNTS on call/night team for a cot management back transfer; in addition it may take the team away from any potential ITU transfer. It was noted that some units are not choosing the correct baby for transfer and the Consultant is not always involved in the decision. JL confirmed that a baby was recently transferred out of region from Worcester to Wrexham as there were no beds available at Shrewsbury. The baby was taken nearer to its home address. RM said staff need to look at the bigger picture and if it is best for the family and the Consultant is happy, the transfer is acceptable. 3

4 JH confirmed that CQUINS dashboard information is collated by units detailing babies transferred between units, local repatriations and exception reports are generated where repatriations have been delayed. 5. Governance Issues/Clinical Incident Reporting (Appendix 2) 6. Training 73 incidents were reported 2011/12 equating to 7% of total transfers for the year. Temperature incidents are recorded when the baby s temperature is less than 36 C. Communication incidents usually relate to when the team are delayed waiting for information, if a baby is infected and other parties are not aware Equipment incidents have risen drastically due to wear and tear on WMNTS kit JH confirmed that incidents are followed up by writing to individual units. ABR asked whether WMNTS could request units to transfer notes across from Badger to the receiving unit, instead of being delayed waiting for information during time critical transfers. AP was concerned that by doing so, WMNTS would not be in possession of the full picture as they would not have all of the baby s history. It was decided to look at minimum information required by WMNTS for time critical transfers and to set a time limit for the referring unit to collate records (1 hour?). IA agreed that a time limit would be a good proposal and prevent potential incorrect diagnosis by cutting corners. If units are happy to accept minimum history and WMNTS are able to give a hand over on this basis, AP is happy to accommodate. Proposal to be put forward to Clinical Leads and Nurse Managers in both networks. MP suggested this is trialled with time critical babies primarily. WMNTS STUDY DAY 15 delegates attended the Transfer Medicine Study Day held on 15 December were students from the SSBCNN Feedback was good, the few negative comments were about the venue WMNTS are involved in the forthcoming HiE Study Day to be held by SWMNN at Friars Gate on 18 June 2012 There will be further Transfer Medicine Study Days in both networks: - SWMNN multidisciplinary study day, November 2012, date to be notified - SSBCNN 4 th December 2012, venue Keele University UHNS complex Sonia Saxon, WMNTS ANNP, is hoping to offer outreach study days on level 1 (SCBU) units soon SpR FEEDBACK JK commented that it is very useful to have an element of transport included in the SpR competencies She commented that being in the back of an ambulance on your own with a nurse is very different to working on the unit as the space is confined and you have sole responsibility Managing clinical conditions within a transport environment proved to be clinically useful Communication was difficult whilst within transport as there were inconsistencies on how calls were triaged / managed and what calls were accepted / refused. Responsibility rested with the team leader to base their decision on clinical or personal judgement. JK would like to see a WMNTS guideline in place detailing acceptable transfers and which ones should be refused (eg CenTre network calls) for future SpRs The management experience was very useful because even though you liaise with Consultants and have their full support, you actually lead the team. JK said that she learnt to use transport equipment proficiently AP JH 4

5 She also experienced dealing with different people at all levels on various units JK feels that all SpRs should receive training in the transport environment. Feedback is required from all Deanery posts and used to promote the achievements and implement a future training pathway. JK said that units need to look at where trainees are in relation to transport competencies. Anju Singh has formulated a set of SpR transport competencies for review, to be combined with the Nurses and ANNPs. Anju Singh and JK both agreed that 3 months is too short a time to spend within transport, a longer period is required in order to experience different transfers and scope 7. Cot Locator / Single Number Update COT LOCATOR JH confirmed that WMNTS recently re-circulated flyers detailing cot locator contact numbers/operating times and that the cot status is updated twice daily on the website. All requests are documented. Andrew Short would like to know how many antenatal transfers went out of region. Andrew Short would also like to know the number of cardiac and cooling babies transferred by WMNTS. JE to supply Worcester transfer information IUT information is collected by Judith Forbes, cot locator clerk but as the service only currently operates Monday Friday 9am-5pm it is impossible to retain a complete record when babies/mothers are transferred out directly by their unit without cot locator involvement. SINGLE NUMBER UPDATE JH stated that there have been numerous meetings with Birmingham Children s Hospital and a business plan has being put forward for approval. Changes in both services may be required to meet this standard. She is hoping to be able to proffer additional information soon. 8. Therapeutic Hypothermia Audit Dr Vidya Garikapati VG circulated a new cooling collection form (Appendix 3) and proposed a prospective audit to currently run alongside TOBY data The aim of the form is to ensure the baby is receiving standardised care All present commented that the form was straightforward but many useful comments were made and adjustment of the forms will need to be made. ABR queried whether VG could use the same audit tool as the East of England as they presented excellent data at the Neonatal Society and this would ensure consistency KP made a valid point that not all babies are transferred to other units for cooling; some babies remain on their home unit. Badger will collate information on babies who are cooled and remain on the unit VG would like to share the information with other cooling centres in both networks It was suggested the wording of when the time cooling commenced by WMNTS needs to be amended slightly to read Time baby transferred over to transport incubator AP commented that people s definition of active and passive cooling is very different and this needs clear definition. AP/SS/NB and VG to go out and review other team s paperwork Anju Singh said there can be 2 different cooling methods depending on what the team have access to eg active back to passive (WMNTS do not currently have cooling equipment) Time at which cooling commenced is taken at the age of the baby. JE AP 5

6 JC commented that if the temperature was recorded at the point of cooling, this could not be done in the middle of resuscitation Temperature to be recorded every 15 minutes It was queried whether WMNTS retain the data Referral pathway to be agreed; referring unit start filling in the form and hand over to WMNTS for completion. WMNTS to fill in the details of interventions they perform; it is the responsibility of the referring unit to fill in all other details; this must not delay the transfer. Collection form to be circulated with minutes any comments to be sent to VG who will complete a formal draft following comments received. 9. Audits COOLING ACTIVITY (Appendix 4) NB presented her cooling data for 2011/12 SURGICAL TRANSFER ACTIVITY Previously mentioned under section 3 STABILISATION TIMES AUDIT (Appendix 5 and 5a) JH presented a stabilisation time audit on behalf of Maxine Vincent, Transport Nurse The audit detailed all ITU transfers that went over the agreed stabilisation time of 2 hours. Table 2 gives the reason for delay. 119 did not achieve the target transfer rate out of 1,037 transfers WMNTS will not depart until the transfer letter is ready Andrew Short would like a breakdown of how many babies were not ready for transport per unit, information should be sent to each unit A more in depth breakdown of stabilisation times is required REFUSALS AUDIT (Appendix 6) KP enquired whether a back transfer to a paediatric ward for cot management would be carried out. JH confirmed that this is a valid transfer and should not be refused JH confirmed that PDAs are not undertaken unless there are 2 teams available. KP stressed there may be a clinical risk where the baby needs to be admitted and asked who would be responsible in such a case. JH replied that it is easier to transfer a PDA in the morning or if it has been pre-planned, the main problem for WMNTS is that it can take a team out of service for the whole of the day on occasion Neonatal units perform PDAs themselves as WMNTS are currently short staffed due to maternity leave, sickness, annual leave commitments and vacant posts It was suggested that Birmingham Children s Hospital set aside a regular day for drive through transfers so that an additional team could be rostered, staff levels permitting ABR suggested MP and herself take suggestion to Birmingham Children s Hospital CEO and for Mel Bridges to take forward to the Clinical Quality Assurance meeting at Birmingham Children s Hospital The major issues and impact (governance risks) of depleting staff from WMNTS and neonatal units must be highlighted MF MP/ABR/ MB 10 Any Other Business CONTINGENCY ARRANGEMENTS Ruth Moore (Appendix 7) There have been 2 occasions in 12 months where WMNTS have not been able to provide a transport team for a short period of time due to sickness and annual leave After raising the issue at SSBCNN December board meeting, RM has drawn up a short draft statement detailing contingency arrangements 6

7 Andrews Short asked whether time critical/non time critical transfers had been considered and whether the proposal had been discussed with KIDS. The draft has been agreed in principle by WMNTS and SWMNN and will be circulated to all units for comment KIDS and neighbouring transfer services to be made aware of the statement JE JE Updated Parent Leaflet The updated leaflet is now in circulation Parent Feedback Questionnaires Carried forward to next meeting JA SSBCNN Transport Lead KP said that there was no appointment made following the SSBCNN Transport Lead interviews January 2012 Interviews to take place 8 May for a 6-12 months substantive post NOTE: The 2 PAs SSBCNN Transport Consultant vacancy has now been appointed to, and Dr Amar Asokkumar will commence in post August 2012 for 12 months WMNTS Charity Quiz Night Due to take place 25 May 2012 at Barnt Green Sports Club, for further details contact JE or Sonia Saxon 11. Date of Next Meeting Monday 15th October Walsall Manor Hospital, Seminar Room 9, Manor Learning & Conference Centre Route 301, Manor Hospital, Moat Road, Walsall West Midlands WS2 9PS ACTION POINTS JOINT TRANSPORT GROUP Meeting held on the 27 April 2012 Parents travelling in the ambulance guideline in progress Feedback from parent questionnaires to be circulated CDH babies to be discussed with the surgical board Minimum transfer records required by WMNTS to be decided together with a maximum time span for referring unit to collate data Worcester transfer information to be supplied to Andrew Short Transfer requests flow chart to be instigated Other team s cooling paperwork to be reviewed Further breakdown of stabilisation times is required Draft contingency arrangement to be circulated to all units/with minutes Draft contingency arrangement to be sent to KIDS and neighbouring transport teams Parent questionnaire to be discussed at next meeting Maria Francis Jo Arnold Ruth Moore/Mary Passant Alex Philpott to write to clinical leads for consensus Jane Edwards Jackie Harrison Alex Philpott Maria Francis Jane Edwards Jane Edwards Jo Arnold 7