Paediatric Escalation Policy

Transcription

1 Paediatric Escalation Policy Specialty: Paediatrics Approval Body: WCH Quality and Safety Group Approval Date: 21 st January 2015 Date of Review: December 2018

2 PAEDIATRIC SERVICES ESCALATION POLICY FOR ABM UNIVERSITY HEALTH BOARD AIMS OF POLICY The purpose of this policy is to assist in providing a safe Paediatric Service across ABM University Health Board by clearly outlining the management process to be initiated in the event of increased activity, staff shortfall or serious clinical incident. It is rare that there will be a need to close the paediatric services and this would only be considered when all other potential solutions have been exhausted. However it is important to ensure there is a consistent management approach adopted across the Health Board with clear and safe alternative arrangements made for the care of children and young people. The individuals who are likely to be involved in the decision to close the service should be notified at an early stage of the risks. This course of action must be considered as part of the Health Boards risk management strategy. THE BLEEP HOLDER Within inpatient Paediatric Services on both Morriston and Princess of Wales site, a Bleep Holder system is in place for routinely managing day to day activity, staffing and acuity. The identified Bleep Holder for each ward is the most senior Children s Nurse working within the Clinical area and is responsible for measuring the activity and communicating to the appropriate personnel. In addition, an inpatient daily status activity report has been in operation since 1 st June 2009 and helps identify cross site workload on a daily basis. IDENTIFICATION OF INCREASING WORKLOAD PRESSURES When requesting additional help or escalating to senior management staff, the occupancy and dependency levels should be communicated as the common language. using SBAR Tool. It is expected that as well as the daily status report, the Bleep Holder / Lead Nurse Mon-Fri will: Assess the staffing levels at regular intervals and alert the senior management team of potential problems. Escalate status report to senior management team and initiate the agreed procedures for escalation. IDENTIFICATION OF A SERIOUS CLINICAL INCIDENT The Bleep Holder system is not only in place to measure occupancy and dependency but also for managing the situation following a Serious Clinical Incident. The identified Bleep Holder / Lead Nurse for Morriston site and nurse in charge at the Princess of Wales site is responsible for managing the situation, within the ward and communicating to the appropriate personnel (as outlined in appendix 5). It is expected that the Bleep Holder / Nurse in charge will ensure that when a Serious Clinical Incident occurs they will: Reassess the staffing levels, dependency levels and bed occupancy. Initiate the agreed procedures for escalation.

3 ESCALATION ALERT CATEGORIES When the children s ward on either site (Princess of Wales or Morriston) is faced with increasing activity, for example high activity levels, lack of bed capacity, a shortfall of staff, the Consultant and the Bleep Holder / Lead Nurse co-ordinating the ward should adopt the following escalation alert categories. These categories will be on display to all staff and will be standardised across the Child Health inpatient areas. GREEN: AMBER: RED: No problem with occupancy, dependency or staffing levels The pressure is building Little or no capacity for further admissions GREEN Continue with four to six hourly occupancy and dependency monitoring. AMBER ALERT Increase the monitoring of twice daily bed capacity and staffing levels across the Directorate to every 4 hours. If there is a shortfall in either bed capacity or lack of safe staffing levels commence the escalation procedure. The Bleep Holder will liaise with each of the Children s Inpatient Units across the Directorate to assess the bed occupancy and staff availability and will advise of the current position in their Unit. The area affected by high occupancy and dependency or staff shortages must be the priority, with all other areas providing support when required. The Bleep Holder and the Consultant Paediatrician will be responsible for identifying actions to implement and monitor these actions. Daily bed notices posting regular updates of bed capacity and staffing levels. The Bleep Holder together, with the Lead Nurse for Paediatrics has the responsibility to initiate the process of re-deployment of staff. This may initially be from within the unit. Once this option has been exhausted Children s Nurses from other areas within the Directorate will be asked to attend area of high activity. This may include re-directing community staff or clinic staff if deemed safe. A risk assessment of re-deployed staff should be undertaken to maximise skill mix to caseload demands. It is acknowledged on rare occasions staff will be requested to work across the whole Health Board (see appendix) The Medical Team will be responsible for reviewing all inpatients on the Unit to decide the most appropriate plan of care i.e. discharge home where possible, cancellation of elective procedures or transfer to other Units within the Trust. When all available rostered staff across the Health Board have been utilised consideration should be given to obtain extra shifts from existing staff, in the form of over time/extra hours and then bank staff. Repatriate any Specialist Nursing Staff to assist in area of high activity. Clinical Risk Form to be completed for each incident of activating the Escalation Policy

4 If pressure continues to escalate the Bleep Holder and the Consultant Paediatrician will be responsible for initiating RED ALERT and notifying the appropriate personnel as outlined in Appendix 5. RED ALERT Red Alert status represents an extreme situation where further activity could result in increased clinical risk leading to an unsafe Inpatient Paediatric Service. It is at this stage closure of the ward will be considered if all other actions have failed to improve the capacity. The decision to greatly restrict or close the service must be made following discussion with the Lead Nurse, Consultant Paediatrician on call, the Clinical Director, and Head of Nursing and the on call manager.. This procedure should occur at all times of day or night. The Clinical Director or Head of Nursing will inform the Executive on call It is the responsibility of the Consultant Paediatrician to co-ordinate the procedure for closure of the Inpatient Unit for Children & Young People and to divert all potential admissions to the nearest inpatient children s facility. (This will entail patients being assessed and if requiring inpatient facilities, prior to being transferred to nearest inpatient facility. This does not mean the hospital site diverts all children and young people to elsewhere until they have been assessed). If Children/Young People who are in-patients are to be transferred to another hospital the Bleep Holder /Lead Nurse in consultation with medical staff must make the required decision taking into account the distance to the receiving hospital and the clinical risk posed. It is the responsibility of the bleep holder and consultant on call to make the following contacts: Inform ED of bed capacity and reduction of patients. Neighbouring Paediatric Units should be informed of the situation and it might also be necessary to contact units further afield who will be willing to accept Children/Young People. All transfers from other Units should be refused In the event of transferring a Child/Young Person to another Unit a record of transfers should be maintained. If transferring a Child/Young Person in an ambulance to another unit a registered Children s Nurse will accompany them. It is the responsibility of the Bleep Holder to continue to measure the occupancy and dependency of the unit and as the situation improves in collaboration with the on call Consultant to decide when to step down to amber alert. Communicating the change in status must again be alerted to all key personnel as outlined in Appendix 5. A record of the actions, time of escalating and stepping down must be documented in the escalation record sheet outlined in appendix 4. An incident form must be completed and given to the Lead Nurse.

5 Appendix 1 FLOW CHART FOR INCREASING ACTIVITY Increased Activity Sufficient Staffing Continue to Monitor Beds Capacity across sites Increased workload Staffing levels not sufficient to cope with workload. Bleep Holder Cover with Extra Hours Bank within existing staff Unable to cover Inform Lead Nurse Paediatrics Increase frequency of bed capacity monitoring Communicate with Paediatric In- Patient Services off site E.g. Morriston,, Bridgend to provide cover, also CNS Unable to cover bleep holder to work clinically to ensure patient safety Inform Asst Head of Nursing/ Head of Nursing/DGM/CD Inform Lead Nurse Assess workload with medical staff Inform Hospital Bed Manager Discharge where appropriate Cancel routine cases Redeploy Specialist nursing Staff Agency Staff Assess all referrals and divert any referrals that require inpatient care

6 Appendix 2 CHECKLIST FOR MANAGING CAPACITY ISSUES REGARDING ESCALATION OF PAEDIATRIC UNIT (Please indicate which inpatient wards POWH/Morriston) Date Time Bleep Holder Number of Beds available Number of Cubicles available Number of Inpatients Number of HDU Patients Number of Staff available Swansea POW Paediatric Assessment Activity Number of Patients waiting to be admitted Numbers due to be discharged home Number of Patients requiring Short Stay Patients suitable to repatriate to either Morriston or Princess of Wales Repatriate any Children from another geographical area back to their Unit

7 Appendix 3 ESCALATION RECORD SHEET Date.. Time (Please indicate which inpatient wards POWH/Morriston) ACTIVITY Number Inpatients Number of HDU Patients Number of Staff Admissions pending Discharges pending.. MANAGEMENT PLAN ACTIONS TAKEN Signature Print Name and date

8 CLOSURE OF PAEDIATRIC UNIT (Please indicate which inpatient wards POWH/Morriston) Appendix 4 Date of Closure Time of Closure 1. Reason for Closure delete as appropriate Insufficient medical/nursing staff Inappropriate skill mix No beds Infection as directed by Microbiologist Major Incident/power failure Personnel notified of closure Date:.. Time:... Bleep Holder Lead Nurse Consultant Paediatrician Deputy Head of Nursing Head of Nursing Ambulance Control Clinical Director Bed Manager / A&E On-call Manager. Receiving Units asked to record names of Children directed to them Form completed by Name and designation Form to be retained within the department and sent with IR1 form

9 Appendix 5 RE-OPENING OF PAEDIATRIC UNIT Please indicate which inpatient ward POWH/Morriston) Date of Re-Opening Time of Re-Opening Total days/hours closed Days Hours.. Personnel notified of Re-Opening Date.. Time... Lead Nurse Deputy HON Children s services Head of Nursing Consultant Paediatrician Ambulance Control Clinical Director Bed Manager / A&E On-call Manager.... Receiving Units asked to record names of Children directed to them Form completed by Name and designation

10 Appendix 6 NAME OF HOSPITAL TIME OF PHONE CALL WHO YOU SPOKE TO COMMENTS MORRISTON OAKWOOD POW NEWPORT ROYAL GWENT CARMARTHEN ROYAL GLAMORGAN NEVILLE HALL PRINCE CHARLES MERTHYR TYDFIL UNIVERSITY HOSPITAL OF WALES ST MICHAELS BRISTOL SOUTHMEAD BRISTOL

11 Directorate of Women & Child Health Checklist for Clinical Guidelines being Submitted for Approval by Quality & Safety Group Title of Guideline: Paediatric Escalation Policy Name(s) of Author: Eirlys Thomas Chair of Group or Committee supporting submission: Myriam Bonduelle Issue / Version No: 2 Next Review / Guideline Expiry: December 2018 Details of persons included in consultation process: All Band 7 Registered Nurses in Child Health. Sian Passey, Eirlys Thomas, Sian Townsend. Consultant Paediatricians in Child Health Brief outline giving reasons for document being submitted for ratification To provide practitioners with a safe pathway during times of high activity Name of Pharmacist (mandatory if drugs involved): None Please list any policies/guidelines this document will supercede: Paediatric Services Escalation Policy dated December 2009 Keywords linked to document: Escalation, Paediatrics, Acuity, Activity Date approved by Directorate Quality & Safety Group: 21 st January 2015 File Name: Used to locate where file is stores on hard drive pow_fs1\abm_w&ch_mgt\clinical Governance - Q&S\Policies & Procedures etc - Ratified\Paediatrics