HDU policy Management of children requring Critical care and transfer to tertiary care Version: 2.0 Final Authorised by: Children's clinical governance group Date authorised: January 2017 Next review date: Janaury 2020 Document author: Dr A.Petkar Author designation: Consultant Paediatrican
VERSION CONTROL SCHEDULE Version Number Issue Date Revisions from previous issue 1.0 November 2013 New Policy 1.1 December 2016 Additions to defintion and monitoring 2.0 Janaury 2017 Ratified VERSION 2.0 Page 2 of 6
TABLE OF CONTENTS INTRODUCTION... 4 PURPOSE... 4 SCOPE... 4 DEFINITIONS... 4 DUTIES... 4 POLICY STATEMENT... 4 Implementation... 6 Review... 6 Monitoring... 6 Bibliography... 6 VERSION 2.0 Page 3 of 6
INTRODUCTION Communication between all professionals and anticipatory planning are important aspects of care of sick children. PURPOSE This document aims to provide guidance to all professionals caring for sick children who are receiving HDU care and may need transfer from secondary to tertiary provider for ongoing management of their health condition/s. SCOPE This guidance is applicable to all medical and nursing staff working on the children s ward. DEFINITIONS HDU- high dependency unit- There is a lack of clarity on what constitutes high dependency care in children. For the purpose of this document HDU care is described as care provided to a child who may require closer observation and monitoring than is usually available on an ordinary children s ward.there is change in this terminology and high dependency care is now described as paediatric critical care. NWTS- North West and North Wales transport service Difficult airway- A difficult airway is generally defined as a situation in which a clinician experiences difficulty with face mask ventilation, laryngoscopy, or intubation. DUTIES All paediatric medical and nursing staff working on the children s ward should be aware of the policy. Medical staff in anaesthesia and ENT should be made aware of this policy. POLICY STATEMENT 1. Any child receiving medical care in the high dependency area on the paediatric ward or 1:1 care on the children s ward must be discussed with the paediatric hot week consultant / paediatric consultant on call. 2. The paediatric consultant and anaesthetic team on call must be informed when the NWTS team are contacted for advice regarding management/ transfer of a sick child. 3. When a decision is made for transfer of a sick child to a tertiary provider after discussion with NWTS team or a tertiary specialist, this should be requested VERSION 2.0 Page 4 of 6
a) Within 48 hours for children receiving non HDU care for example, transfer of a child with pneumonia and pleural effusion and b) Within 24 hours for children receiving HDU care, for example, a child receiving 1:1 care and requires surgery or ENT procedure. If a transfer for assessment or management cannot take place within these time frames, then an alternate provider (another tertiary provider) should be contacted. 4. For children accepted by specialties at Royal Manchester children s hospital- When a child is accepted by a tertiary provider and cannot be transferred due to bed space not being available at the receiving hospital, the medical staff should discuss transfer of the child initially to the paediatric emergency department at RMCH for assessment/ admission by the accepting team. 5.1 The medical and nursing staff on the children s ward should undertake an assessment of the appropriate method of transfer depending on the child s condition and any underlying health problems which may destabilise the child s condition during transfer. 5.2 Consider involving the anaesthetic colleagues and NWTS team in discussion about transfer of sick children to a tertiary provider depending on the underlying health problem. 6. CHILDREN WITH DIFFICULT AIRWAY 6.1 All children with potentially difficult airway should have a written plan of management. This should be obtained promptly from tertiary specialists / paediatric intensivists once concerns regarding a difficult airway are raised. 6.2 A copy of the management plan should be kept in the HDU folder (forward to Sr Keane) and Open access folder (forward to Sr M.Morrisroe). 6.3 Children known to have difficult airway can be advised to attend children s ward or a&e for initial assessment of the acute illness which may be unrelated to the airway problem. On assessment, if there are concerns regarding airway compromise and/ or underlying respiratory pathology, the paediatric consultant should be contacted. The anaesthetic team and NWTS team should be involved early in the management if there are concerns regarding airway compromise. 6.4 Children with difficult airway should be transferred to a tertiary provider as per policy statement 3 and 4. 6.5 A careful assessment of airway and breathing should be undertaken to decide the need for transfer by NWTS or anaesthetic team. 7. Children awaiting transfer to the tertiary provider- the band 6 nursing staff/ nurse VERSION 2.0 Page 5 of 6
in charge will contact the tertiary bed manager on a daily basis to check for bed availability. The medical staff, paediatric middle grade / consultant will provide daily update to the tertiary specialist regarding the condition of the child. Implementation The policy was discussed in the children s clinical governance group meeting and disseminated to all medical and nursing staff working on the children s ward. The policy is applicable with immediate effect and is available on the intranet and resus folder kept on the children s medical unit. Review This policy will be formally reviewed as stated on the title page, or earlier depending on the results of monitoring, audit results, new national guidance or recommended changes in practice. Monitoring By ongoing yearly HDU audit undertaken by Sr Keane and regional critical care audit. The audit will be presented in the paediatric audit group. Bibliography Advanced Paediatric life support Paediatric difficult airway guidelines, Difficult airway society, UK High Dependency Care For Children Time to move on, RCPCH 2014 VERSION 2.0 Page 6 of 6