Profile of Learning Opportunities for Student Physiotherapists ACUTE PAEDIATRIC PLACEMENT Completion Date September 2005 Review Date September 2007
INTRODUCTION Welcome to the paediatric team here at the Newcastle upon Tyne Hospitals NHS Trust. We hope that you enjoy this placement and that it allows you to consolidate all the skills you ve gained in your training so far, whilst gaining many more!! The aim of this pack is to give you an introduction to our team and information about your placement. Prior to starting your placement please do a SWOT analysis to enable you to identify areas for development and set your objectives for the placement. 2
CONTENTS Page Learning Zone 4 Area Profile 5 Who s Who 5 General Information RVI NGH FRH 6 9 12 Example Timetable 14 Learning Objectives Clinical Skills Management/Organisational Skills 15 16 3
LEARNING ZONE PICU Medical/Surgical Wards Regional CF Service Rheumatology RVI Regional Oncology Service Regional Neonatal Service (SCBU) Pain Team SALT Nursing Staff Social Workers Supraregional BMT Unit Trauma Orthopaedics Regional Head Injury Unit Regional Neurooncology Service PICU NGH Nursery Nurse/Play Specialist Neurology/ Neurosurgery Radiotherapy General Medical Teachers ACUTE PAEDIATRIC PHYSIOTHERAPY Clinical Nurse Specialists Midwifery Staff Occupational Therapist Hydrotherapy FRH Elective Orthopaedics Clinical Specialist Clinics Gym Class Musculoskeletal Outpatients
The Newcastle upon Tyne Hospitals NHS Trust PHYSIOTHERAPY SERVICE PAEDIATRICS AREA PROFILE We are a busy paediatric team, providing care over all three hospital sites, to all acute paediatric patients excluding hands, burns and plastics, and cardiothoracic. The paediatric service treats children and young adults up to the age of 21. Many of the services we cover are supra-regional, or regional specialities, and therefore the caseload is extremely varied. Paediatrics is a challenging area to work within, and consideration needs to be given not only for the children and young adults you are treating, but also the parents/carers and family. The Paediatric Team Who s who! Liz Hardy Team Leader FRH RVI NGH Sharon Solan Clinical Specialist Julie Allen Clinical Specialist Fiona Beckerlegge Rotational Senior II Suzanne Spencer PTA Nuala Byrne Clinical Specialist Victoria Mitchinson Senior I Pat Dulson Senior I Rachel Evans Senior I Louise Zebhollah Rotational Senior II Rotational Junior Michelle Mooney Senior I Vacant Senior I Meg Ruecroft Senior II Rotational Junior
WHILST AT THE RVI: A placement at the RVI is predominantly a respiratory placement. Here is some general information you may find useful: General Information: Working Times - 08.00 a.m. - 16.00 p.m. Lunch Time - 12.30 p.m. - 13.30 p.m. IST - Late Morning - 11.15 a.m. alternate Mon/Thurs - Junior IST every Thurs at 11.30am Uniform - see uniform policy in Department POLO Contact Numbers: Paediatric Room - 0191 2825329 (Direct Line) Physio Department - 0191 2825484 (Direct Line) Victoria Mitchinson 29372 Pat Dulson 29373 These are DECT phones carried by the senior members of staff at all times during the working day It is your responsibility to let your supervisor know as near to 08.00 a.m. if you are unable to attend work for any reason. WARDS COVERED: At the RVI site specialities include Nephrology, Oncology, Rheumatology, Cystic Fibrosis, PICU, Surgery, Medicine, and SCBU. Ward 3 Ext 25003 An eight bedded regional surgical intensive care unit but does take some medical patients in the paediatric age range. The unit predominantly looks after babies born with abnormalities requiring surgery e.g. tracheo-oesphageal fistula, gastroschisis, exomphalus, diaphragmatic hernias; medical problems such as bronchiolitis and post-op chest complications etc. Ward 4 Ext 25004 A regional surgical ward for babies under one year old. Most of the babies require surgery for GI complications e.g. Hirschsprung s Disease, Pyelomyotomy, renal insufficiency and hernia repairs. Ward 3 patients are transferred to Ward 4 in preparation for to discharge home. Ward 5 Ext 25005 6
This is the paediatric day unit catering for emergency medical admissions, referrals from GP s and fast track from casualty. Ward 6 Ext 25006 One of the medical paediatric wards providing regional paediatric metabolic services along with endocrinology and general medicine. Children with newly diagnosed or difficult to control diabetes are admitted to this ward. CF patients who have Burkolderia Cepacia infection or MRSA are also admitted to this ward. Ward 7 Ext 25007 This is the other paediatric medical ward specialising in regional renal and GI medicine, along with general acute medical chests and most CF patients. Ward 9 Ext 25009 This is a general surgical ward with day beds as well as in-patient surgery. It generally caters for older children having surgery and is also a regional unit. Ward 16 and Teenage Cancer Unit Ext 25016 This is a regional oncology unit for children and adolescents with a malignancy (except most brain and some spinal tumours). These include bone cancers, lymphomas and leukaemias. SCBU Special Care Baby Unit. The workload on the RVI site also includes input into: Juvenile Idiopathic Arthritis - Outpatients, hydrotherapy and clinic. Cystic Fibrosis clinic. Conditions to be treated include: Cystic Fibrosis/Bronchiectasis Pneumonia/Chest Infections Post surgical patients i.e. Exomphalus, gastroschisis, nephrectomy, renal transplant, bowel surgery Bone tumours Leukaemia Non-CNS tumours CNS tumours requiring high dose chemotherapy Rheumatology patients i.e. Juvenile Idiopathic Arthritis, Septic arthritis Developmental Delay Children with chronic illness i.e. Cerebral palsy, muscular dystrophy, long term ventilated patients 7
Premature babies on PICU and SCBU Additional Learning Opportunities Visit CF clinic Oncology Meeting Work with Nursing staff on PICU Observe operations in theatre Hydrotherapy Visit other paediatric sites Recommended pre-placement reading: Differences between adult and paediatric respiratory anatomy and physiology. Paediatric respiratory assessment. Paediatric medical chest conditions. Cystic Fibrosis. Paediatric surgical conditions. Normal development of children. Prasad, A and Hussey, J (1995). Paediatric Respiratory Care. Chapman and Hall Pryor and Webber (2004). Physiotherapy for Respiratory and cardiac problems. Churchill Livingstone Harden, B (2003). Emergency Physiotherapy: On call survival Guide. Churchill Livingstone H.M Treasury (2003). Every Child Matters: Also known as Children s Green paper. The stationary Office Book Whilst on placement you will receive a lot of specific teaching but we also expect you to participate in the learning process. You will also be required to present a case study at the end of your placement. 8
WHILST AT NGH: If your placement is at NGH you will find the following information useful: General Information: Working Times - 08.00 a.m. - 16.00 p.m. Lunch Time - 12.30 p.m. - 13.30 p.m. IST - Late Morning - 11.15 a.m. alternate Mon/Thurs - Junior IST every Thurs at 11.30am Uniform - see uniform policy in department POLO Telephone Numbers: Newcastle Hospitals Switchboard - 0191 233 6161 Paediatric Physio Room - Ext 22314 Contact Number: Michelle Mooney - Bleep 1912 Senior II - Bleep 1212 To use bleep, dial 52, then the number you wish to bleep, then your extension. Replace handset and bleep holder will phone you. It is your responsibility to let your supervisor know as near to 08.00 a.m. if you are unable to attend work for any reason. WARDS COVERED: PICU A 10 bedded regional unit taking patients with head injuries, brain tumours, epilepsy, and various types of brain surgery, medical chests and meningitis, burns and trauma. SCIDS UNIT (Severe Combined Immune Deficiency Syndrome) This is a regional centre for severely immuno-compromised babies and children. (It has six laminar-flow bed cubicles). Bone marrow transplants are looked after in this ward and this includes oncology as well as S.C.I.D. patients. Ward 24 Ward 26 This is a general paediatric ward looking after children with a variety of neurological conditions and muscular dystrophies along with orthopaedic trauma and general medical conditions. This ward also is the regional neurology unit for children with brain and spinal tumours. Again this is a general paediatric ward with similar conditions to Ward 24, however, children with head injuries are also admitted to this ward for rehabilitation. 9
Conditions to be treated include: This is not an exhaustive list Multi-trauma Head Injury CNS tumours Neuromuscular disorders i.e. Muscular dystrophy (including Duchenne), Spinal Muscular Atrophy (SMA) Neurological conditions i.e. Guillian Barre, De-George Syndrome, AVM Immunodeficient patients i.e. Severe combined immuno-deficiency syndrome (SCIDS) Pneumonia/chest infection Developmental delay Post neurological surgery Children with chronic illness Children requiring ventilation following respiratory failure Trauma orthopaedic patients Sepsis Burns Meningitis and meningococcal sepsis Additional Learning Opportunities Oncology MDT meeting Head Injury/ Neurology MDT Meeting Work with nursing staff on PICU Visit radiotherapy Visit theatre Other paediatric sites BMT MDT meeting Recommended pre-placement reading: Edwards, S (2002) Neurological Physiotherapy. A problem solving approach. Churchill Livingstone Whaley, L.S and Wong, S (2002) Nursing Care of Infants and Children. Mosby Hough, A (2001). Physiotherapy in Respiratory Care: An evidence based approach to respiratory and cardiac management. Nelson Thornes Prasad, A and Hussey, J (1995). Paediatric Respiratory Care. Chapman and Hall Pryor and Webber (2004). Physiotherapy for Respiratory and cardiac problems. Churchill Livingstone Harden, B (2003). Churchill Livingstone Emergency Physiotherapy: On call survival Guide. 10
H.M Treasury (2003). Every Child Matters: Also known as Children s Green paper. The stationary Office Book Differences between adult and paediatric respiratory anatomy and physiology. Paediatric respiratory assessment. Paediatric medical chest conditions. Head injury in children Normal development of children. 11
WHILST AT THE FREEMAN HOSPITAL During a placement at the Freeman Hospital students will be involved in seeing children with musculoskeletal and orthopaedic conditions. You may find the following information useful: General information: Working Times - 08.30 a.m. - 16.30 p.m. Lunch Time - 12.30 p.m. - 13.30 pm. *The full time paediatric staff at Freeman Hospital each work one late night per week. Your clinical educator will discuss your working hours with you to arrange working times to ensure you are reaching the stated requirement. IST - Monday Late Morning - 11.15 a.m. Uniform - see uniform policy Telephone Numbers: Freeman Hospital - 0191 2336161 Physiotherapy Department - - 0191 2231024 Paediatric PT Room - Ext. 27212 Ward 17 - Ext. 37017 Staff Room - Ext. 26769 Contact Numbers: Sharon Solan/Julie Allen - 48221 Senior II - 48217 It is your responsibility to let your supervisor know as near to 8.30 am as possible if you are unable to attend work for any reason. WARDS COVERED: Ward 17 Ward 11 This is paediatric elective orthopaedic ward looking after patients with a variety of conditions who are having planned orthopaedic surgery. There is also occasional long stay orthopaedic trauma patients, with conditions like fractured femurs, or slipped upper femoral epiphysis (SUFE). This ward is an elective ENT surgical ward, and occasionally patients will be reviewed on this ward, if they have any underlying respiratory problems. Students will also be involved in daily hydrotherapy sessions and paediatric musculoskeletal outpatients. Conditions to be treated include: Elective orthopaedic patients i.e. osteotomies, hip reconstruction, soft tissue lengthening Congenital talipes equinovarus 12
Perthes disease Leg lengthening with Ilizarov frames Additional Learning Opportunities Hydrotherapy Visiting surgery Weekly ward round Talipes Clinic Gait lab Visiting other sites Recommended pre-placement reading: A Textbook of Paediatric Orthopaedics from the Royal Children s Hospital, Melbourne Edited by Nigel S Broughton 13
The Newcastle upon Tyne Hospitals NHS Trust PAEDIATRIC PHYSIOTHERAPY SERVICE EXAMPLE STUDENT TIMETABLE NAME: CLINICAL SUPERVISOR: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Set learning Respiratory CF Medical outcomes assessment conditions WEEK 1 Welcome to paeds team Orientation to dept. and team. Specific paeds issues WEEK 2 Ventilation Anatomy and physiology Scenarios/ quiz questions Normal development Visit to CF clinic with CF specialist WEEK 3 Informal case presentation Visit FRH Hydro and wards WEEK 4 Spend day with paediatric OT 1/2way appraisal Visit NGH WEEK5 Case presentation ward work Final assessment ward work NB - This is an example timetable from the RVI site, and will change accordingly on different sites 14
CLINICAL SKILLS LEARNING OBJECTIVES To assess paediatric patients with a variety of pathologies, identifying problem lists and treatment plans. To demonstrate treatment of paediatric patients with a variety of pathologies RESOURCE Physiotherapists, Clinical Specialists. Observation of other physiotherapists and other student assessments. Clinical Reasoning formal / informal sessions. Physiotherapists, Consultants, GP s, OT s, Clinical Specialists, Medical Staff, SALT To demonstrate the use of manual techniques to treat patients. Practical sessions with physiotherapist Observation of physiotherapist s treatment sessions. To use exercise therapy in the management of patients including physiotherapy tools. To enhance / apply skills of manual handling. To develop an awareness of consent issues in paediatrics To apply knowledge of pharmacology to patients This will be done through practice with physiotherapist and then patients. This will be done through supervision and practical sessions with other students and physios Educator, teaching folder, IST Pharmacists, physiotherapists, Internet/intranet, BNF 15
MANAGEMENT / ORGANISATIONAL SKILLS LEARNING OPPORTUNITIES To prioritise case load /time management To manage own clinical caseload including assessment / treatment To assess patients and plan appropriate management necessary To demonstrate effective management within the team which means asking for assistance appropriately To assess patients notes investigations / interpretation of these with regard to future management RESOURCE Physiotherapist / educator Have list of patients independent of educator, but regular supervision Refer on for further tests / investigations, liase with consultants and other physiotherapists. All team members Radiologists, consultants, physiotherapists