Carol Jackson Cheshire and Merseyside Neonatal Network Nurse Consultant for Neonatal Transport

Carol Jackson Cheshire and Merseyside Neonatal Network Nurse Consultant for Neonatal Transport

Transport Service Facilities 1. Access to 24/7 Cheshire and Merseyside Perinatal Cot Bureau and Data Management System. 2. 24/7 Supernumerary dedicated Transport Practitioner Team. 3. Dedicated Intensive Care Transport Systems. 4. Provision of a Transport Outreach Stabilisation Training Programme (Drills and skills). 5. Development of educational link nurses for each unit within North Wales.

Ownership of Service All North Wales staff involved in neonatal care will have a collaborative role to play in the service. All North Wales acute transfers undertaken 24/7 The success of this service will also depend on the involvement of medical and nursing staff in all North wales units. Clinical governance arrangements - LWH as host for CMNNTS. Neonatal Network Board and Network Clinical Effectiveness Group (clinical governance issues).

Transport Service Staffing Nurse Consultant for Neonatal Transport Lead. Medical support (Arrowe Park Consultants 1/6 weekday) Medical / ANNP support (Liverpool Women s weekend) 1 Nursing Team Leader 6 whole time equivalent transport nurses 1 whole time equivalent service administrator A second acute transfer team (Nurse/Doctor or ANNP will be required to cover North Wales acute transfers in order to provide a responsive service (60 minute despatch from service base for all transfers deemed time critical). Additional administration support will be required to collate data reports and additional cot bureau support.

ino cylinder Monitoring System Hose connections with monitoring gauge

Transport Team: Work to agreed transport protocols and guidelines to reduce variations in practice across the network and North Wales units.

Access to CMNNTS Dedicated priority Hot Line Number and phone line for antenatal and postnatal referrals: 0151 702 4469 General information direct line with answer phone: 0151 702 4470 Fax: 0151 702 4471 Conference call facilities

Functions of the Perinatal Cot Bureau / Data Management System: 1. Information gathering Contact with each unit 3 times per day for intensive, high dependency and special care cot availability. Maintain a database of neonatal cot availability across Cheshire and Merseyside. Provide a link to national database of level 3 intensive care cot availability. Support network wide perinatal transport audit.

Functions of the Perinatal Cot Bureau 2. To act as first point of contact for all acute antenatal and postnatal referrals To gather identification and brief clinical details. To liaise with clinical staff and transport team. To liaise with ambulance service. To keep all parties informed of the transfer status. Maintain a record of all transfers undertaken.

Practical details (1) Information requested on cot availability Telephone call to Senior nurse on duty at 08.00, 14,00 and 21:00. Number of Intensive, High Dependency and Special Care infants on unit. Unit status open or closed? Reason for closure? Expected admissions and discharges. Is admission status expected to change?

Practical details (2) Information requested on referral enquiry Referrer s details Antenatal or postnatal request Infant and Maternal identifiers Type of referral Gestation and Weight Infant problems ( Urgency of transfer Comments

Yes < 25 + 0 weeks Complex Out of network Transport Consultant to discuss appropriateness of transfer with referral unit This decision should be made by the on-call Consultant responsible for the C&MNN Transport Service ## No Meets NEWTS criteria? No Appropriate transfer? Yes Accept transfer and locate cot No Yes Discuss with NEWTS Decline transfer Singleton < 27 + 0 weeks * Twin < 28 + 0 weeks * BW < 800 g * Anticipated need for ventilation > 48h Severe respiratory failure # Therapeutic hypothermia Surgical/NEC Yes No Closest NICU open with < 80% occupancy Closest LNU/NICU open with < 80% occupancy Other NICU open with < 80% occupancy Next closest LNU/NICU open with < 80% occupancy Consider transferring to an appropriate open unit with > 80% occupancy, or appropriate unit out of Network This decision should be made by the on-call Consultant responsible for the C&MNN Transport Service ## following a careful risk assessment

Practical details (3) Communications 2 dedicated telephones: One hotline reserved for referrals; One phone for enquiries. Hot line phone. Conference call facilities

Functions of a Perinatal Cot Bureau. To act as first point of contact for all acute antenatal and postnatal referrals. To gather identification and brief clinical details. To liaise with clinical staff and transport team. To liaise with ambulance service. To keep all parties informed of the transfer status. Maintain a record of all transfers undertaken. Exclusions for transfer by CMNNTS Repatriations into North Wales Intra North Wales Transfers requests will be directed to North Wales Transport Team.

Note on team configuration The team is configured based on the category of the transfer and clinical needs of the child. Neonates requiring respiratory and/or cardiovascular support are medically or Consultant Nurse/ANNP led with the provision of a supernumerary Transport Practitioner. All non-acute transfers are solely nurse led.

Nurse Led Criteria Nurse only transfers are NOT available for the following group of infants: Intensive care babies (BAPM). Babies below 1kg in weight. Babies below 28 weeks gestation and less than 48 hours of age. Unstable high dependency infants. Infants with complex cardiac problems or those that require medication to maintain duct dependent lesions. Infants with complex surgical problems. Neurological problems that require constant monitoring and treatment to maintain stability.

Nurse Led Criteria Nurse only transfers can be undertaken for the following patient group: Stable special care infants. Stable infants requiring out patient appointment. High dependency infants who have been for 48 hours. Infants who have been extubated 24 hours after being electively intubated for surgery and are stable in air.

For Emergency Retrieval Nurse Escorts (Medical/Cardiac/Surgical) Request to be made via dedicated priority phone line and number. Patient /clinical and referring hospital details will be required by the team on request. A unique transport reference number and case note file will be allocated to the patient. The allocated transport team member will liaise between the referring and receiving unit team. Ambulance booked by transport team.

NWTS North West and North Wales Paediatric Transport Service For referrals into PICU AHCH. Will transfer infants > 2kg Ventilated. Will not do repatriations or HDU transfers. Referral Tel: 08000 84 83 82 Lead Consultant: Kate Parkins Kate.parkins@nwts.nhs.uk

Cheshire and Merseyside Multidisciplinary Transport Outreach Stabilisation Programme To be developed transport training programme developed and based on structured ACCEPT ALSG approach and principles. Pre Transport Stabilisation Workshops. Annual training report to be provided North Wales.

Transport Service Monitoring and Evaluation Data for all stakeholders on key performance parameters including: 1. Number of transfer requests received and accepted. 2. Number of time critical transfers and monitoring of team despatch times. 3. Number of transfers involving the movement of infants into and out of the C&MNN and North Wales. 4. Number of North Wales infants and antenatal patients allocated beds outside of C&MNN due to network capacity issues. 5. Response times and delays. 6. Multiple transfers for antenatal and neonatal patients. 7. Out of transport service hours antenatal and postnatal transfer refusals. 8. Transport related critical incidences and adverse events.

Clinical Monitoring Pre transport stabilisation times and outcomes. for planned and unplanned transfers. Physiological outcomes generated throughout the transport process. Survey Feedback from Stakeholders

Preparation of North Wales Units Prior To Launch Date North Wales Unit Visits Neonatal and Obstetric departments. Transfer Request Procedure information packs to be placed in all units. Pathway of communication and guidelines in utero transfer policy and postnatal transfer guidance. Link nurses North Wales units. Lead Obstetric Link for North Wales Contact point.