Paediatric Escalation Policy Document ref. no: PP(14)316 For use in (clinical areas): For use by (staff groups): For use for (patients/treatments): Document owner: Status: Paediatric Unit All staff working within the Trust Managing safe patient flow within Paediatric Unit Paediatric Department Approved Purpose of this guideline The purpose of this policy is to provide a structured and detailed plan of the actions to manage the flow of patients to the ward and to escalate an increase in that flow that might necessitate the closure of Paediatric Unit to admissions to ensure that patients are in the most appropriate place, dependent upon their needs. Background The Paediatric Unit has for many years had informal ways of addressing an increase in the number of patients requiring admission and how/when methods were used to assist the ward in reducing the flow until the patients were moved to other appropriate areas. With an increase in the number of patients that now attend the unit following the opening of the Children s Assessment Unit and the continued demand for elective patients it was felt that we need to formalise the process that is used. Contents Source: Paediatric Issue date: May 2014 Page 1 of 7
1. Introduction 2. General Guidance 3. Action 4. Ward Closure 5. Special Circumstances 6. Development of Policy 7. Contributors and peer review Appendix 1 Site Manager Hospital Checklist Appendix 2 Paediatric Escalation Flow Chart Source: Paediatric Issue date: May 2014 Page 2 of 7
1. Introduction This policy gives guidance on how to escalate the change in patient flow to other relevant areas within the Trust. It is applicable to all staff that work within the Trust and admit children to the Paediatric Unit. It will explain when to implement the Escalation Policy and who to contact within the Trust to ensure that everyone is aware of the situation. 2. General Guidance This policy is to be followed if The Children s Advanced Nurse Practitioner (CANP), Nurse in Charge or the Paediatric Consultant identifies that it is not safe to admit any further children. The ward has reached full capacity i.e. 15 beds (There is the capacity to flex up to 20 beds but consideration must be given to safe staffing levels) This might involve staff being asked to move from another area within the Trust. The CANP, Nurse in Charge and the Paediatric Consultant agree that there are too many sick children for the number of nurses to care for safely with no anticipated or actual discharges (waiting for drugs/transport) pending. There are only two Registered Nurses on the shift or the following shift, therefore making a 1:2 ratio for nursing HDU children impossible Paediatrician on call feels that there is insufficient medical cover. 3. Action 1. The CANP, Nurse in Charge is to discuss the problem with the on call Paediatric Consultant. If extra nursing staff and/or medical staff would alleviate the problem, the CANP, Nurse in Charge and/or Paediatric Consultant will seek permission from the Paediatric Unit Manager/Paediatric General Manager, Paediatric Head of Nursing [Clinical Duty Manager (888) at night] to allocate one person (preferably unregistered) to phone available staff to do extra work 2. The CANP or Nurse in Charge will contact the Midwifery Bleep holder (519) and Clinical Duty Manager (888) 3. The Consultant or CANP will reassess and review all patients at regular intervals. Discharge if appropriate, or plan next day review. 4. Liaise closely with other Admitting teams about all of the above via Clinical Duty Manager. (I.e. Surgical, Orthopaedics & ENT) 5. Inform Accident & Emergency of situation and the potential management of further admissions. This may include review of patients by a Paediatric Doctor in A/E. Source: Paediatric Issue date: May 2014 Page 3 of 7
6. Out of hours the Paediatric Registrar should inform switchboard to divert all GP phone calls to him/her to enable senior screening of referrals. Suggest to GP s that children in Stowmarket, Newmarket and Haverhill should be advised to go to nearest hospital if condition allows, e.g. Ipswich, Addenbrookes unless they are known to the ward. 7. Consider cancellation of routine admissions; notify relevant Consultant, Theatres & Waiting List office. 8. The CANP or Nurse in Charge to ask Clinical Duty Manager (888) to enquire about beds in other hospitals and Consultant will contact Paediatrician on call at Ipswich/Cambridge to inform them of possible closure and transfers. Referral will then take place on a case by case basis i.e. Registrar to Registrar 9. Medical and nursing staff to discuss the possible transfer of current stabilized inpatients to other hospitals. 10. Contact Paediatric Unit Manager for advice/support. 4. Ward Closure Decision to close must be made in consultation with Clinical Duty Manager and the Paediatric Consultant on-call. The Clinical Duty Manager will liaise with The Senior Manager or Executive Director on call. The Clinical Duty Manager Bleep 888 will inform the speciality registrars (ENT orthopaedic, surgical). When an HDU bed is required and the Paediatric Unit are unable to provide it, consider the following options:- i. Discussing it with the ITU Consultant (who cannot always guarantee support in the form of supplying an HDU bed) ii. Possible transfer to another unit. Children with permanent open access should be referred to the Paediatric Registrar for advice 5. Special Circumstances 999 Emergency Admissions ALL CHILDREN admitted by Blue Light Ambulance should ALWAYS go to Accident & Emergency to be assessed, whether this policy is in use or not. Source: Paediatric Issue date: May 2014 Page 4 of 7
Oncology Patients All Oncology children who phone in as unwell must ALWAYS be seen on Ward/CAU, assessed, bloods taken & treatment initiated. Only then can a decision be made as to where they are admitted. If the patient lives equal distance to Addenbrooke s and they have beds only in this instance could the child go directly there, after Registrar to Registrar discussion. 6. Development of the policy Changes compared to previous document No previous approved Escalation Policy. 7. Contributors and peer review This document has been circulated to the Paediatric Unit staff, Nursing and Midwifery Practices Committee. Author(s): Dawn Dorrington Paediatric Unit Manager Katherine Piccinelli Paedaitric Lead Consultant Other contributors/ Reviewers: Approvals and endorsements: Shena Scholes Paediatric Practice Development Nurse Gemma Dale Children s Advanced Nurse Practitioner Paediatric Clinical Governance Group Clinical Duty Manager A&E Service Manager A&E Unit Manager A&E Consultants Critical Care Services Deputy General Manager for Surgical wards, Patient Flow and Critical Care Services Nursing and Midwifery Practices Committee Operational Steering Group Source: Paediatric Issue date: May 2014 Page 5 of 7
Appendix 1 SITE MANAGER HOSPITAL CHECKLIST Addenbrookes Hospital Paediatric Bed Manager 01223 245151 Bleep 007 Colchester Hospital General Bed Manager 01206 747474 Bleep 333 Paediatric Matron 01206 747474 Bleep 953 Hinchingbrooke Hospital Hospital Switchboard 01480 416 416 Registrar On Call 01480 416 416 Bleep 1156 Holly Ward 01480 423163 Ipswich Hospital Hospital Switchboard 01473 712233 Registrar On Call 01473 712233 Bleep 544 SHO On Call 01473 712233 Bleep 566 Bergholt Ward 01473 702194 Kings Lynn Hospital General Bed Manager 01553 613613 Bleep 1231 Norfolk & Norwich Hospital Senior Nurse On Call (During the day) 01603 28 286 Bleep 0068 Paediatric Medical Registrar On Call (During the evening) 01603 286 286 Bleep 0009 Paediatric Surgical Registrar On Call 01603 286 286 Bleep 1047 Broomfield Hospital Hospital Switchboard 01245 362 000 Registrar On Call Ask Switchboard to bleep Phoenix Ward (General Paeds) 01245 513 904 Children s Burns Ward 01245 513 912 James Paget Hospital Hospital Switchboard 01493 452 452 Registrar On Call Ask Switchboard to bleep Children s Ward 01493 452 010 Source: Paediatric Issue date: May 2014 Page 6 of 7
P4 Paediatric Escalation Policy Flow Chart LEVEL 1 Possibility of Paediatric Unit Closure due to staffing issues( medical/nursing) patient dependency or lack of beds. Nurse In Charge to discuss with Consultant Paediatrician and CANP, they will assess all patient s currently on CAU/F1 and discharge as appropriate. Nurse in charge to Inform 1) Paediatric Ward Manager 2) Paediatric General Manager 3) Paediatric Head of Nursing 4) Midwifery Bleep Holder (519) 5) Clinical Duty Manager (888) 6) A&E Nurse In Charge 7) Speciality Registrars (ENT,Surgical,Orthopaedic) Oncology Patients Nurse In Charge to discuss with Paediatric General Manager, Paediatric Head of Nursing and Paediatric Unit Manager sourcing staff to allow Paediatric Unit to flex its beds to 20 ( Unit can only flex up to 20 beds if safe staffing levels can be maintained) During this time inform A&E that a Paediatric doctor may come to A&E to assess patients - Suggest to GPs to delay admissions/attend another hospital if condition allows - Consider cancellations of routine admissions 999 Emergency Admissions ALL CHILDREN admitted by Blue Light Ambulance should ALWAYS go to Accident & Emergency to be assessed, whether this policy is in use or not. All Oncology children who phone in as unwell must ALWAYS be seen on Ward/CAU, assessed, bloods taken & treatment initiated. Only then can a decision be made as to where they are admitted. If the patient lives equal distance to Addenbrooke s and they have beds only in this instance could the child go directly there, after Registrar to Registrar discussion LEVEL 2 - CLOSE Decision to close made with Clinical Duty Manager, Consultant Paediatrician, Paediatric General Manager, Paediatric Head of Nursing, Paediatric Unit Manager and CANP Anticipate length of closure Consider cancellation of routine admissions and inform relevant teams Consider appropriate stable patients for transfer Keep situation under constant review and re open unit as soon as practical and safe to do so. Source: Paediatric Issue date: May 2014 Page 7 of 7