UNIT: SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE NEONATAL TRANSPORT TEAM STANDARD #: EFFECTIVE DATE: REVISED DATE: STANDARD TYPE: 11/93 3/18 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 8 NEONATAL TRANSPORT TEAM STANDARD I The transport team members will possess the combined expertise to effectively assess, plan, implement, and evaluate actual and potential problems of the infant during transport. 1. Each individual transport (patient) shall be staffed per 64J-1.006.The transport team is composed of a neonatal transport nurse and a registered neonatal respiratory therapist or qualified paramedic. A neonatologist may accompany any transport. Personnel staffing the transport shall be compliant as per 64J-1.006. a. The RN will be licensed in accordance with Chapter 464, F.S., will have a minimum of 4000 hours RN experience which includes 2000 hours of Level III NICU nursing experience, and has an American Heart Association (AHA) and Neonatal Resuscitation (NRP) certification, and an approved letter of recommendation from the Medical Director. The RN will accompany a minimum of six (6) neonatal transports prior to staffing a neonatal transport as the only RN in attendance. It is the transport nurse s responsibility to complete the competency checklist either in the NICU or while on transport orientation prior to staffing a neonatal transport as the only RN in attendance. The transport RN will be required to maintain annual competency either by attending simulations and or successfully being checked off in the NICU by a Neonatologist. b. The Neonatal Respiratory Care Therapist will be registered by the National Board of Respiratory Care with a minimum of 2,000 hours of Level III NICU experience and will be AHA, ACLS and NRP certified and an approved letter of recommendation from the Medical Director. The RT will accompany a minimum of six (6) neonatal transports prior to staffing a neonatal transport as the only RT in attendance. It is the transport RT s responsibility to complete the competency checklist either in the NICU or while on transport orientation prior to staffing a neonatal transport as the only RT in attendance. The transport RT will be required to maintain annual competency either by attending simulations and or successfully being checked off in the NICU by a Neonatologist. c. The Paramedic must be a Florida licensed paramedic with a minimum of 5,000 hour experience and has AHA and NRP certification and successfully completed the Paramedic NICU/Maternal Experience Checklist and the NICU Respiratory/Observation Checklist and attend a neonatal stabilization program prior to staffing the transports. d. The EMT on the transport team shall meet the requirements of 64J-1.006. All 64J- 1.006 requirements and certifications for EMT and EMT-P are regulated and maintained by Ambitrans Medical Transport Company.
2 of 8 2. The primary team leader is the RN, unless the neonatologist is present on transport and shall possess the clinical, medical/nursing, and leadership expertise necessary to direct the provision of safe and competent patient care. 3. A physician shall be designated and available for consultation and medical control by phone and/or radio for all non-physician managed transports. 4. The program clinical coordinator shall demonstrate clinical and leadership expertise necessary to evaluate the clinical competence and job responsibilities of the transport team members. 5. An objective evaluation of the team member s competence to perform his/her specific job responsibilities in the transport role is conducted throughout and upon completion of the orientation program and documentation in the employee s record/personnel file will include the content and scope of the program and the extent of the participation of the transport team member. The orientation program will be completed prior to the individual performing independent transport care activities. 6. The combined transport team members shall demonstrate competency in the following neonatal areas to include but not limited to: 6.1. Neonatal Resuscitation Program 6.2. Maternal physiologic and pharmacologic factors affecting the neonate. 6.3. Assessment. 6.4. Oxygen monitoring. 6.5. Thermoregulation. 6.6. Fluid and electrolyte therapy. 6.7. Pharmacology. 6.8. Anatomy, pathophysiology, assessment, and treatment for these categories: 6.8.1. Acute/chronic respiratory disease. 6.8.2. Cardiovascular abnormalities. 6.8.3. Surgical problems. 6.8.4. Infectious diseases. 6.8.5. Musculoskeletal abnormalities. 6.8.6. Neurological abnormalities. 6.8.7. Gastrointestinal emergencies. 6.8.8. Genitourinary disorders. 6.8.9. Prematurity/postmaturity. 6.8.10. Hematologic disorders. 6.8.11. Integumentary disruption. 6.8.12. Metabolic/endocrine disorders. 6.8.13. Genetic/dysmorphology. 6.9. Psychosocial/grief support and crisis intervention. 6.10. Medico legal concerns. 6.11. Performance improvement. 6.12. Transport policies and procedures. 6.13. Problem-solving and priority setting. 6.14. Mechanical ventilation techniques for transport. 6.15. Transport equipment including back-up systems and troubleshooting.
3 of 8 7. The transport team members shall possess the combined expertise and legal scope of practice to perform the following neonatal procedures according to the guidelines and policies of Sarasota Memorial Hospital: 7.1. Endotracheal intubation. 7.2. Nasal/endotracheal CPAP. 7.3. Oxygen therapy (including high flow oxygen delivery). 7.4. Needle thoracotomy. 7.5. Mechanical ventilation. 7.6. Bag/mask ventilation or T-piece resuscitator. 7.7. Intravenous/intra-arterial access including: 7.7.1. Peripheral venous cannulation. 7.7.2. Umbilical artery/venous catheterization. 7.7.3. Arterial puncture. 7.7.4. SaO 2 monitoring. 7.7.5. EKG monitoring. 7.7.6. B/P monitoring. 7.8. Venipuncture blood culture. 7.9. Cardiopulmonary resuscitation. 7.10. Medication administration. 7.11. Nitric Oxide therapy 7.12. Stabilization for hypothermia NEONATAL TRANSPORT TEAM STANDARD II In all transport settings, the level of care provided by transport personnel shall reflect the infant s actual and potential problems. 1. The members of the transport team will accurately identify the infant to be transported. 1.1 When transport is outbound, infant will have identification band checked and a time out will be performed prior to the transport process. (Policy #01.PAT.18) 1.2 When the transport team arrives at the receiving facility, a time out and patient identification band check will be performed with the receiving RN. 1.3. When transport is inbound, the transport team arrives at the referral facility, infant will have identification band checked and a time out will be done prior to the transport process. 1.4 Prior to leaving the referral facility, an SMH ID band with admission number will be placed on infant (and mother and support person if present) according to Policy 01.PAT.09 Patient Identification: Inpatient/Outpatient. A time out will be done and the SMH Patient ID form will be signed by a nurse from the referral facility and the transport nurse. 2. The members of the transport team will obtain a systematic history that includes (as available) maternal history, perinatal history, antepartum test results, delivery history, neonatal history. 2.1. A complete systematic physical exam will be completed and include the current vital signs and assessment of the following systems: pulmonary, cardiovascular, neurological, GI/GU, skin, musculoskeletal, and any indwelling lines or tubes
4 of 8 including condition of IV/IA sites. 3. A clinical problem list will be formulated and actual or potential problems will be treated in order of priority. 3.1. Airway and vascular access will be assessed as top priority and steps will be taken to establish one or both dependent on the infant s condition. 3.1.1. These conditions will be treated in accordance with direct orders from the transport physician or if there is no physician on transport, in accordance with written patient care policies and protocols and with phone consultation with the physician at the receiving hospital. 3.1.2. If unable to have phone contact, team leader will use best medical knowledge until physician can be reached. 4. Assessment and treatment will include the following, but is not limited to: respiratory distress, shock, sepsis, hypothermia, hypoglycemia, complications of prematurity, hyperbilirubinemia, pneumothorax, congenital anomalies, hypoxic ischemic encephalopathy, and dehydration. 4.1. These conditions will be treated in accordance with direct orders from the transport physician or if there is no physician on transport, in accordance with written patient care policies and protocols and with phone consultation with the physician at the receiving hospital. 5. All indwelling lines, tubes, and catheters will be secured and in a documented acceptable position prior to leaving the referring hospital. 6. All infants will be monitored with a continuous cardiorespiratory monitor during the transport process. 7. Infant status will be monitored continuously with written documentation a minimum of every 30 minutes, or more frequently if the infant s condition warrants. A pain assessment will be part of the observation and documentation (Policy # 00.PAT.44) 8. Documentation will reflect assessment, interventions, responses to interventions, and evaluation. 9. A written, as well as, a thorough verbal report will be given to the receiving hospital. NEONATAL TRANSPORT TEAM STANDARD III The transport team will incorporate a family-centered care approach to promote optimal function of the family in time of crisis.
5 of 8 1. The parent(s)/guardian will be informed as soon as possible about the need for transfer of their infant to another facility. 2. The transport team will establish communication with the parent(s)/guardian as soon as possible after arrival of the transport team at the referring hospital once the infant s condition has been assessed and stabilized. 3. The transport team will seek additional pertinent medical history information from the parent(s)/guardian to thoroughly plan and implement a comprehensive plan for the infant requiring transport. 4. The transport team leader will provide/reinforce the following information for the parent(s)/guardian: 4.1. Reason for transport. 4.2. Mode of transport. 4.3. Destination and approximate length of time the transport will take. 4.4. Pertinent information regarding the infant s condition. 4.5. Anticipated care/types of procedures anticipated during transport. 4.6. Composition of the transport team accompanying the infant. 5. The transport team will give information regarding Sarasota Memorial Hospital (or other hospital as applicable) to the parent(s)/guardian before departure from the referring hospital. 6. The transport team will provide parent(s)/guardian with the opportunity to see and touch the infant prior to transport, infant s condition permitting. When it is not possible for a family member to ride along during transport, the transport team will provide directions along with guidance and support for family members. 7. The transport team will obtain, or verify presence of completed current written consent for transport including risks and benefits. 8. The team will obtain a parental/guardian signature on the Inpatient/Outpatient General Consent and Financial Agreement form, and any other consent forms physician has deemed necessary and has explained to parent/guardian. NEONATAL TRANSPORT TEAM STANDARD IV Appropriate communication will be initiated and maintained throughout the transport process. 1. Access of a neonatal transport team at Sarasota Memorial Hospital will be available through the Neonatal Intensive Care Unit or SMH Transfer Center. Collaboration with the All Children s transport team will occur by the Neonatologist for transport, as needed. 2. The transport team will serve as the liaison between referring and receiving hospitals. 3. In the transport vehicle, there will be equipment to communicate within the vehicle itself as well as with the transporting facility, the physician responsible for the
6 of 8 transport, and the receiving hospital. 4. The transport team will follow-up communication with the family as appropriate, beginning with arrival at the receiving hospital. Follow up with the referral facility will be done when appropriate. NEONATAL TRANSPORT TEAM STANDARD V The transport process will have an ongoing Quality Improvement coordinator designed to systematically monitor and evaluate the quality and appropriateness of patient care, to pursue opportunities to improve patient care, and to resolve identified problems relating to the transport process. 1. The program objectives and organization will include the following monitors: 1.1. Response time of transport team 1.2. Evaluation of appropriateness of care 1.3. Maternal and Neonatal outcomes. 1.4. Denied transports 2. Policies and procedures are available to all transport personnel and are reviewed annually for current accuracy. 3. For all identified problems and opportunities to improve, a written action plan will be developed, implemented and evaluated. NEONATAL TRANSPORT TEAM STANDARD VI The comprehensive program will be in existence to ensure safety throughout the transport process. 1. Once the team is in the ambulance and prior to departure, the Transport Safety Checklist will be completed and any concerns addressed as appropriate. 2. To provide safety during the transport process, the infant will be properly secured/restrained in the transport incubator, and transport personnel will use safety restraints. 2. While remaining restrained, team members will have a visual access of the infant at all times. 3. All equipment will be appropriately secured. 4. In the event of inclement weather, the need for transport shall not outweigh safety consideration of the transport personnel and infant. 5. The patient care area will be adequately lit.
7 of 8 7. All transport personnel will be familiar with all safety features of vehicles and equipment. 8. All transport equipment will be checked for readiness on a daily basis. 9. It will be the decision of the registered nurse on board to initiate lights and sirens. Appropriate initiation may include sudden deterioration of the patient or some unforeseen emergency (Policy #126.663 Mode of Response for Maternal and Neonatal Transport Vehicles ). REFERENCES: Rules of the Department of Health and Rehabilitative Services Florida Emergency Medical Services Act, Chapter 64-J1.006 Neonatal Interfacility Transfers Florida Administrative Code Emergency Medical Services January 2011 1.Handbook of Pediatric and Neonatal Transport Medicine, 2 nd Edition. 2002 Jaimovich and Vidyasagar 2.Guidelines for Perinatal Care, 7th Edition, AAP, ACOG 3.Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients, 4 th Edition, 2016 AAP 4.SMH Policy # 01.PAT.09 Patient Identification Inpatient/Outpatient 5. SMH Policy.# 01.PAT.18 Correct Patient, Procedure, and Site Verification 6. SMHCS Policy # 00.PAT.44 Pain Management REVIEWING AUTHORS: Donetta Dangleis, RRT, Manager, Respiratory Services Heather Graber BSN, RNC-NIC-Manager of NICU and Maternal/Neonatal Transport Services Susan Doyle, BSN, RNC-NIC, Clinical Coordinator NICU
8 of 8 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date Title: Title: Pam Beitlich RN, MSN, Director Woman s and Children s Services 3/6/18 3/2/18 Title: Mark Pellman, RRT, Director, Respiratory Services Title: Committee/Sections (if applicable): Clinical Practice Council 3/1/18 Administrative/Director (if applicable): Title: Vice President/Administrative Director (if applicable): Title: Vice President/Administrative Director (if applicable): 3/8/18 Title: Connie Andersen, Vice President, Chief Nursing Officer