Hong Kong Paediatric Nurses Association ISSUE 50 April 2018 Experience Sharing Gastrostomy Tube Insertion A Systematic Approach Ms Kwee Yung, Nurse Specialist, Paediatrics, Tuen Mun Hospital A nasal gastric tube (NGT) or oral gastric tube (OGT) is a most often readily available means to provide enteral feeding for sick children at bedside. However, some potential risks reported with prolonged NGT or OGT include oral aversions, pharyngeal discomfort, sinusitis, gastritis, psychological trauma, misplacement etc. So, when children with expected prolonged need of enteral feeding and a reasonable prospect of patient survival, gastrostomy tube (G-tube) placement should be considered. In the past, parents and caregivers often had a wrong concept of replacing an NGT/OGT with a G-tube as a big surgery that may limit the daily activities of their child. Clinically, there is a lack of standardized guidelines to provide a systematic approach for gastrostomy tube placement. In early 2016, a comprehensive approach for gastrostomy tube placement was developed in Tuen Mun Hospital. The approach includes care pathway, guidelines, discharge and follow up process to guide and provide a holistic approach for the whole journey. The guidelines include four domains: Feature Story 1. Decision for Gastrostomy Placement When a decision to proceed a gastrostomy insertion is made by clinical management team, doctor and specialist nurse will discuss with the child & his/her parents to clarify any query. Appropriate information will be provided by the ways of demonstration, dialogue conversation and written information. All cases will also be referred to aero-digestive team for comprehensive assessment and Paediatric Surgeon will be consulted too. 2. Perioperative Management Systematic workflow checklist is developed for standardized perioperative management includes pre-operative preparation and post-operative immediate and subsequent care. 3. Caregivers Empowerment Training Before patient discharge, gastrostomy care training will be provided with demonstration and return demonstration to ensure care-takers are competent in managing routine care and emergencies at home. 4. Multidisciplinary Follow Up After Discharge Upon discharge, patient will be referred to multidisciplinary team: paediatric www.hkpna.com.hk In this issue : Experience Sharing: Gastrostomy Tube Insertion A Systematic Approach Symposium on Towards Better Health for Children 2018 Nurse s Story: Take the Ride The Journey Starts at the Paediatric & Adolescent Medicine HKPNA Activities: Spring Dinner 2018 Professional Development Activities Forthcoming Events & International Conference Renewal & Application of Membership Member s Communication Channel Submission to HKPNA Newsletter & Young Nurses Sharing Continue on next page
Continue from last page surgeon, dietitian, Community Nursing Service etc. for follow up to ensure patient will receive holistic care even after discharge. Result There were total seventeen children underwent gastrostomy tube insertion from early 2016 till end of 2017. Ten of the children were out-patients and were discharged on Day 9 Day 36 post-operatively; five were transferred out to other hospitals for continuous care. For those out-patient cases, phone follow up was provided. All of the children did not encounter significant problems after discharge and the care-takers were confident in handling the gastrostomy tube at home. 10 2 5 In-patients Transfer to other hospitals Conclusion Home after operation A comprehensive standardized guidelines and care pathway clarify pre-operative misunderstanding, provide comprehensive logistics and strengthen the care-takers competence in taking care of patients with gastrostomy tube insertion.
Symposium on Towards Better Health for Children 2018 Ms Tang Sze Kit, Ward Manager, Prince of Wales Hospital As one of the country members of the Asia Pacific Paediatric Nurses Association (APPNA), the Hong Kong Paediatric Nurses Association (HKPNA) was glad to host a symposium, themed Towards Better Health for Children 2018 on 13 Jan 2018 in Hong Kong. More than one hundred participants joined the symposium. After a simple but solemn opening ceremony, Associate Prof. Rashanee Seeda, President of APPNA and Ms Susanna Lee, founding President of APPNA gave the opening and welcome addresses to all participants. It was honored that APPNA had invited well-known paediatric experts to be the speakers at the symposium. Speakers included Professor Kate Chan (Assistant Professor of the Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong); Professor Simon Lam (Associate Professor of the Department of Paediatrics, the Chinese University of Hong Kong); Dr. Daniel Chiu (Specialist in Paediatrics); Ms Chan Yim Fan (International Board-certified Lactation Consultant); Ms Chan Kam Ming, Maria (Nurse Consultant - Neonatal Care, Department of Paediatrics and Adolescent Medicine, United Christian Hospital) and Dr. Dorothy Tam (Specialist in Paediatrics). Wide ranges of paediatric health care topics were shared in the symposium. All the participants enjoyed an updated information on respiratory syncytial virus disease in infants, micronutrients and child health, updated on vaccination for children, breastfeeding in infants and myths of feeding from neonate to toddler. After the symposium, a gala dinner was arranged to thank all the speakers and organizing committee for their unfailing support to APPNA and the symposium.
Nurse s Story Take the Ride? Mr Wong Chi Fung, Registered Nurse,Tuen Mun Hospital Babies are no different from adults; they may encounter brain, eye, heart, lung, gut problems as you could ever think of, especially for premature babies. Babies are admitted in the neonatal intensive care unit (NICU) for treatment and life support. The ward that I work in is not a surgical center; so babies who require surgery are needed to be transferred out to other hospitals. Transporting a sick baby is never easy and always an emergency. An incubator, a portable ventilator, a cardiac monitor, two cylinders of oxygen tanks and a medium-sized shoulder bag are all you have to carry on board the ambulance with your little baby and the escorting doctor. The journey usually takes at least 30 minutes to another hospital. Should anything happen during the journey you need to manage by your own. Therefore, I found transporting a sick baby is a super challenging and exciting task. To do so, firstly, you need to equip your brain. I feel grateful that my supervisor has given me chances to attend valuable courses like the S.T.A.B.L.E. Program especially for sick infants, Inter-Facility and Critical Transport Medicine Course (ICCTM) and safe procedural sedation program. Besides knowledge that I have acquired from these programs, I have also learnt about one word - Preparation : always prepare yourself, your equipment and your mind. Finally yet importantly, bringing money with you to take the ride as you need to take a taxi for the return journey. Secondly, you need to know your equipment. Learn more, know better and equip yourself - one of my mentors always told me. I am glad that I have joined the Equipment Competency Enhancement Program. In the program, members made quick references and did demonstrations repeatedly so I could refresh myself and through practices to familiarize with the equipment operations. In these two years, I have been many NICU babies papa. If you ask me now, Are you still afraid of transporting a sick baby? I will answer YES. Nevertheless, if you ask me Can you take this baby for the ride? I will give you the definite answer YES because a father will do everything for his babies. The Journey Starts at the Paediatric & Adolescent Medicine Department Ms Tang Chung Yan, Sandy, Registered Nurse, Alice Ho Miu Ling Nethersole Hospital From University to Hospital As a freshman in society, I was excited but yet nervous towards my first job in nursing. I was grateful that the Hospital Authority has implemented mentorship program for new graduates to help newbies to adapt to the new environment. Moreover, the inclusiveness and affinity of other team members have made me get involved very quickly into the department. I was pleased that my journey started with this great team. Establishing Trust with Patients and Their Relatives The therapeutic communication technique I learned in school has been used most frequently. Kids, young adolescents as well as parents need more communication and interactions to build up trustful relationships. Therapeutic communication helps me prioritize the physical, mental and emotional wellbeing of patients while maintaining professionalism. Continue on next page
Continue from last page Evolving from Manual to System The rapid development of science and technology enhances and optimizes different industries. Our team has undergone a transition in the drug administration process. The new system In-patient Medication Order Entry (IPMOE), has been introduced in the beginning of 2017 in our department. It redesigns the workflow for doctors, pharmacists and nurses to replace the traditional manual prescription. Besides, Electronic Patient Assessment Form-Paediatrics (epaf) was implemented for better access and documentation of initial nursing assessment. With the new systems, we have enhanced work efficiency and accuracy. Personal Development To enhance professionalism, we need to receive various trainings to equip ourselves for challenges. Regular drills enrich my experience to cope with different cases and emergencies. My problem-solving skills have been cultivated throughout these trainings. In addition, lectures held by doctors and experienced nurses help consolidate my clinical skills and knowledge. On-line resource is another platform providing the most up-to-date and evidence-based information to nurses without boundaries. With the solid foundation that I have built, I am confident that I am well equipped and ready to continue my nursing career journey. Spring Dinner 2018 Ms Connie Tse, Editorial Committee, HKPNA HKPNA Activities Chinese New Year is a time of good fortune and happiness, celebrating the custom of reunion and blessing. The Year of the Dog has come swiftly and the celebration of it seems to have come to a halt. To let the festive continue, the HKPNA has held a spring dinner on 9 Mar 2018, to give members a chance to chat and greet. The dinner started after President Ms Iris Yeung gave her blessing and led a toast to the floor. Eight tables were filled with cheerful faces. The joyous atmosphere was pushed high by interesting games arranged by the organizing committee. Members exhibited their talents and teamwork to grab as many gifts as they can. A Big Group of the HKPNA Members Fishing for Luck Members with Guest Professor Lau Yu Lung Members Awarded with Their Presents
P rofessional Development Activities Professional CME Meeting on Child Health 2018 - Gut Microbiome and Use Of Probiotics, Prebiotics and Synbiotics in Children, co-organized with the Hong Kong Paediatric Foundation was held on 6 Feb 2018. Hong Kong Society of Paediatric Surgery Dinner Symposium on The Management of Intestinal Failure in Children", coorganized with the Hong Kong Society of Paediatric Surgery was held on 7 Feb 2018. Hong Kong Paediatric and Adolescent Dermatology Society - 2018 HKPADS Paediatric Dermatology Symposium, coorganized with the Hong Kong Paediatric and Adolescent Dermatology Society was held on 3 Mar 2018. Professional CME Meeting on Child Health 2018 - Human Milk Oligosaccharides and Neonatal Immunity, co-organized with the Hong Kong Paediatric Foundation was held on 13 Mar 2018. Hong Kong Society of Paediatric Surgery Annual General Meeting & Annual Scientific Meeting - Paediatric Solid Tumors, Surgical Management of Paediatric Solid Tumors, Building Blocks of Psychosocial Care & Child Life Services for Child Cancer Patients and Their Families, Nursing Management of Paediatric Patient with Solid Tumors, coorganized with the Hong Kong Society of Paediatric Surgery, was held on 17 Mar 2018. Hong Kong Society of Paediatric Respirology and Allergy - What's New? Gut Microbiota & Food Allergies Management, co-organized with the Hong Kong Society of Paediatric Respirology and Allergy, was held on 20 Mar 2018. F orthcoming Events The 7 th ICCN International Conference on Clinical Neonatology Symposium organized by HK Neonatal Society will be held on 23-26 May 2018 in Turin, Italy. Please visit www.iccn2018.eu for details. Evening seminar - Anxiety problems in students across the spectrum from the mild to the severe end, co-organized by the Hong Kong Society of Adolescent Health, will be held on 11 May 2018 R enewal & Application of Membership Registered and Enrolled nurses who have experience in paediatric care are welcome as members. Any nursing undergraduate and pupil nurse, of the universities and nursing schools, who has interest in paediatric nursing are also welcome. Please complete the Membership Application/Renewal Form and return it to Ms Caroline Lee, Hon. Dep. Secretary, S404, QEH together with a cheque made payable to Hong Kong Paediatric Nurses Association Ltd. Application forms can be obtained from HKPNA Hospital Coordinators or downloaded from web site http://www.hkpna.com.hk. Kindly fill in your email address when returning the completed form, so that we can keep you informed of the activity / course information updates. Life Members are also welcome to update any personal particulars annually and furnish your email address using the same form. M ember s Communication Channel HKPNA treasures every idea and comment from members. Please forward your suggestions or input in writing to either the President, Ms Iris Yeung at DOM (PAED) Office, 9/F, Block F, QEH. Besides, you can contact us via email address: hkpna@ymail.com S ubmission to HKPNA Newsletter The HKPNA Newsletter is published three times annually. Articles such as case studies, research findings, work reports, member s views and ideas are welcome. Each article is preferably no more than 250 words. Submit either the hard or electronic copy of full text and photographs with subtitles. Author name(s) and contact details should be included. It is the author s responsibility to comply with patient privacy and data protection. Where necessary, informed consent should have been obtained before submission. The Editorial Committee reserves the right to select or reject the submitted article. Send submission to: Ms Lee Wan Ming, at NC (PAE/Neonatal) Office, K-1007, Block K, QMH OR e-mail: leewm1@ha.org.hk Invitation of Articles Submission Paediatric Young Nurses Sharing To facilitate young nurses working in paediatrics to speak up / out for professional growth and development that knows no boundaries, and share in the HKPNA Newsletter column Please send submission to: Ms Lee Wan Ming at NC (PAE/Neonatal) Office, K-1007, Block K, QMH or Email: leewm1@ha.org.hk with template download from HKPNA website I nternational Conference The 6 th Asia Pacific Congress of Pediatric Nursing (APCPN) Pediatric Nurses - A unified Voice towards Achieving SDGs and Reducing Inequalities Organized by the APPNA will be held on 27-29 Aug 2018 in Bali Nusa Dua Convention Center (BNDCC) Nusa Dua - Bali, Indonesia. Please visit www.apcp-pitika2018.org for details. The HKPNA offers sponsorship for members to attend the APCPN, interested members please contact hospital coordinator for details. The 14 th Congress of the Asian Society for Pediatric Research Emergent and Relevant Issues in Child Health Hosted by the Philippine Pediatric Society, Inc. will be held on 2-4 Oct, 2018 in Philippines. Please visit http://aspr2018.com/ for details. Chair: Members: Editorial Committee 2016-2018 Lee Wan Ming, QMH Tse Connie, CMC (Chief Editor) Chan Eugenie, QMH Cheng Sau Wai, QEH Law Shing Ping, PWH Lo Carol, CMC Ma Ella, HKCH Commissioning Views expressed in this publication are not necessarily those of the Editorial Committee, nor of the HKPNA. The publishers accept no liability for the contents in this publication. Articles may be reproduced only with the prior consent of the Editorial Committee.