Neonatal Nurse Consultant role in Surgery

1
Neonatal Nurse Consultant role in Surgery

• New ways of working
• 2005

2
Nurse Consultant- NeonatalSurgery- Yorkshire
Neonatal Network
3
Background

• Pressure from surgeons, obstetricians, nurses
• Media pressure, mothers transferring out of
  region.
• Audit trail 2002, Jan July, babies who could
  have been transferred to local hospital if
  support was available.
• 466 days, from 300 - 900 pounds per day.

4
Background

• 63 miles each way
• Resident / work
• Expressing milk
• Finances, food, car parking, drinks, washing
  clothes,
• Relationships
• Multiple professionals

5
Policy documents

• DoH (2000) The New NHS Plan
• Neonatal strategy working group (2002)
• DoH (2003) The Green Paper, Every Child Matters
• DoH Childrens Act (2004),
• NSF for Children (2005)

6
Remit

• Increase cot capacity - 50 babies
  transferred
• to
  hospital near home
• Decrease refusal rate - collecting data.
• Decrease out of region transfers collecting data
• Safe transfer, care and management of surgical
  babies to a hospital near the home 1 re
  admission for oesophageal dilation, 1
  bronchoscopy.

7
Nurse Consultant

• Expert clinical practice
• Leadership
• Politics
• Education
• Research and audit

8
Leadership

• Lead Nurse neonatal surgery
• Pain management
• Sensory relaxation and stimulation
• Wound assessment

9
Leadership as CN

• Guidance for medical and nursing staff on
  management of transferred infants who have had
  surgery
• Guidelines, protocols, trouble shooting
  information
• Parental information, discharge planning

10
Education

• Surgical teaching- medical, nursing, PAMs.
• Study days
• Universities
• Blackboards
• Book review

11
Audit

• Pain
• Rectal washouts
• Surgery numbers at Hull and Leeds.
• Refusal data, delayed discharge data
• No of babies transferred, complications, re -
  admissions

12
Research

• Evidence based practice
• e.g Central line management
• Sucrose
• Dressings post surgery
• Feeding regimes
• Gastro oesophageal reflux management

13
Research

• Study to identify the concerns for parents who
  had to travel long distances to visit their baby.
• A three point evaluation on the outcomes of a
  surgical support role for infants who are
  transferred to their local hospital or discharged
  home.

14
What do I do?

• Teaching and planning for transfer before it
  happens
• Close regular contact with nurse caring for
  infant
• Liaise with medical staff, dietician, physio etc
• Physical examination
• Recommend ongoing management

15
Problem solving

• Diarrhoea
• Constipation
• Reflux
• Medications
• Immunisations
• Passing naso- jej tube
• without x-ray.

• Prolapse vesicostomy
• Removal of percutaneous feeding jejunal tube
• Blood in stools
• Abdominal mass

16
Good things that have happened

• Parents visit more often
• Parents spend less money
• Parents feel they can take siblings to special
  care
• Special cares are less noisy the Surgical ward
• Primary care teams are involved earlier, visit
  nnu and support for discharge home appears to be
  good.

17
What else has happened

• Referrals about babies who have transferred out
  of region and come back to local hospital
• Referrals about inguinal hernias, increasing head
  circumference.
• Referral of a baby for tender loving care -
  planning

18
Working together with parents and professionals
19
Enhancing communication to improve patient care
I did tell you that if you fed me properly I
would grow!!!! Bye for now, safe journey.