Transcript The Role Of the Nurse Consultant – Neonatal Surgery

Neonatal Nurse Consultant
role in Surgery
New ways of working
2005
Nurse Consultant- Neonatal
Surgery- Yorkshire Neonatal
Network
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.
Background
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63 miles each way
Resident / work
Expressing milk
Finances, food, car
parking, drinks,
washing clothes,
Relationships
Multiple professionals
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)
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.
Nurse Consultant
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Expert clinical practice
Leadership
Politics
Education
Research and audit
Leadership
• Lead Nurse neonatal
surgery
• Pain management
• Sensory relaxation
and stimulation
• Wound assessment
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
Education
• Surgical teaching-
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medical, nursing,
PAM’s.
Study days
Universities
Blackboards
Book review
Professionals
Self
Public
Parents
Audit
• Pain
• Rectal washouts
• Surgery numbers at Hull and Leeds.
• Refusal data, delayed discharge data
• No of babies transferred, complications, re
- admissions
Research
• Evidence based practice
e.g Central line management
Sucrose
Dressings post surgery
Feeding regimes
Gastro oesophageal reflux management
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.
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
Problem solving
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Diarrhoea
Constipation
Reflux
Medications
Immunisations
Passing naso- jej tube
without x-ray.
• Prolapse vesicostomy
• Removal of
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percutaneous feeding
jejunal tube
Blood in stools
Abdominal mass
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.
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
Working together with parents and
professionals
Enhancing communication to
improve patient care
I did tell you
that if you fed
me properly I
would grow!!!!
Bye for now,
safe journey.