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, PAM’s. • 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. 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 Problem solving

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.