All Wales Neonatal Standards Wales... · 2013-08-08 · All Wales Neonatal Standards - 2 nd Edition June 2013 - 7 - Standard 1: Access to Neonatal care Rationale: All newborn babies

All Wales Neonatal Standards 2nd Edition

All Wales Neonatal Standards - 2nd Edition

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Acting on behalf of Local Health Boards in Wales in the Planning and Securing of

Specialised Services


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CONTENTS Forward 4 Introduction 5 Background 5 Delivering the Standards 6 Standard 1 Access to Neonatal Care 7 Standard 2 Staffing of Neonatal Services 8 Standard 3 Facilities for Neonatal Services, Including Equipment 14 Standard 4 Care of the baby and family/ Patient Experience 17 Standard 5 Transportation 22 Standard 6 Clinical Pathways, Protocols, Guidelines and Procedures/Clinical Governance 23 Standard 7 Education and Training/Clinical Governance 25 Appendix 1 27 References 30


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Forward

The All Wales Neonatal Standards1 were first published in 2008 as part of a series of Standards for specialised services for children and young people in Wales. The Standards were based on recommendations from a number of reviews and on the best practice principles published by the British Association of Perinatal Medicine (BAPM): Standards for Hospitals Providing Neonatal Intensive and High Dependency Care (December 2001).2 The All Wales Neonatal Standards were recommended by the Minister for Health and Social Services and provide a framework for the planning and delivery of effective neonatal care and a mechanism for assessing the quality and safety of services. Responsibility for implementing the Standards lies primarily with Local Health Boards (LHBs) and Welsh Health Specialised Services Committee, (WHSSC) and monitoring compliance against the Standards has been undertaken by the Wales Neonatal Network (WNN) since Autumn 2010. In August 2010 BAPM published updated ‘Standards for Hospitals Providing Neonatal Care’.3 These revised standards provide greater detail, particularly in relation to staffing, than the original BAPM 2001 Standards. At the time it was agreed that these revised Standards would not be incorporated into the All Wales 2008 Neonatal Standards as Health Boards were starting to make good progress against the Welsh Standards resulting in improvements to services. A review of the All Wales Neonatal Standards was planned for 2012 to take into account the updated BAPM 2010 Standards, as well as the latest evidence from across the Service. Work to revise the All Wales Standards has been led by the Wales Neonatal Network and has involved professionals from across the service as well as Bliss and parent representatives. This 2nd Edition of the All Wales Neonatal Standards has been endorsed by the Welsh Government’s Paediatric and Child Health National Specialist Advisory Group (NSAG) and is supported by the Royal College of Paediatric & Child Health in Wales (RCPCH). It provides an up to date framework for the delivery of neonatal care across Wales whilst maintaining the essence of the 2008 Standards.

Mark Drayton Clinical Lead Wales Neonatal Network


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Introduction

The Standards and their key actions have been developed to provide a basis for the planning and delivery of effective and equitable neonatal services across Wales. They are to be used to benchmark current services and inform the development of future services to meet the specialised health needs of children and young people across Wales. Representatives of key stakeholders have been involved in the review and development of the revised Standards. The Standards have been quality assured by the RCPCH (Wales) National Specialist Advisory Group (NSAG) for Paediatrics & Child Health details of which are included as Appendix A.

Background Since 2008 there have been a number of significant developments and documents that have influenced the shape and direction of neonatal services. The 'Toolkit for High Quality Neonatal Services', 20094 provides a common structure for neonatal services in England and the underlying key principles are relevant across the whole of the United Kingdom. The toolkit sets out the principle that neonatal care should be delivered through clinical Networks and describes Networks as being comprised of three different types of Units: Special Care Units (SCU) These provide special care for their own local population. Depending on arrangements within the Neonatal Network, they may provide some high dependency services. Local Neonatal Units (LNU) These provide special care and high dependency care and a restricted volume of intensive care (as agreed locally) and would expect to transfer babies who require complex or longer-term intensive care to a Neonatal Intensive Care Unit. Neonatal Intensive Care Units (NICU) These are larger Intensive Care Units that provide the whole range of medical (and sometimes surgical) neonatal care for their local population, along with additional care for babies and their families referred from the Neonatal Network in which they are based. Within a Network at least one hospital will have a Neonatal Intensive Care Unit, offering a specialist centre of expertise and experience for the sickest infants. NICUs will work closely with the other Network LNUs and SCUs. Many will be sited alongside specialist obstetric and fetal maternal medicine services and will require close working arrangements with all of the relevant paediatric sub-specialties. In August 2010 BAPM produced updated Standards for Hospitals Providing Neonatal Care’, 2010. These replaced the 2001 BAPM Standards and included greater clarity in a number of key areas:


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1. The role of Networks is outlined as:

• undertaking adequate assessment of need and provision of appropriate capacity

• monitoring compliance • working with education providers

• undertaking workforce planning 2. Clearer responsibilities are defined for different teams of professionals

including nursing, medical and allied health professionals 3. Numbered Levels of Care have been replaced by Intensive Care

(previously Level 3), High Dependency (previously Level 2), Special Care (previously Level 1) for simplicity and to improve understanding.

In August 2011 BAPM published updated Categories of Care, 2011.5 These replaced the Categories of Care that were previously defined by BAPM in it’s 2001 document. Up to date definitions are provided for the categorisation of care on a neonatal Unit by Intensive Care (IC), High Dependency (HD) and Low Dependency or Special Care (SC) level. A description of what is considered to constitute Transitional Care is also provided. This is care within a dedicated transitional care ward or within a postnatal ward. In either case the mother must be resident with her baby and providing care. Care above that needed normally is provided by the mother with support from a midwife/healthcare professional who needs no specialist neonatal training. In 2012 Bliss published its Baby Charter Audit Tool,6 based on the Bliss Baby Charter Standards, 2nd edition7 published in 2011. This provides a framework for Units to examine their service provision and to develop family centred care. In 2011 the Department of Health, produced planning and design guidance for Neonatal Units8. Whilst this is an NHS England document the principles are relevant to the planning and development of neonatal facilities in Wales.

Delivering the Standards Health Boards in Wales have responsibility for the provision of quality neonatal care. The All Wales Neonatal Standards outline the requirements for high quality, person centred, safe and effective neonatal care and provide a framework to support delivery at Unit level. These Standards are intended to be applied at Unit level, however on occasions, Units may need to look to neighbouring Units to provide support. Where this happens, Health Boards need to be explicit about how they are meeting the Standards. The Standards will be monitored and progress reported.


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Standard 1: Access to Neonatal care

Rationale: All newborn babies who require healthcare over and above the

normal birth pathway have equitable access to the appropriate level of care in a timely manner.

Key Action Responsible organisation

1.1 Neonatal care is commissioned to meet the local and national population need based on an adequate assessment of need being undertaken.1

WHSSC LHBs WNN

1.2 Neonatal care is available at all levels as close to home as possible as part of a Clinical Network. Each Clinical Network has defined Neonatal Intensive Care Units (NICUs).3

LHBs WNN

1.3 All Neonatal Networks should have in place a clinical lead who has time dedicated to the role.1

WHSSC

1.4 There is a clear documented referral pathway to and from all levels of care. These pathways include: • Feto-maternal assessment

• Transfer of the mother ante-natally (including from home to specialist centre for high-risk management)

• Local neonatal stabilisation arrangements

• Transfer of the neonate who requires care at a level not available at the place of birth

• Access for step up from special care to high dependency care and subsequent step down

• Access for step up from high dependency care to intensive care and subsequent step down

• Access to other specialist services i.e. surgery, cardiology, neurology and ECMO

• Coordinated transfer of mother and baby when moving back to a Unit near home.3

LHBs, including Obstetric services

1.5 Effective communication mechanisms are in place for access to and discharge from special care, high dependency and intensive care services.1

LHBs


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Standard 2: Staffing of Neonatal Services

Rationale: Neonatal services are staffed with appropriately trained, multi-

disciplinary professional teams, according to the level of service they provide.


All neonatal services

2.1 All obstetric delivery Units involved in the care of babies have associated neonatal staffing arrangements for the prompt, safe and effective resuscitation and stabilisation of babies.9 Ongoing stabilisation may be necessary until retrieval to a Unit able to provide ongoing care at the appropriate level.

LHBs

2.2 The Standards for neonatal resuscitation are set out in the Neonatal Life Support Manual which is issued under the auspices of the Resuscitation Council (UK) and reflect current opinion published by the International Liaison Committee on Resuscitation (ILCOR).

• Units should ensure that their staff are NLS trained and certified and that resuscitation equipment complies with the latest Resuscitation Council Guidelines.

• In particular, in term infants receiving resuscitation at birth with positive pressure ventilation, it is best to begin with air rather than 100% oxygen. If despite effective ventilation there is no increase in heart rate or if oxygenation (guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered. The need to start resuscitation at birth with air whilst retaining the ability to offer additional oxygen to a small minority of babies means that both gases, and the ability not only to blend them but also to monitor oxygenation, will need to be available at delivery.

• Delivery Units should provide access to compressed air, air-oxygen blenders and pulse oximeters.10

LHBs

2.3 Staff trained in neonatal resuscitation are available at every birth. When delivery of a baby at <30 weeks gestational age is anticipated, a consultant or career grade/training grade doctor with neonatal training and experience should also be present.1

LHBs


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2.4 All staff involved in the delivery of high-risk pregnancies are trained to recognise and manage neonatal and obstetric emergencies.11

LHBs

2.5 When a delivery is planned at <28 completed weeks, arrangements are in place for the baby to be delivered at a NICU if in-utero transfer is safe for mother and baby.11

LHBs

2.6 All neonatal Units have a designated neonatal nurse with protected time dedicated to providing teaching and education of the neonatal team.3

LHBs

2.7 All neonatal Units will ensure that a designated link nurse(s) within the workforce has responsibility for the following areas:

• Breast feeding • Infant development • Family support • Safeguarding children • Bereavement support and palliative care • Discharge planning

• Health, safety & risk management.3

LHBs

2.8 All neonatal Units should have appropriate access to specialist paediatric Dieticians with knowledge of complex neonatal and surgical dietetics.3

LHBs

2.9 All neonatal Units should have appropriate access to neonatal physiotherapists or neonatal occupational therapists with the appropriate skills, knowledge and experience to guide neurological assessment and care.

LHBs

2.10 All neonatal Units should have appropriate access to specialist speech and language therapists with specialist training in dysphagia and management of infant feeding and swallowing.

LHBs

2.11 All neonatal Units should have appropriate access to paediatric pharmacists with the appropriate skills, knowledge and experience in neonatal intensive care.

LHBs

2.12 Follow up support near the baby’s home is available, coordinated by the local Community Children’s multi-disciplinary team, (including therapists) and where appropriate in liaison with specialist outreach neonatal and therapy staff. The local model for providing this care is likely to vary, depending on size and level of neonatal service.

LHBs


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2.13 All neonatal services should have access to the following support services these include:

• Screening • Genetics • Social work

These should include staff with expertise in the care of neonates.

LHBs WHSSC

Requirements for a Neonatal Intensive Care Unit (NICU)

2.14 A nursing ratio of 1:1 is provided for babies requiring Neonatal Intensive care. The named nurse is Qualified in Speciality (QIS) and should have no other managerial responsibilities during the clinical shift. The nurse may be involved in the support of a less experienced nurse working alongside in caring for the same baby.3

LHBs

2.15 The Unit can provide evidence that the establishment is correct for the number of neonatal intensive care cots commissioned.3

LHBs

2.16 At Tier 3 all consultants should be identified neonatal specialists. There is a neonatal consultant 24/7 on-call rota, separate to general paediatric cover at Tier 3 with a minimum of 7 Staff.3

LHBs

2.17 All consultants will have CCT in Paediatrics, Neonatal Medicine or equivalent training.3

LHBs

2.18 At Tier 2 there is a separate neonatal rota 24/7 with a minimum of 8 staff, made up from the following:

• Paediatric ST4-8 • Specialty doctors

• Other non training grade doctors • ANNPs (with appropriate additional skills and

training)

• Resident neonatal consultants.3

LHBs

2.19 At Tier 1 there is a separate neonatal rota with a minimum of 8 staff, made up from the following:

• Paediatrics ST1-3 • ENNPs • ANNPs • Specialty doctors.3

LHBs


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2.20 All NICUs should provide:

• A minimum of 0.05 – 0.1 specialist dieticians per intensive care cot. This specialist neonatal dietician may also need to provide advice to neighbouring LNUs and SCUs and if so additional capacity may be required in job plans to provide that advice and support the Network

• A similar level of provision should be provided for occupational therapist or physiotherapist. This shall optimally be at Band 7 or 8a and may need to be enhanced further if the therapist is required to deliver follow up care in the community

• Access to specialist neonatal speech and language is essential for NICUs. The staff level should be decided locally according to the size and organisational arrangements.3

LHBs

2.21 Clerical and support staff are in place in all Units to provide discharge support, e.g. specialist nurse, liaison health visitor. This is in addition to the clinical establishment.1

LHBs

2.22 Every NICU will have a designated senior nurse manager who is supernumerary to the staff establishment. An element of this role will be to manage the NICU and its relationship with SCUs and LNUs in its Network.1

LHBs

Requirements for a Local Neonatal Unit (LNU)

2.23 A nursing ratio of 1:2 is provided for babies requiring High Dependency care. The named nurse is Qualified in Speciality (QIS). More stable and less dependent babies may be cared for by registered nurse not QIS, but who are under the direct supervision and responsibility of a neonatal nurse.3

LHBs

2.24 The LNU can provide evidence that the establishment is correct for the number of High Dependency cots commissioned.1

LHBs

2.25 At Tier 3 the LNU has a minimum of 7 consultants on the on-call rota. A minimum of one consultant who has a designated lead interest in neonatology and is responsible for the direction and management of the Unit including the monitoring of clinical policies, practice and standards.3

LHBs


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2.26 The LNU should have 24-hour 7 day availability of a paediatric/neonatal consultant who can demonstrate expertise in neonatal care (based on training, experience, CPD and on going appraisal).3

LHBs

2.27 At Tier 2 the LNU may have a shared rota with paediatrics, with a minimum of 8 staff. * Staff will have the training and experience to resuscitate and stabilise babies unexpectedly requiring short term intensive care. Staffing will be made up from the following:

• Paediatric ST3-8 • Specialty doctors • Other non training grade doctors

• ANNPs • Resident paediatric/neonatal consultants.3

* Where LNUs regularly provide intensive care and/or have a very busy

paediatric service and/or have a neonatal and paediatric services that are a significant distance apart the above staffing should be enhanced. Such

enhanced measures would include separate Tier 2 rotas 0900 until 2400 each day or, depending on an assessment of patient safety, throughout

the 24 hours.

LHBs

2.28 At Tier 1 the LNU should have a separate rota with a minimum of 8 staff who do not cover general paediatrics in addition at any time of day or night, made up from the following:

• Paediatric ST1-2 • GPST1 or FY2 • Specialty doctors • ENNPS or ANNPs • Non training grade doctors.3

LHBs

2.29 All LNUs should have access to a highly skilled specialist neonatal dietician and other therapists whose job plan contains sufficient capacity to provide advice and support across the Network. The dietician may work from the adjacent NICU.3

LHBs

Requirements for a Special Care Unit (SCU)

2.30 A nursing ratio of 1:4 is provided for babies requiring Special Care. Registered nurses and non-registered clinical staff must be under the direct supervision and responsibility of a neonatal nurse QIS.3

LHBs

2.31 The SCU can provide evidence that the establishment is correct for the number of Special Care cots commissioned.3

LHBs


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2.32 At Tier 3 there should be a minimum of 7 consultants on the on-call rota with a minimum of one consultant with a designated lead interest in neonatology.1

LHBs

2.33 At Tier 2 there should be a shared rota with paediatrics with a minimum of 8 staff.3

LHBs

2.34 At Tier 1 the rotas should be EWTD compliant with a minimum of 8 staff who may cover paediatrics in addition, made up from the following:

• Paediatric ST1-2 • GPST1 or FY2 • Specialty doctors • ENNPS or ANNPs • Non training grade doctors.

In some settings Tier 1 and 2 may be able to merge

where appropriate skilled nursing support exists.3

LHBs


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Standard 3: Facilities for Neonatal Services, including Equipment

Rationale: Appropriate, up to date and safe equipment and facilities are

available to care for babies with neonatal care needs and their families.


3.1 Neonatal facilities are commissioned based on population need, taking into account local differences.1

LHBs

3.2 Neonatal facilities are adjacent to labour suites.2 LHBs

3.3 Neonatal facilities include a compliment of cots at each acuity taking account of planned delivery population needs and patient flows within the Network.3

LHBs

3.4 Cot space requirements:

• Adequate space to facilitate clinical functionality at each acuity level and minimise cross infection risks. Detailed advice is provided in ‘Neonatal Units: Planning and Design Manual’.8

LHBs

3.5 Clinical spaces are to include: • Staff communication base • General office/clinical administration room

• Transfer/reception area • Resuscitation facilities • Treatment room • Transitional care (this may be provided off the

neonatal Unit) Clinical support spaces to include:

• Laundry room • Milk expression room • Milk kitchen and store • Bereavement suite

• Near patient testing room • Equipment store • Maintenance area • Transport incubator bay

Staff spaces to include:

• Offices • Facilities for training and learning.8

LHBs


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3.6 Dedicated facilities are available for parents and families of babies receiving neonatal care. As a minimum there is:

• Overnight accommodation for parents: o One room per intensive care cot located

within 10–15 minutes’ walking distance (dressing gown distance) of the Unit

o Two rooms within or adjacent to the Unit (with gas and air supply points to be available) for ‘rooming in’ prior to discharge

o All rooms should be free of charge and with bathroom facilities

• Arrangements for secure and readily accessible storage of parents’ personal items

• Cot-side, non-secure storage for personal items (e.g. baby clothes)

• A parent sitting room • Appropriate access to hot drinks and food outside

normal hours

• A toilet and washing area • A changing area for other young children

• A play area for siblings of infants receiving care • Access to a telephone and internet connection within

the hospital

• A room set aside and furnished appropriately for counselling and to provide distressed parents with privacy and quiet.4,6

LHBs

3.7 Family friendly outpatient facilities will include: • An appropriate area to feed baby • Changing area • Access for prams • Consulting room large enough for baby, parents and siblings • Play area • Appropriate toys available.4,6

LHBs

3.8 All neonatal Units are able to transfer clinical details of a baby electronically when a baby is transferred.1

LHBs

3.9 Appropriate resources are available to purchase and maintain equipment for the level of neonatal care being provided.1

LHBs


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3.10 Joint working arrangements are in place with the local Medical Technical Department responsible for equipment safety and maintenance including the blood gas analyser.1

LHBs

3.11 24-hour laboratory services are available which are orientated to neonatal needs.1

LHBs

3.12 Each cot on a Neonatal Intensive Care Unit and Local Neonatal Unit has the following equipment as a minimum: • Incubator or unit with radiant heating

• Ventilator* and NCPAP/BIPAP driver and/or oxygen high flow unit with humidifier

• Syringe/infusion Pumps

• Facilities for monitoring the following variables: o Respiration o Heart rate o Intra-vascular blood pressure o Oxygen saturation o Temperature, skin and rectal o Ambient oxygen

*Intensive Care Cot only.1

LHBs

3.13 Each Neonatal Intensive Care and Local Neonatal Unit has access to the following equipment:

• Resuscitaire • Blood gas analysis (on the neonatal Unit for use by

Unit staff)

• Phototherapy • Non-invasive blood pressure measurement • Transillumination by cold light • Portable x-rays • Ultrasound scanner

• Internal hospital transport equipment (including mechanical ventilation)

• Instant photographs (consent based)

• Specialist equipment to support discharge home.1

LHBs

3.14 Each Neonatal Intensive Care Unit should have facilities to provide:

• Inhaled NO • Total body cooling • High Frequency Oscilatory Ventilation.

LHBs


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Standard 4: Care of the baby and family/Patient Experience

Rationale: The baby and the family receive holistic child and family

centred care as close to home as possible, with ease of access to specialist centres when this care is required. Family centred care is a philosophy of care that helps families whose baby is in a neonatal hospital cope with the stress, anxiety and altered parenting roles that accompany their baby’s condition. It puts the physical, psychological and social needs of both the baby and their family at the heart of all care given. Ultimately family centred care may enhance attachment between a baby and the family and result in an improved long-term outcome for both. This will be demonstrated through the process of staff governance, ensuring quality of communication; involvement in decision-making and planning of care; ensuring treatment with dignity and respect; access to professional support; and in the level of facilities available.


Communication

4.1 Every parent has unrestricted access to his or her baby, unless individual restrictions can be justified in the baby’s best interest.4

LHBs

4.2 A prior visit to the Unit and an opportunity to meet staff should be offered to parents with a predicted need for neonatal care, or a transfer to another Unit for ongoing care.4,6

LHBs

4.3 All parents are fully inducted on entry to the Neonatal Unit, so they can orient themselves with routines and staff and are aware of the different equipment and noises or alarms within the Unit. 4,6

LHBs

4.4 Written information is accessible (in languages and formats appropriate to the local community) to all users of the service, to permit early and effective communication with parents covering at least: • Admission to hospital, including travel, parking and information on local amenities • Transfer service and repatriation • Discharge service and arrangements for going home • National and local support groups available

LHBs


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• Who to contact in the hospital with queries or for advice • Where to go for further information and support,

including sources of financial support and useful websites

• Services to which a baby is being transferred, including a named contact and telephone number

• Condition/diagnosis • Treatment options available • Likely outcomes/benefits of treatment • Possible complications/risks

• Circumstances requiring consent.

4.5 Parents being offered the opportunity to discuss their baby’s diagnosis and care with an experienced clinician within 24 hours of admission, or following a significant change in condition.4

LHBs

4.6 Parents being offered access to appropriate communication and advocacy services to support them in their participation in ward round discussions, clinical care decision making, palliative care planning and end of life care if required.4,6

LHBs

Parental Involvement

4.7 Up to date and documented care plans are used to direct and are formulated in discussion with parents.6

LHBs

4.8 Every baby is treated with dignity and respect: • Appropriate positioning is promoted and encouraged • Clinical interventions are managed to minimise stress, avoid pain and conserve energy • Noise and light levels are managed to minimise stress • Appropriate clothing is used at all times, taking into account parents’ choice • Privacy is respected and promoted as appropriate to the baby’s condition.4,6

LHBs

4.9 Parents are encouraged and supported to participate in their baby’s care at the earliest opportunity, including: • regular skin-to-skin care • providing comforting touch and comfort holding, particularly during painful procedures • feeding • day-to-day care, such as nappy changing.4,6

LHBs


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4.10 Parents being offered the opportunity to be present when care and other medical interventions are delivered if clinically appropriate.4,6

LHBs

4.11 Every effort is made to keep the mother and her baby/babies in the same hospital.4

LHBs

4.12 If required, palliative care planning and end of life decisions are made in partnership between professionals and parents in an appropriate environment. The available options including hospice and homecare will be discussed if clinically appropriate.6

LHBs

4.13 Psychological and social aspects of care for the whole family (including siblings) are recognised and included throughout the baby’s care pathway and especially at critical times for example when receiving sensitive news and at end of life.4,6

LHBs

Breast feeding

4.14 Maternity and neonatal services encourage breastfeeding and the expression of milk through the provision of information and dedicated support, including: • Whenever possible, initiation of breastfeeding as soon as possible after birth • When necessary, support to start expressing as soon after delivery as the mother’s condition allows to maximise the benefit of colostrum • The availability of a comfortable, dedicated and discreet area • The facility and space to express discreetly at the cot-side • The availability of breast pumps and associated equipment for every mother who requires them • Supporting breastfeeding as part of the discharge process • Promotion of safe and hygienic handling and storage of breast milk • Access to donor breast milk, as clinically indicated.4,6

LHBs

Discharge

4.15 Health and social care plans are co-ordinated to enable the safe and effective discharge of a baby: • Parents are involved in multi-disciplinary discharge planning from the point of admission and plans are continually reviewed

LHBs


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• Families have appropriate information and training (for example in infant resuscitation) before being discharged home • The baby and family have their ongoing needs at home co-ordinated and met by health professionals appropriately skilled in delivering neonatal care and support in the community • Parents have access to accommodation so they can be with their baby and develop confidence in day-to day care prior to discharge • Parents meet with the team providing community care prior to discharge • A named member of staff is responsible for co- ordinating a multi-agency discharge process for each baby and family • Plans include support and monitoring for vulnerable families to safeguard and promote the welfare of the baby • Where there is no continuing specialist neonatal care requirement, the responsibility for ongoing health monitoring is transferred to universal services • Where there is a need for continuing care or palliative care, the responsibility for meeting those additional needs will rest with a workforce skilled in delivering neonatal care in the community.4,6

Research Consent

4.16 All efforts are made to include families and their baby in clinical research activity:

• Families and carers are informed about all research that their baby is eligible to participate in by using appropriate leaflets, inserts in maternity notes and inserts in Unit induction packs

• When a baby becomes eligible for a research study during their admission parents and carers are informed about this

• Each Unit supports families and carers during the research process by providing regular updates after a baby has been recruited to a study

• Families and carers are informed that they can withdraw from research trials at any time without compromising the care of their baby. 4

LHBs


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4.17 Access to the following support services are available:

• Social Worker • Spiritual Adviser • Bereavement Counsellor

• Breast feeding support staff • Psychological advice by trained Clinical Psychologists

specialising in Neonatal care

• Psychiatric support • Multi-ethnic health advocates and translators.1,3

LHBs

4.18 Information is available at all antenatal facilities about post natal service provision, including information on neonatal services.1

LHBs


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Standard 5: Transportation

Rationale: A transport service, staffed by trained personnel is in place

24/7 for all areas of Wales, to provide rapid and timely transport of neonates to and from appropriate services across the Network and country boundaries. At the same time, safe care is maintained at the inpatient Units.


5.1 Transport services are planned and commissioned 2 on an All Wales basis with working arrangements in place for each Network and across the border with England. All Units accepting and/or referring neonates have or have access to, an appropriately staffed and equipped transport service.

WHSSC WAST*

5.2 Arrangements are in place in partnership between maternity and neonatal Units for the timely transfer of the mother (in-utero transfer) when a high-risk situation is anticipated in line with the All Wales In -Utero Transfer Guideline.12

LHBs WAST

5.3 Staff responsible for transfers are in addition to those of the clinical inpatient team.1

LHBs

5.4 Each Neonatal Unit keeps a detailed log of all neonatal transfers including unmet requests with the reasons. This information should be included as part of Unit and Network Annual Reports.1

LHBs WNN

5.5 Each Maternity Unit keeps a detailed log of all in-utero transfers of mothers whose babies are likely to need neonatal care.1

LHBs

* Welsh Ambulance Service Trust (WAST)


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Standard 6: Clinical Pathways, Protocols, Guidelines and Procedures/Clinical Governance

Rationale: Care will be delivered based on the best available evidence.

Pathways and guidelines circulated widely and agreed nationally will ensure that the child receives high quality care wherever it is delivered.


6.1 Documented Clinical pathways and Guidelines are in place at a Unit and where appropriate, at a Network level and are audited within the Network. These should include as a minimum: • Neonatal infection control arrangements

• The management of common neonatal conditions • Those conditions requiring transfer to NICUs for

more specialised clinical management1

• Safeguarding Children.15

LHBs WNN

6.2 Every Neonatal Unit should have an agreed protocol for the resuscitation and management of the extremely preterm infant.3

LHBs WAST

6.3 Protocols are in place to ensure babies are transferred between Units within the Network according to clinical need. Arrangements are in place with neighbouring Networks to ensure a seamless service when babies need to be transferred across Wales or across the border to England.1

WHSSC LHBs WNN

6.4 Protocols are in place for:

• Cerebral Ultrasound examination of the brain • Screening and treatment for retinopathy of

prematurity

• Screening for hearing loss • Screening of hip abnormalities • Post mortem examination procedures

• Infection control (including HIV and Hepatitis B).1

LHBs NPHS

6.5 Every Unit must submit reports on morbidity/mortality to the Neonatal Network in an agreed format. The Network will produce an annual report that assesses morbidity/ mortality.1

LHBs WNN

6.6 Systems are in place to feed into National Databases including CARIS, MBRRACE-UK (includes AWPS), NNAP. 1

LHBs


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6.7 Every Unit will:

• Identify a named individual who is responsible to the Health Board clinical governance lead for the comprehensive capture of information on all neonatal cases admitted to the Unit

• Produce an annual report for the Health Board on quality of care.1

LHBs WNN

6.8 Every Unit will: • Ensure exception reporting to the Health Board occurs when patient safety is compromised • Ensure systems are in place for reporting, investigating and learning from adverse incidents as well as sharing such learning opportunities at a Network level.1

6.9 Every Unit will:

• Participate in the National Neonatal Audit Programme (NNAP)

• Participate in audit programmes coordinated through the Neonatal Network

• Consider audit reports produced by the Unit lead clinician and recommend improvements within the Health Board

• Audit their service against the All Wales Neonatal Standards – 2nd Edition and report the outcome to the Health Board clinical governance committee on an annual basis.1


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Standard 7: Education and Training/Clinical Governance

Rationale: All members of the multi-professional team are trained to the

required standard to deliver a high quality service safely.


7.1 Staff attending home births, including paramedics are trained in Newborn Life Support (NLS) and maintain NLS certification.1

LHBs WAST

7.2 All doctors and nurses caring for critically ill neonates should receive Newborn Life Support (NLS) training and maintain NLS certification.9

LHBs

7.3 Nurse post registration neonatal education is readily available based on the Matching knowledge and skills for Qualified in Speciality (QIS) Neonatal Nurses competency framework.13

WG LHBs

7.4 Non registered clinical staff (including nursery nurses) should complete the child specific Credit Qualification Framework Wales (CQFW)13 level 3 training within 1–5 years of appointment.3

LHBs

7.5 For nurses QIS working in roles with enhanced practice skills (ENNP), a defined level of competency for the theoretical and practical assessment of new skills needs to be agreed with local higher education institutions (HEI).3

LHBS WNN

7.6 Nurses working in roles using enhanced skills should have their time acting in these roles defined over and above the nursing workforce of neonatal nurse QIS.3

LHBs

7.7 Clear tiers of responsibility and accountability should be put in place for staff working in Advanced Neonatal Nurse Practitioners (ANNPs) roles.3

LHBs

7.8 All staff involved in feeding babies should receive training on supporting the family unit for successful breastfeeding.1

LHBs

7.9 Therapists working in Neonatal Units need to have specialist training and defined competencies. They will be required to provide specialist support to community based Therapy teams on discharge.1,3

LHBs

7.10 Pharmacists working in Neonatal Units should be suitably trained and experienced and as a minimum, have successfully completed the Centre of Postgraduate Pharmacy Education paediatric learning pack or have equivalent levels of skills and knowledge.1.3

LHBs


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7.11 All staff involved in delivering neonatal care are trained in safeguarding children in accordance with competencies in the Intercollegiate Document.16

LHBs

7.12 Research into neonatal care is a core component of the service. A Network research strategy should be in place.3

WNN LHBs

7.13 Within the Network, arrangements should be in place for leadership of:

• Education • Training • Guideline development • Audit.

WNN LHBs


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Appendix 1

RCPCH (Wales) National Specialist Advisory Group for Paediatrics & Child Health

Position Membership route

Key Responsibilities

Chair Ex officio RCPCH Officer for Wales

Chair and convene meetings

Lead for the College

Report to Council

Report to the Welsh Medical Committee Executive.

Report to Welsh Government & advisors

Responsible for planning the proactive business of the committee

Vice Chair / WPS Representative

Ex officio Vice Chair / WPS Honorary Secretary

Deputise and support Chair as required

Provide input with the perspective and representation of the membership of the Welsh Paediatric Society

Council Representative

Ex officio RCPCH Regional Council Member

Provide input with the perspective of experience of current clinical practice and represent the RCPCH Council

South & South East Regional Representative

Ex officio from RCPCH Wales Executive Committee

Provide input with the perspective of experience of current clinical practice representing paediatricians from the South & South East region of Wales

Mid & West Regional Representative


Provide input with the perspective of experience of current clinical practice representing paediatricians from the Mid & West region of Wales

North Regional Representative


Provide input with the perspective of experience of current clinical practice representing paediatricians from the North region of Wales


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Academic Representative

Ex Officio RCPCH Regional Academic Advisor

Provide input with the perspective of experience of current paediatric academia

Specialty Training Representative

Ex officio Deanery specialty advisor and reconfiguration lead

for Paediatrics

Provide input with the perspective of experience of specialty training for paediatrics.

Ensure a link to Wales Deanery and ensure co-ordination with the Deanery on issues where appropriate

Community / BACCH Representative

Ex officio BACCH Wales Representative

Provide input with the perspective of experience of current clinical practice of community paediatrics

Surgery Representative

Co-opt externally from BAPS

Provide input with the perspective of experience of current clinical practice of paediatric surgery

Ensure a link to the membership and Officers of the RCS and BAPS and ensure co-ordination with the RCS and BAPS on issues where appropriate

Anaesthesia Representative

Ex Officio President PAG (Wales)

Provide input with the perspective of experience of current clinical practice of paediatric surgery

Ensure a link to the membership and Officers of the RCA and ensure co-ordination with the RCA and PAG on issues where appropriate

Neonatal Representative

Ex Officio Network Lead for Neonatal Services (Wales)

Provide input with the perspective of experience of current clinical practice of neonatal paediatrics

Specialist Services Representative

Ex Officio Specialist Services Officer - WHSSC

Provide input with the perspective of experience of current clinical practice and specialised services

Safeguarding / CP Representative

Ex-Officio Designated Doctor

Provide input with the perspective of experience of current clinical practice of safeguarding and child protection


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CAMHS Representative

Co-opt from externally from RCPsych

Provide input with the perspective of experience of current clinical practice of Child and Adolescent Mental Health

Ensure a link to the membership and Officers of the RCPsych and ensure co-ordination with the RCPsych on issues where appropriate

Welsh Government Representative

Ex-Officio Welsh Government Senior Medical Officer (Maternal & Child Health)

Provide input with the perspective of experience of child health strategy within the Welsh Government

Therapy Representative

Ex Officio Representative Welsh Therapies Advisory Committee

Provide input with the perspective of experience of current clinical practice of therapies and paediatrics

Children’s Nursing Representative

Ex Officio Chair All Wales Senior Children’s Nurse Forum

Provide input with the perspective of experience of current clinical practice of paediatric nursing

Ensure a link to the membership and Officers of the RCN and ensure co-ordination with the RCN on issues where appropriate

Advocacy representative

Provide input with the perspective of experience of children’s rights and advocacy

Primary Care Representative

Co-opt from RCGP Provide input with the perspective of experience of current clinical practice of primary care Ensure a link to the membership and Officers of the RCGP and ensure co-ordination with the RCGP on issues where appropriate


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References 1. Welsh Assembly Government (October 2008) All Wales Neonatal Standards for Children and Young People’s Specialised Healthcare Services: Welsh Assembly Government.

2. British Association of Perinatal Medicine (December 2001) Standards for Hospitals Providing Neonatal Intensive and High Dependency Care: London. BAPM. 3. British Association of Perinatal Medicine (August 2010) Standards for Hospitals Providing Neonatal Care: London. BAPM. 4. Department of Health (2009) Toolkit for High Quality Neonatal Services: Department of Health. 5. British Association of Perinatal Medicine (August 2011) Categories of Care: London. BAPM. 6. Bliss (2012) Bliss Baby Charter Audit Tool: London. Bliss. 7. Bliss (2011) The Bliss Baby Charter Standards, 2nd Edition: London. Bliss. 8. Department of Health (November 211) Neonatal Units : Planning & Design Manual Version:0.6: England. 9. British Paediatric Association. (1993) Neonatal Resuscitation. London. BPA. 10. Resuscitation Council (UK) Newsletter (Summer 2011) Air / oxygen blenders and pulse oximetry in resuscitation at birth. London. Resuscitation Council (UK) 11. Confidential Enquiry into Stillbirths and Deaths in Infancy (33) Project 27/28. An Enquiry into quality of care and its effect on the survival of babies born at 27/28 weeks. London. CESDI. 12. Royal College of Paediatrics and Child Health RCPCH (Wales) National Specialist Advisory Group for Paediatrics & Child Health (January 2011) All Wales In Utero Transfer Guideline for Obstetrics and Gynaecology. Cardiff. 13. British Association of Perinatal Medicine (April 2012) Matching knowledge & skills for Qualified in Speciality (QIS) Neonatal Nurses : A core syllabus for clinical competency: London. BAPM. 14. Welsh Government (March 2009) The Credit and Qualification Framework 15. Welsh Government (2008) All Wales Child Protection Procedures


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16. Royal College of Paediatrics and Child Health (RCPCH) (September 2012) Safeguarding Children and Young People: Roles and Competencies for healthcare staff. Intercollegiate document

Documents

All Wales Neonatal Standards Wales... · 2013-08-08 · All Wales Neonatal Standards - 2 nd Edition June 2013 - 7 - Standard 1: Access to Neonatal care Rationale: All newborn babies