Guidelines for Admission to the Neonatal Unit Alexandra Hospital

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Lillian Fields
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1 Guidelines for Admission to the Neonatal Unit Alexandra Hospital This guidance does t override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient and/or carer. Health care professionals must be prepared to justify any deviation from this guidance. Introduction These guidelines aim to ensure that all babies requiring special care and transitional care receive this care in an appropriate area with minimal disruption to the family whilst ensuring relevant equipment/supplies are available. The patients covered by this guideline are all babies on the maternity unit at the Alexandra Hospital. This guideline is for use by the following staff groups: Medical staff, qualified midwives and neonatal nurses working within the Maternity Unit. Mrs Vicky Bullock Lead Clinician(s) Guideline reviewed and approved by Accountable Director on: NICU Manager 21 st August 2014 This guideline should t be used after end of: 21 st August 2016 Key amendments to this guideline Date Amendment By: 15/03/2005 Approved by Clinical Effectiveness Committee 16/03/2007 Reviewed by clinical lead mir amendments made to content 16/06/2008 Mir amendment to correspond with WAHT-OBS /02/2009 Reviewed by clinical lead and agreed to continue for a further period with mir amendment No amendments made to guideline V Bullock 21/1/11 Special care at the bedside, delete unaccompanied babies S Ali and those for adoption, but move to babies nursed in nursery whose mums are t inpatients Babies born at 35+6 or less, for initial assessment of feeding S Ali etc. to be cared for on Neonatal Unit. Unaccompanied babies and those for adoption, to be cared for in nursery. Babies requiring short term CPAP to be cared in Resuscitation area. 7/8/14 No amendments made to guideline S. Ali WAHT-NEO-004 Page 1 of 6 Version 10.1

2 Guidelines for Admission to the Neonatal Unit Alexandra Hospital Introduction These guidelines aim to ensure that babies requiring special care and transitional care receive this care in an appropriate area with minimal disruption to the family whilst ensuring relevant equipment/supplies are available. Training required All staff will need to be familiar with both the ward and the unit practices. These should t be greatly different. Midwives ongoing updating of drug calculating. GUIDELINE The following should be cared for on the postnatal ward by the midwives, although neonatal staff will be available for advice and support: Babies requiring phototherapy. Well babies requiring intra veus antibiotics. Babies requiring assessment of bilirubin levels and phototherapy. Routine monitoring of blood sugar levels. Babies of substance abuse mothers (if they are showing signs of withdrawal). Readmissions for breast feeding problems. Babies with cleft lip and palate who do t require nasogastric tube feeds. Well babies of 36 weeks and above who require incubator/hot cot care to maintain temperature. The following will be cared for by the Neonatal Nurses Special Care at the bedside/on the maternity ward Preterm babies requiring nasogastric tube feeding. Babies requiring monitoring of blood sugar levels, where nasogastric tube feeding is necessary to maintain levels. Babies requiring short term intraveus glucose to maintain blood sugar levels if otherwise well. Babies of a lesser corrected gestational age may be nursed in this area once assessment of their condition has been made. This will be dependent on mothers still being resident which may be less likely. All babies less than 1.8kg. Babies with neonatal abstinence syndrome, who are showing signs of withdrawal. Babies born at 35+6 or less, for initial assessment of feeding etc. WAHT-NEO-004 Page 2 of 6 Version 10.1

3 Nursery Area Babies whose mothers are t resident on the unit. Babies who require long term oxygen and/or continuous monitoring. Unaccompanied babies for adoption, or those whose mothers are in ITU. Resuscitation Area Any baby who requires care above that of routine Special Care. Babies requiring ventilation support will be cared for in this area until retrieval. Babies requiring oxygen and continuous monitoring. Some of these babies will improve and can then be transferred to the ward area. Others will go on to need transfer to Worcester or elsewhere depending on there requirements. These babies will require careful observation and assessment during the first few hours. Babies requiring short term CPAP. Babies with a cord blood ph of less than 7.0 Babies requiring short term CPAP a) babies who respond well to CPAP, with stable blood gases-should be able to stay at the Alexandra b) babies requiring CPAP for more than 24 hours transfer to Worcester should be considered c) babies with an increasing oxygen requirement and/or unstable blood gases should be transferred to Worcester Babies may be transferred back to Redditch for ongoing care if they are stable and their corrected gestation is above 32/40. The unit will be staffed by a specialist neonatal nurse and a neonatal nurse at all times. These staff will work alongside the midwives who will be caring for the mothers. Handover will take place between the neonatal nurses at the cot side where appropriate. We ackwledge that confidential issues will need to be discussed elsewhere on the unit. Parents will be fully involved in planning the care for their babies and will be encouraged to deliver that care where appropriate. Sick babies requiring medications (particularly in an emergency) will require the support of the medical staff to check and sometimes administer the medication. The drug cupboard is located in resuscitation area. Monitoring Tool STANDARDS % Clinical Exceptions All babies will be nursed alongside their 100% Babies whose mothers are unable mothers if well eugh to be resident on the unit WAHT-NEO-004 Page 3 of 6 Version 10.1

4 Contribution List Key individuals involved in developing the document Name Vicky Bullock Sharon Ali Designation NICU Manager Neonatal Unit Manager Circulated to the following individuals for comments Name Designation Dr N Ahmad Dr M Ahmed Dr T Bindal Dr D Castling Dr T C Dawson Dr T El-Azzabi Dr G Frost Dr A Gallagher Dr M Hanlon Dr L Harry Dr B Kamalarajan Dr K Nathavitharana Dr C Onyon Dr J E Scanlon Dr A Short Clinical Director/ Dr V Weckemann Mrs P Arya Mrs S Ghosh Mrs J Shahid Miss D Sinha Mr J Uhiara Miss R Imtiaz Consultant Obstetrician Mr A Thomson Clinical Director - Mrs A Talbot Matron Maternity IP Services Alex Mrs R Carter Matron Maternity IP Services WRH Mrs M Stewart Matron Maternity OP & Community Services Circulated to the chair of the following committee s / groups for comments Name Committee / group Judi Barratt/ Maternity Guidelines & Documentation Group Rachel Duckett WAHT-NEO-004 Page 4 of 6 Version 10.1

5 Supporting Document 1 - Equality Impact Assessment Tool To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Yes/No Comments 1. Does the policy/guidance affect one group less or more favourably than ather on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? If you have identified a potential discriminatory impact of this key document, please refer it to Human Resources, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Human Resources WAHT-NEO-004 Page 5 of 6 Version 10.1

6 Supporting Document 2 Financial Impact Assessment To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Title of document: 1. Does the implementation of this document require any additional Capital resources 2. Does the implementation of this document require additional revenue Yes/No 3. Does the implementation of this document require additional manpower 4. Does the implementation of this document release any manpower costs through a change in practice 5. Are there additional staff training costs associated with implementing this document which cant be delivered through current training programmes or allocated training times for staff Other comments: If the response to any of the above is yes, please complete a business case and which is signed by your Finance Manager and Directorate Manager for consideration by the Accountable Director before progressing to the relevant committee for approval WAHT-NEO-004 Page 6 of 6 Version 10.1

Worcestershire Obstetric Warning (WOW) Chart

Worcestershire Obstetric Warning (WOW) Chart This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient