Guidelines for Follow-up of Children s Accident and Emergency Department Attendances, Hospital Discharges and Referral Appointments

Transcription

1 Guidelines for Follow-up of Children s Accident and Emergency Department Attendances, Hospital Discharges and Referral Appointments All healthcare professionals must exercise their own professional judgement when using guidelines. However any decision to vary from the guideline should be documented in the patient records to include the reason for variance and the subsequent action taken. Version: Final Ratified by (name of Committee): Provider Services Quality and Safety Committee Date ratified: 24 November 2009 Date issued: December 2009 Expiry date: December 2012 (Document is not valid after this date) Review date: March 2011 Lead Executive/Director: Name of originator/author: Target audience: Vicky Preece, Associate Director of Nursing and Therapies Helena Wood- Clinical Service Lead Health Visiting Karen Watts- Paediatric Liaison Nurse Staff and patients and partner organisations of WPCT

2 CONTRIBUTION LIST Key individuals involved in developing the document Name Anna Dodd Jane Cahill Alison Deacy Juliet Wear Julie Bragg Helena Wood Amalie Carr Cheryl Hall Sue Thomas Claire King Liz Parkes Alison Strong Alison Schanz Julia Greer Bev Downing Karen Watts Jo Thompson Catherine Whitehouse Designation Clinical Lead School Nursing Team Leader School Nursing Team Leader School Nursing Team Leader School Nursing Team Leader School Nursing Clinical Lead Health Visiting Paediatric Liaison Nurse Named Nurse LAC Nurse Consultant Child Protection Circulated to the following individuals for comments Name Marie McCurry Designation Safeguarding Children Health Forum Team Leaders Health Visiting WPCT Children s Forum Team Leaders School Nursing Associate Director of Provider Services Children s Lead Approved by the Clinical Policies and Guidelines Committee 11 November 2009 And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 2 of 13

3 CONTENTS INTRODUCTION 4 PURPOSE OF GUIDELINE 4 1. FOLLOW UP FOR ACCIDENT AND EMERGENCY ATTENDANCES - HEALTH VISITOR RESPONSE 4 2. FOLLOW UP FOR ACCIDENT AND EMERGENCY ATTENDANCES SCHOOL NURSE RESPONSE 5 3. OTHER ACCIDENT AND EMERGENCY ATTENDANCES 6 4. NOTIFICATION OF DISCHARGE FROM HOSPITAL OF PRE-SCHOOL CHILDREN HV RESPONSE 6 5. NOTIFICATION OF DISCHARGE FROM THE NEO-NATAL UNIT 7 6. NOTIFICATION OF DISCHARGE FROM HOSPITAL FOR SCHOOL AGE CHILDREN 7 7.NOTIFICATION OF NON ATTENDANCE FOR HOSPITAL APPOINTMENTS OR FOLLOW UP CLINICS. 8. MONITORING AND REVIEW 9 REFERENCES 9 And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 3 of 13

4 Introduction Each year in the United Kingdom, non-fatal injury results in more than six million visits to Accident and Emergency departments and approximately two million of these are children. Unintentional injury is a leading cause of death among children aged 1-14 years and puts more children in hospital than any other cause. It is a major concern for all those seeking to improve health and reduce inequalities. Up to a half of infants under twelve months and a quarter of older children will attend an Accident and Emergency Department each year. Children under five years old carry a disproportionate burden of injuries from falls and fires. They suffer nearly 45 per cent of all severe burns and scalds. About 50 per cent of these happen in the kitchen and approximately 50 per cent of all injuries to the under fives occur in the home. In any one year, one in eleven children will be referred to a hospital outpatient clinic and one child in fifteen will be admitted into hospital. In order to provide seamless care to children and young people there needs to be effective pathways and information sharing between health professionals in acute hospital trusts and primary care services. Following the Laming Inquiry into the death of Victoria Climbie (DH 2003) Laming 09 recommendations were made that information relating to a child s attendance at Accident and Emergency Department, discharge from hospital and follow up appointments should be shared with primary care and community services to ensure an effective handover of care and provision of services. Purpose of Guideline To promote effective communication pathways and systems which co-ordinate children s care between hospital and community services. To identify children and families who may require increased support or services. To safeguard children and young people and promote their welfare. To reduce preventable accidental injuries in children. 1. Follow Up for Accident and Emergency Attendances - Health Visitor Response All notifications of pre school children who attend the Accident and Emergency Department, Minor Injuries Unit or who are referred from NHS Direct will be forwarded to the relevant health visitor by the Paediatric Liaison Service. Accident and Emergency and minor injury staff will inform parent/carer of the child that information relating to their child s illness/injury will be shared with their general practitioner and health visitor. Health Visitors should make contact with the parent/carer for the following attendances within 5 working days of receiving the notification from the Paediatric Liaison Health Service And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 4 of 13

5 The following will require a home visit: Where safeguarding concerns have been identified. Liaison with duty team children s services should take place before the home visit. Looked after Children Travelling families where not registered with GP, Team Leaders will be informed & case allocated within team Child safety concerns particularly in relation to supervision, parenting capacity or environmental factors Feeding difficulties in babies under twelve weeks Growth and developmental issues Fractious, irritable baby with no identifiable underlying medical cause Identified significant family or parental problems and stressors Urgent health promotion requirements Referral from A&E department Frequent attendance at A&E, Minor Injuries Unit ( 3 attendances within a 6 month period, with issues relating to safety and lack of supervision ) All notifications of attendances at Accident and Emergency Department, minor injuries unit or contact with NHS Direct should be documented in the child s health record and NCRS and the subsequent action and outcome recorded if a contact or home visit has been undertaken. 2. Follow Up for Accident and Emergency Attendances School Nurse Response Notifications of attendances at Accident and Emergency Department, Minor Injuries Unit or contact with NHS Direct for school age children are screened by the Paediatric Liaison Services and forwarded to the relevant school nurse for follow up in the community. Parents/carers and the young person are informed by the Accident and Emergency Department that notification of their attendance will be shared with their general practitioner and school nurse. The following attendances require a contact within 5 working days of receiving the notification from the Paediatric Liaison Nurse or Health Visitor During school holidays the responsibility for follow up of priority attendances will be held by the nominated member of staff as per rota. This rota is circulated by Clinical Service Lead for School Nursing to Paediatric Liaison Services and Health Visiting teams Where child protection concerns have been identified liaison with children s services to occur before contact takes place Where child safety concerns have been highlighted relating to supervision, risky behaviours/lifestyle or vulnerability And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 5 of 13

6 Identified significant family or parental problems and stressors Self Harm where there is no involvement with mental health services Alcohol/Substance misuse where there is no involvement from support services Bullying Assault Emergency contraception All notifications of attendances at the Accident and Emergency Department, Minor Injuries Unit and NHS Direct should be recorded in the child s health record and the subsequent action and outcome if a contact or home visit has been undertaken. 3. Other Accident and Emergency Attendances Any other notifications received by health visitors or school nurses may require follow up based on professional judgement. The following questions should provide the basis for the decision. If one or more of the factors below feature in the received information contact should be made with the parent/carer or young person: 1. Is there a child protection plan? 2. Has the child previously been subject to a child protection plan? 3. Is there a known history of violence within the family? 4. Has the child got a known chronic illness or disability? 5. Are there frequent attendances at Accident and Emergency or Minor Injuries Unit with issue relating to safety & lack of supervision? A&E staff may flag this issue with Paediatric Liaison Service(More than three in a 6 month period) 6. Has the child recently moved into the area and is not yet registered with a general practitioner and/or school? 7. Has the child attended an accident and emergency department in another area without a legitimate reason? 8. Did the child/young person leave the department without waiting for treatment? 4. Notification of Discharge from Hospital of Pre-school Children HV Response Notification of discharge from hospital for pre school children will be forwarded to the health visitor and the Paediatric Liaison Service informed A telephone contact to the family should be made within 5 working days for the following discharges: Identified child protection concerns liaison with the duty team Children s Services And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 6 of 13

7 should occur before contact is made Child safety concerns particularly in relation to supervision, parenting capacity or environmental factors Feeding difficulties Growth or developmental problems Convulsions or fits Newly diagnosed condition or disability Significant family/parental problems or stressors Head Injury Burns or Scalds Discharge of child against medical advice The information should be recorded in the child s health record and NCRS record and any subsequent action or outcome relating to the contact should be documented. 5. Notification of Discharge from the Neo-natal Unit Health Visitors should receive notification of the discharge of babies from the unit by the Paediatric Liaison Service and or Neo-natal unit staff. Contact should then be made with the community midwife to check their involvement and co-ordinate follow up and support for the family. 6. Notification of Discharge from Hospital for School Age Children Notification of hospital discharges for all school age children will be forwarded to the relevant School Nurse by the Paediatric Liaison Service. Children not attending Worcestershire Local Authority maintained school who require follow up will be considered individually and if required discussed with named nurse for safeguarding children. Contact should be made within 5 working days with the parent/carer or young person for the following discharges: Identified child protection concerns liaison with Children s Services before contact Safety concerns supervision, risky lifestyles, vulnerability Overdose/attempted suicide where no mental health services are in support Bullying/Mugging/Assault where no support services are engaged with the young person Identified family/parental problems or stressors And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 7 of 13

8 Newly diagnosed condition or disability Road Traffic Accidents Where child/young person has been discharged against medical advice During school holidays responsibility for urgent follow-up with the parent/carer or young person lies with the nominated member of school nurse team. The information should be documented on NCRS and in the child s health record any subsequent actions or outcome recorded following contact. 7. Notification of children who do not attend (DNA) hospital appointments or follow up appointments Children and young people are seen in a wide range of services, clinics and settings throughout the PCT. The PCT is required to have a robust system for following up of children and young people who fail to attend for appointments where the child has been referred for that appointment [Care Quality Commission 2009; Laming 2009]. The Children Act 1989 and 2004 state that a child is anyone who is yet to reach their 18 th birthday; although a young person under 18 may consent to treatment, for this policy they are deemed to be a child. Some young people may be living independently, attending further education, be a member of the armed forces, a hospital inpatient, in prison or a Youth Offenders Institution; however this does not change their status or entitlement to services or protection under the Children Act 1989 and 2004 (Working Together to Safeguard Children 2006). The Process: The DNA flowchart (appendix 1) should be followed for all children and young people who are not yet 18 years old where intervention / treatment is being offered when a referral has been received by the PCT. The decision to discharge a child should be made by the lead consultant / clinician for the child / young person. The Safeguarding Team should be notified when a child is discharged following DNA if the child is subject to a Child Protection Plan. The following professionals should be notified of DNAs by letter, or by telephone if considered more urgent: The original referrer General Practitioner Child 0 to school age Health Visitor Child school age School Nurse Child school age with special or complex needs attending special school 18yrs Special School Nurse And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 8 of 13

9 Every child / young person known to Children s Services Social Worker There is a presumption that health visiting or school nursing will be notified. If the clinician decides not to notify health visiting or school nursing they should justify their decision and document this in the clinical notes. The clinician should also consider the need to notify any other health professional involved with the family. Sample letters templates are attached to this guideline (appendix 2 and 3). In line with copying letters to patients wherever possible families should be included in all correspondence. All actions taken must be clearly documented in the child s notes. Consultants will contact Health Visitors and School Nurses in relation to a child or young person not attending for hospital appointments or follow up clinics. If a child is discharged following non attendance the Named Nurse for Safeguarding Children Acute Trust will notify the Paediatric Liaison Services 8. Monitoring and Review A yearly audit will take place tracking one week of notifications to all health visitors and school nurses to assess speed of notification, classification of injury/illness and outcome. The audit will be carried out by the Safeguarding Children Health Team and Paediatric Liaison Services each September. The guideline will be reviewed by the Safeguarding Children Health Forum every two years. References 1. Healthcare Commission. Improvement review into Services for Children in Hospital. Commission for Healthcare Audit and Inspection. February providerinformation/reviewsand inspections/improvementreviews/servicesforchildreninhospital.cfm 2. DOH. National Service Framework for Children and Young People and Maternity Services Department of Health 2004: AndGuidance/HealthAndSocialCareTopics/ChildrenServices/ChildrenServicesInformati on/childrenservicesinformationarticle 3. DfES.Working Together to Safeguard Children:A guide to inter-agency working to safeguard and promote the welfare of children. Department for Education and Skills: HMSO. The Victoria Climbie Inquiry:Report of an Inquiry by Lord Laming. The Stationery Office.2003,London: 5. National Institute of Clinical Excellence in Health and Social Care (NICE) Detecting Child Maltreatment Guidance The Protection of Children in England, Laming Framework of Assessment And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 9 of 13

10 And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 10 of 13

11 Appendix 1 - Process for follow up of children who do not attend Referral received considered via appropriate allocation system/ process/pathway used Signposted elsewhere Offered 1 st Appointment Returned to referrer as it doesn t meet the criteria for the service Attended Did Not Attend *** If DNA at any time the clinician should consider if there are any know reasons eg holidays, in hospital; there is a need to continue treatment; etc If the clinician is concerned they should follow the steps from *** Attempt to contact the family/patient by telephone to ascertain the reason. Either send a further appointment or Send a letter to the referrer to check if the appointment is still required Appointment required Appointment not required 2 nd appointment offered telephone contact/support may be required Discharge with letter to referrer and HV/SN Attended Did Not Attend The following professionals should be notified by letter or telephone if considered more urgent of DNAs: The original referrer General Practitioner Child 0 to school age Health Visitor Child school age School Nurse Child school age with special or complex needs attending special school 18yrs Special School Nurse Every child / young person known to Children s Services Social Worker * There is a presumption that health visiting or school nursing will be notified. If the clinician decides not to notify health visiting or school nursing they should justify their decision and document this in the clinical notes. And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 11 of 13

12 Appendix 2 sample follow up letter to referrer Ref Date GP Dear Re: Childs details inserted here Child s name had an appointment to attend at....hospital on. However,.. did not attend that appointment. There is, of course, the possibility that.. is now better, and a hospital appointment is no longer needed. It is also possible that the appointment may not have been received. If that is the case we would of course be happy to send out another appointment. A new appointment can be arranged by contacting my secretary on I will send a copy of this letter to the family and also the noting the child s non-attendance at the appointment and offer them the opportunity to make another appointment if one is still needed. If we do not hear that such an appointment is needed no further appointment will be sent out. Yours sincerely Cc to: Parent/carer Young Person if applicable Health Visitor [if child under 5yrs of age] Appropriate professionals involved and Trust safeguarding nurse And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 12 of 13

13 Appendix 3 Sample letter to parents/carer Ref NHS No Clinic Date Todays date To parents of Childs name Childs address. Dear Parents Childs name.. did not attend for his/her outpatient appointment today. Unfortunately, as this appointment was made via the Choose & Book System you will need to telephone them directly on in order to re-book an appointment for your child, if necessary. Yours sincerely Consultant CC GP Health Visitor [ if child is under 5 yrs of age] And Emergency Department Attendances, Hospital Discharges and Referral Appointments Page 13 of 13