Children's Community Nursing Service - Need To Know

Transcription

1 CLCH Quality Report 2012 Children s Community Nursing Service 1. Summary of the service and the main features Locations The Children s Community Children s Nursing Service provides care to children under the age of 19 years with additional health needs, living in Barnet, Kensington and Chelsea, Hammersmith and Fulham and Westminster. Aims and Objectives We provide a variety of care, usually in the home, but also in other community settings, such as schools and Day Nurseries. These interventions include:- Acute nursing needs (inner London) Palliative and End of Life Care School nursing service in Special Needs Schools Community Therapeutic Play services. Respite care provision and nursing support for children with complex health needs The purpose of the service is to promote early discharge from hospital, minimise hospital visits and prevent readmission to hospital, supporting GP s in keeping children at home. We promote use of the key worker/lead professional role in order to co-ordinate care with all services involved with the family. Outcomes Expected outcomes are the improved management of children with long term conditions and overall improved experience for the child, by providing good quality care from trained and experienced paediatric nurses and care workers in conjunction with therapeutic and preparatory play to minimise fear and enhance the experience of the health service for the whole family. We support parents in becoming experts in their own child s care and building their confidence to work with care professionals to achieve the best health outcomes and quality of life for the child.

2 2. Patients at the heart of everything we do The Children s Community Nursing Service is designed around the needs of patients; we collect feedback from patients so that we can develop the service around their needs. The following words are taken from a parent s story and give an example of the flexibility of the service hours and working with the family to maintain a normal routine. We have also built a bond with the [Nurses] there are about three different ones who come but they are all the same. This makes a difference to us as a family because we have a lot of appointments, see lots of different doctors and nurses, but when you have someone coming to your home it is really important that you know them. They are very flexible with their times which is important now that the children are at school. They will come early in the morning so that there is no disruption to the school day and this is important because this is a long term condition. They will always work with us and if it is not convenient for them to visit in the morning I will let them know and they will come in the evening instead. 3. Looking back what have we done to improve the quality of the service? Children s Community Nursing applies a continuous improvement cycle approach, to how we work with our clients, families and develop service. Paramount to this is a focus on safety and clinical effective. Below are some examples of how we have achieved this. Patient safety - a culture of being open and safe The safety of the children for whom we provide a service is a high priority. Many of the children we visit are unable to express their views and concerns verbally and are particularly vulnerable. It is therefore important that we develop open and informative relationships with the children and their families. One of our safety measures in the last year has been the introduction of the Policy for accepting and managing infants and children with naso gastric tubes. This is being used in the home and school settings in order to standardise care and ensure patient safety. We look at issues that arise on an individual basis with the families and apply the knowledge gained from that experience to influence risk assessment and planning of care for other children Recently a family in the Barnet area whose child is ventilator dependent were affected by a power cut, lasting about 4 hours. Arrangements are always in place for children who are ventilator dependent and who require a lot of electrically operated equipment, such as always having the batteries fully charged and an arrangement with the

3 power suppliers that the family home is a priority for return to service. The care worker worked closely with the family to ensure that the child routine was maintained, all of the equipment continued to function and the child suffered no ill effects. However, when reflecting afterwards it was noted that one of the difficulties as it grew dark was being able to check the readings on the machines just by torchlight. The Team have now arranged for battery operated lights to be available in the homes of children with such health needs in the future. - Clinical effectiveness - no decision about me without me The involvement of children and families in the planning of care begins from our first introduction, including explanations to the child of any procedures that are necessary, according to their understanding. Decisions are made with the involvement of the family, after providing relevant and current information. Below are some of the steps we have taken to improve clinical effectiveness in the last year: - The introduction of care plans with pupil photograph in Jack Tizard School to ensure that pupils who are not able to communicate easily can be identified when administering treatment. The photographs are restricted to the clinical room and are taken with parental consent. - An audit to ensure continuity in accessing central lines at home and use of aseptic non-touch technique. - The development of evidence-based Clinical skills guidelines for use across all inner London Boroughs with the plan to extend to Barnet. These will be used as templates for individual care plans on RIO when they are complete. - We endeavour to treat the children and their families in an individual way, to meet their needs, as indicated by the following PREMS responses from parents: lovely community nurses. Always go the extra mile and very kind Looks outside the box to find answers to our questions My daughter s confidence and speech much improved after seeing play specialist for a few weeks.she used to be very shy and wouldn t talk to anyone, now she is getting out of her shell Working with parents to learn to give care. From a parent s story At first the nurses would come half an hour before the injection was due, to check the dosage and that I was okay. They continued to come and observe until I was thoroughly confident to do it myself - Patient experience - you said-we did The Children s Community Nursing Service offers all patients or parents/carers that access the service the

4 opportunity to return a Patient Reported Experience Measures (PREMs) so that patients can provide feedback about the service they receive. There have been a total of 14 PREM responses received this year, of which 100% of patients reported their overall experience of care as good or excellent. You said 1. Parents had fed back that they wanted to have results of blood tests as quickly as possible 2. Parents requested flexibility of respite care provision to meet family needs We did 1. Through good liaison with local hospitals in inner London there is now an efficient system of obtaining results on the same day, which are then phoned, texted or ed to parents 2. A shift was altered for a family in Barnet to enable a grandmother to see her grandchild s nativity play. The usual day of respite care for a child in Westminster was altered so that care worker could accompany the child to the church while his baby sister was christened 3. Working with families of dying children to ensure that the child dies in the place of their choice, in line with ACT guidelines. 4. Parents of children receiving respite care requested their rotas in advance, so that they knew which care worker to expect 5. A family was concerned about a child returning to school following death of her sibling 3. With the exception of one child who died unexpectedly in hospital, this was achieved in the last year and will continue to be an aim of the Kaleidoscope team in the future 4.Rotas are either ed, texted or delivered to the families on a monthly basis 5. The Play Specialist worked closely with the school staff and accompanied the child until she felt confident to attend alone 4. What resources were utilised in the process of improving quality? We have utilised various resources to improve the quality of care provided by the Children s Community Nursing service, some of the main areas include: The Inner London Team moved offices to The Medical Centre, Woodfield Road so that we are all based in one place. This has led to improved communication and greater opportunities to work together. The introduction of McKinley infusion pumps has improved delivery of medication for End of Life Care. We have made good use of the variety of skill mix and staff expertise within the team to draw up Clinical

5 Skills guidelines to ensure continuity of evidence-based nursing care to all of the children. The recruitment of a permanent nurse at Jack Tizard Special Needs School, supported by experienced Care Workers has enhanced service and relationships with Educational staff. We have provided multi-agency Asthma, Allergy and Epilepsy training by the Community Matrons in Barnet and Children s Community Nurses in Inner London. The Barnet Team have provided 16 Basic Epilepsy awareness sessions to 281 attendees, and 6 update sessions to 15 attendees. They also provided an introduction to epilepsy awareness for 15 people. We have also provided training on the care of specific children to schools and Nurseries in order to provide continuity of care in the community setting. In this year to date the Inner London Team (including the Children s Community Nurses, Kaleidoscope Nurse the Jack Tizard School Nurse and the Home Care Support Nurses) have provided training on approximately 23 occasions to groups of between 2 and 10 people. 5. Top Tips Things that worked well Working closer together across Inner London and Barnet and the co-location of the Inner London Team. The allocation of new paediatric staff nurses from Chelsea and Westminster Hospital to spend a day with the CCN Service as part of their induction programme. Continuation of the work started at the end of 2011 to improve discharge of children from hospital to home. Work with other agencies (Noah s Ark and Shooting Star Children s Hospices from the voluntary sector, the Palliative Care Team and Private Health Care providers for a specific child requiring End of Life Care). Clinical Supervision from an external expert with experience in paediatric issues. Things that didn t work as well An audit of care plans highlighted poor levels of uploading care plans on to RiO. The organisational recruitment process which takes time. This is particularly difficult for the recruitment of Band 3 Care Workers who are required to give only one months notice, resulting in long term shortages of

6 staff. The length of the process of obtaining references has also resulted in loss of applicants who were successfully interviewed. Lessons learned The importance of personal contact with parents, particularly when dealing with verbal complaints. Time spent recently with one parent resulted in her ing gratitude for how her concerns were dealt with. The importance of patient stories. We have started to collect stories not only from the child receiving the service but also from family members. Two parents particularly have commented that they felt that their views were valued and taken seriously. Using a variety of communications systems to keep parents informed of rotas, blood results etc. We have found that texts and s have helped considerably in saving time and improving communication. 6. Key Improvement Areas 1. Improved face to face communication with and feedback from families 2. Improved record keeping 3. Standardised training and competency framework for Care workers across all areas 4. Standardised information leaflets for parents and professionals 5. A review of NICE Guidance compliance for the Children s Community Nursing Service is to begin in January 2013

7 7. Action Plan 1. Improvement area Our target How will we measure? Who is responsible? By when? Communication with parents and families Increase patient/family stories Introduce Parent focus groups Introduce Nurse led drop in sessions for parents at Special Needs School Minimum of 10 stories in one year Minutes of groups and actions Feedback of parents and recording of activity on Rio Veronica Mason Community Matrons (Barnet) Claire Dady December 2013 December 2013 July Improved record keeping in both areas Up to date Care plans in all areas Audit of Rio notes Audit of School notes Audit of home notes Elizabeth Welch Veronica Mason Harriet Foster November Co-ordinated training and competencies for care workers, with the potential for some Care workers to work in both geographical areas. For all care workers across all areas to have signed competencies and the ability to adapt to different situations Competency files Pam Mitcham Harriet Foster and Sarah O Donnell November To produce leaflets about our services for families and Production of a leaflet Team Leaders April 2013

8 Informative promotion of the professionals with up to date information and contact details Children s Community Nursing Service 5. Review of NICE guidelines compliance To ensure that there is standardisation of high quality care delivery which complies with NICE guideline Production and implementation/integration of standards To be confirmed March 2014