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Caring for children receiving home intravenous antibiotic therapy

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The development of a community nursing service for children ... Euwas, P., Chick, N. (1999) On caring and being cared for. In: Madjar, I., Walton, J.A. (eds. ... – PowerPoint PPT presentation

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Title: Caring for children receiving home intravenous antibiotic therapy


1

The development of a community nursing service
for children with an acute illness. Carolanne
Getty Community Childrens Nursing Sister
2
  • Aim
  • To describe the development of an acute CCN
    service.

3
Objectives
  • To understand the journey of service development
    for an acute CCN team in Northern Ireland.
  • To appreciate benefits of such a service to
    acutely ill children and their families.
  • To consider the dimensions of care the CCN can
    bring to children who are acutely ill.

4
Structure of Presentation
  • Evidence supporting acute CCN service development
  • Setting up the acute CCN Service in Homefirst
  • Dimensions of care CCN can bring.

5
GEOGRAPHICAL AREA
  • Population 330,000
  • Area 1,200 square miles
  • Mixed urban and rural
  • Largest community trust in Northern Ireland
  • Divided into 3 sectors
  • Antrim/ Ballymena
  • East Antrim
  • Magherafelt/ Cookstown

6
  • Childrens Community Teams including Community
    Childrens Nursing Services need to provide
    appropriate support to children, young people and
    their families which responds to local needs and
    takes account of the need to prevent hospital
    admission, facilitate early discharge, and care
    for children with complex needs
  • NSF (2004) standard 6 13.2

7
Evidence Supporting Service Development
  • World Health Organisation (1978) Health for all
    by the year 2000.
  • United Nations Convention (1989) Un Convention on
    the rights of the child.
  • House of Commons Select Committee (1997) Health
    Services for Children and Young People in the
    Community Home and School. Third Report.
  • RCN (2003) Community Childrens Nursing
    effective team working.
  • Department of Health, Social Services and
    Personal Safety (1999) Nursing services for the
    acutely ill child in Northern Ireland.
  • Department of Health, Social Services and
    Personal Safety (2004) A healthier Future a 20
    year strategy
  • Department of Health (2004) The National Service
    Framework for Children

8
Model for components of care CCN services can be
expected to deliver. (Adapted from DH, 2002 RCN,
2002)
First Contact Acute assessment, diagnosis,
treatment and referral of children
9
Composition of Homefirst Community
Childrens Nursing Service
Community Childrens Nurses Continuing care
team Trust wide
Regional Childrens Palliative Care
Nurse Northern Board
Acute Community Childrens Nursing
Team Antrim/Ballymena
Childrens Diabetes Nursing Service Trust wide
10
MULTI-PROFESSIONAL STEERING GROUP
  • ROLE OF STEERING GROUP
  • Advise on setting up of the service
  • Devise operational guidelines
  • Report to the Inter-Trust
  • Child Health Forum
  • Produce and disseminate
  • information / consult with all relevant groups

11
Questionnaire of potential service
users
12
  • Team recruited
  • 1 G grade with childrens qualification and
    Health Visiting community experience (1 WTE)
  • 3 E grade Staff Nurses with hospital based
    experience (2 WTE)
  • Model of CCN service delivery
  • Community based generalist team

13
Stages of Service Development
  • 1. Preliminary/ preparation stage
  • 2. Implementation stage
  • 3. Evaluation of service role

14
Preliminary stage
  • Develop aims and objectives
  • Develop operational policy
  • Develop evidenced based policies and procedures
  • Develop documentation
  • Logistical issues

15
Implementation Stage
  • Establishing links in hospital and community
  • Raising awareness
  • Identifying staff training needs
  • Staff development

16
Evaluation
  • This is an excellent service. It was offered
    at the right time in the hospital and gave us
    confidence to bring our son home where he made a
    quicker recovery but with the appropriate care
    and support. It should be available more widely
    and publicized as a model of good practice.

17
Challenges
  • Not 24 hour slow rate
    of service referrals
  • Role Protectionism Staffing
    levels

18
Dimensions of care
  • Formal knowledge and skills
  • Coordinating knowledge and skills
  • Skills for managing workload
  • Relational, interpersonal and support skills
  • Teaching skills
  • Thinking skills
  • Proctor et al. 1998

19
SERVICE DEVELOPMENT
  • Amalgamation of Continuing Care and acute CCN
    service.
  • Senior Nurse Practitioner
  • Rolling out of acute CCN service and nurse bank
    to other sectors
  • Expanding teams to provide a skill mix
  • Staff development

20
  • A thousand mile journey starts with a single
    step
  • Lao-tsu, 604 - 531 BC

21
References
  • Callery, P. (1997) Paying to participate
    financial, social and personal costs to parents
    involvement in their childrens care in hospital.
    Journal of Advanced Nursing. 25 746-752
  • Casey, A., Gibson, F., Hooker, L. (2001) Role
    development in childrens nursing dimensions,
    terminologyand practice framework. Paediatric
    Nursing. 13(2)36-40
  • Department of Health (2002) Liberating the
    talents, helping primary care trusts and nurses
    to deliver the NHS plan. London The Stationary
    Office
  • Department of Health (2004) The national service
    framework for children, young people and
    maternity services. London DH www.publications.do
    h.gov.uk/nsf/children
  • Department of Health and Social Services (1999)
    Nursing services for the acutely ill child in
    Northern Ireland. Report of a working group.
    Belfast The Stationary Office.
  • Eaton, N. (2000) Community Childrens Nursing
    services models of care delivery. A review of
    the United Kingdom literature. Journal of
    Advanced Nursing. 32(1)49-56
  • Euwas, P., Chick, N. (1999) On caring and being
    cared for. In Madjar, I., Walton, J.A. (eds.)
    Nursing and the experience of illness. London
    Routledge (pp170-188)

22
References
  • House of Commons Select Committee (1997) Health
    Services for children and young people in the
    community home and school. 3rd report. London
    The Stationary Office
  • Johnston, P. (2004) Community Paediatric Nursing
    Service Ballymena/Antrim Review of Service.
    Unpublished
  • Neill, S. (2005) Caring for the acutely ill child
    at home. In Sidey, A., Widdas, D. (eds.)
    Textbook of Community Childrens Nursing (2nd
    Ed.).Edinburgh Elsevier.
  • Poulton, B. (1999) User involvement in
    identifying health needs and shaping and
    evaluating services is it being realised?
    Journal of Advanced Nursing. 30(6) 1289-1296
  • Procter, S., Campbell, S., Biott, C., Edward, S.,
    Moran, M., Redpath, N. (1998) Preparation for the
    developing role of the community childrens
    nurse. Research highlights. London English
    National Board for Nursing, Midwifery and Health
    Visiting
  • Royal College of Nursing (2002) Childrens
    community nursing information for primary care
    organisations, strategic health authorities and
    all professionals working with children in
    community settings. London RCN (publication code
    001 959)
  • Secretary of State for Health (1999) Saving
    lives Our healthier nation. London The
    Stationary Office

23
References
  • Slevin, O. (2003) Nursing models and theories
    major contributions. In Basford,L., Slevin,O.
    (eds.) Theory and practice of nursing an
    integrated approach to caring practice. (2nd ed.)
    (pp255-280) Cheltenham Nelson Thornes
  • Smith, F. (1995) Childrens nursing in practice
    the Nottingham model. Oxford Blackwell Science
    Ltd
  • United Nations Convention (1989) Un Convention on
    the rights of the child.
  • Volprecht, A. Flannagan, N. Livingstone, A.
    (2001) What parents think about an acute
    community paediatric nursing service. unpublished
    report
  • While, A.E., Dyson, L.(2000) Characteristics of
    paediatric home care provision the two dominant
    models in England. Child Care Health Development.
    26(4)263-275
  • Whiting, M. (2005) Needs analysis and profiling
    in community childrens nursing. In Widdas, D.
    Sidey, A. (eds) Textbook of community childrens
    nursing (2nd ed.). (pp180-194) London
    Bailliere Tindall / RCN
  • World Health Organisation (1978) Health for all
    by the year 2000.

24
Caring for children receiving home intravenous
antibiotic therapy
  • Dianne Cook - Childrens Community Specialist
    Practitioner
  • Central Manchester Primary Care Trust
  • Elaine Salmons Childrens Community Team Leader
  • Queens Medical Centre, Nottingham

25
AIMTo have an increased awareness of
administering IV antibiotic therapy in the
community
  • OBJECTIVES
  • To discuss advantages of IVs in the community
  • To explore issues relating to administration
  • To have a basic awareness and understanding of
    anaphylaxis

26
  • The administration of IV drugs by Community
    nurses has become more widespread in recent
    years. The practice, having initially been
    classed as an extended role of practice has now
    become part of the core skills for general
    nursing practice. This therefore allows an
    holistic approach to care.

27
Advantages of IVs at home
  • Reduction and prevention of hospital admissions
  • Reduced length of stay
  • Increased independence from hospital
  • Less disruption to family routine
  • Continued schooling
  • Reduced risk of cross infection
  • Reduction of winter bed pressures
  • Cost effectiveness
  • Payment by results
  • Autonomy and empowerment

28
Range of Access routes
  • Peripheral Lines Cannula, Longlines
  • Central Venous Routes - Hickman Lines
  • Subcutaneous Implantable Venous access
    devices Portacaths

29
  • The administration of medicines is an
    important aspect of the professional practice of
    persons whose names are on the Councils
    register. It is not solely a mechanistic task to
    be performed in strict compliance with the
    written prescription of a medical practitioner.
    It requires thought and the exercise of
    professional judgement..
  • Guidelines for the administration of medicines
  • NMC 2004

30
  • Children are not miniature adults as they have
    different pharmacokinetic profiles, which require
    specialist knowledge, awareness and expertise

31
  • The safe administration to children is a key area
    of responsibility for practitioners in child
    care, and warrants extra vigilance in order to
    safeguard each childs safety

32
  • Clinical responsibility for a child receiving IV
    therapy at home lies with the GP. If a GP is
    unwilling to accept responsibility, the
    Consultant will normally continue this role

33
  • It is the nurse who is responsible for the
    correct administration of the prescribed drugs.
    Therefore, they should know the therapeutic uses,
    dosage, side effects, precautions and
    contra-indications
  • (Guidelines for the administration of medicines
    2004)

34
  • The NMC welcomes and supports the
    self-administration of medication by carers
    wherever it is appropriate.
  • (Guidelines for the safe administration of
    medicines, NMC 2004)

35
  • If responsibility is delegated then we need
    to ensure that the patient, family or carer is
    competent to carry out the task
  • Education
  • Training
  • Assessment
  • Support
  • Reviewed and reassessed periodically

36
  • Check that the patient is not allergic to the
    medicine before administering it
  • NMC 2004
  • but

37
  • An allergic reaction does not usually occur the
    first time a person is exposed to a drugIt is
    only after the body learns to recognise the
    substance that an immune system reaction is
    triggered

38
  • It therefore, is essential, that more diligence
    be taken throughout the second and subsequent
    administration of drugs given via the IV route,
    especially as these are often administered in the
    community

39
  • Drug allergies occur as a result of a variety of
    complex immune system responses to specific
    medications.

40
  • In most cases, the reaction involves relatively
    mild symptoms, e.g. minor skin rashes and hives,
    itching, generalised flushing of the skin

41
  • However, in some cases a life threatening, acute
    reaction can occur progressing quickly to more
    severe symptoms, massive swelling of the
    respiratory tract, constriction of bronchial
    smooth muscle and extreme vasodilation

42
  • Anaphylaxis is a severe allergic reaction, the
    extreme end of the allergic spectrum. No
    universally accepted definition exists because
    anaphylaxis comprises of a constellation of
    features (Ewan 1998)
  • (Anaphylaxis, BMJ, 316,
    1442-1445)

43
  • Anaphylaxis occurs in an acute and unexpected
    manner. The true incidence is unknown.
    Epidemiological studies have shown differing
    results owing to differences in both definitions
    of anaphylaxis and the population groups studied.

44
  • Anaphylaxis seems to be increasingly common,
    almost certainly associated with a significant
    increase in the prevalence of allergic disease
    over the last two or three decades

45
  • Adrenaline (Epinephrine) is the first line
    treatment for anaphylactic reactions.

46
  • Early intramuscular administration of adrenaline
    is essential for optimal action

47
  • Adrenaline (Epinephrine) is greatly under-used
  • Although widely available in the community, it is
    not given in a timely manner when required
  • (Resuscitation Council UK 2005
  • The Emergency Medical Treatment of Anaphylactic
    Reactions for First Medical Responders and for
    Community Nurses)

48
  • Anaphylaxis is poorly managed

49
  • Treatment Algorithm for Children in the Community
  • Resuscitation Council (UK) 2006
  • (www.resus.org.uk/siteindx.htm)

50
(No Transcript)
51
  • Although anaphylactic reactions are rare, they
    cannot be predicted and have the potential to be
    fatal without treatment
  • (Martin
    2000)
  • (Immunisation, Nursing Standard, 14, 30, 47-52)

52
  • Ideally therefore, no one should give IV
    treatment without access to adrenaline and
    assistance
  • Discuss with management
  • Discuss within own Trust
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