Policy for the Management of Children and Young People with Surgical Problems
Summary statement: How does the document
support patient care?
This document provides clarity regarding patient pathways for
children and young people presenting with an acute problem that
requires the input from any surgical team in the Emergency
Department and the Childrens’ in patient areas
Staff/stakeholders involved in development:
Chief of Service W+C, Chief of service Surgery, Clinical Directors,
Surgery and Paediatrics ,Emergency department,
Consultants, Head of Childrens’ Nursing
Paediatric Matrons, Operational Manager W & C
Divisions:
Women & Children, Surgery
Department:
Paediatrics
Responsible Person:
Rowena Remorino
Author:
Rowena Remorino
For use by:
This document applies to all staff involved in the admission of
children and young people with surgical problems in the emergency
department and the Children’s’ inpatient areas.
Purpose:
This policy governs the operational delivery of children and young
people requiring surgical care in the Emergency and Paediatric
departments.
This
document
Standards and legislation
supports:
Children’s Act 2004
RCN – Service Standards for Children’s wards and departments –
2011
RCPCH Fit for the future 2011
WSHT – Safeguarding Children Guidance
Key related documents:
Pan-Sussex Safeguarding Children guidance 2010 (Intranet)
Approved
by:
Governance/Management Group
Divisional
Approval date:
February 2013
Ratified by Board of Directors/ Committee of
the Board of Directors
For completion by………………………………….
Ratification Date:
For completion by ………………………………….
Expiry Date:
For completion by ………………………………….
Review date:
If you require this document in another format such as Braille, large print, audio or another
language please contact the Trusts Communications Team
Reference Number:
To be added by ……………………………………..
Version
date
Author
Status
1.0
2
Comment
Operational Policy for the management
of Children and Young People with Acute
Surgical Problems
3
Table of Contents
Page
1.
Introduction
5
2.
Routes of Referral and Admission Process
5
Children aged 5 and under
CYP aged 6 – 16
YP aged 16-18
Exceptions
5
5
5
5
3.
Inpatient Management
6
4.
Patients requiring transfer to a Paediatric Surgical Unit
6
5.
Escalation Policy
6
6.
Medication and fluid Prescriptions
7
7.
Safeguarding Children
7
8.
Pain assessment and control.
7
4
1.
Introduction
Children and Young People (CYP) presenting with acute surgical problems need
careful multidisciplinary management with joint medical and surgical
responsibility for their care. It has been highlighted as an area of potential and
actual significant clinical risk. This policy has been formulated after consultation
with Paediatricians and Surgeons on both WSHT sites to reach a consensus
view on safe, patient-centred care. The document applies to general surgery as
well as sub speciality surgical teams.
2.
Routes of referral and admission process.
Western Sussex Hospitals have designated paediatric and adolescent
assessment and in-patient facilities on both the Worthing and St Richard’s site.
CYP presenting with potential surgical problems may present to either the
Emergency Department or via GP referral.
Children aged 5 and under.
Children aged 5 years and under will be referred to and assessed by the
Paediatric on call team and, if appropriate, admitted under their care. These
children will be discussed and transferred as necessary to a centre with a
paediatric surgical unit (Southampton or Brighton).
CYP (children and Young People) aged 6-16
Between the hours of 9am and 9pm these CYP will be referred to, seen and
assessed by the surgical team. The assessment should be performed by a
middle grade or above. The paediatric registrar will support assessment as
required with registrar to registrar discussion taking place as appropriate.
Overnight, between the hours of 9pm and 9am, the initial assessment and
admission will be by the paediatric team on the Worthing site and the Surgical
Middle grade or above on the SRH site. Collaboration should take place between
surgeons and paediatricians as clinically indicated and should be middle grade or
above.
YP (Young People) aged 16-18
The management of YP aged 16-18 is currently under review and an addendum
to this policy will be made once a safe clinical consensus has been achieved. In
the meanwhile current practices will continue.
Exceptions
Children aged 2 years and above presenting with testicular torsion may be
considered appropriate for surgery on one of the WSHT sites. Assessment will
be undertaken by a member of the senior urology team (middle grade or above)
and discussed with the Consultant Anaesthetist on call to decide whether surgery
on site is appropriate or whether transfer to SUHT/Brighton is necessary.
5
Children and Young People with fractures will be assessed by the Orthopaedic
team in the usual way.
MFU patients will continue to have specialist assessment at presentation /
referral, regardless of time of presentation
YP with obvious gynae problems e.g. PV bleed should have initial gynae
assessment, regardless of the time of presentation
All of the above may require Senior Paediatric input at assessment.
3.
In-patient management
CYP admitted to the Childrens’ unit at either Worthing or SRH will be under
shared care. They will have both a named paediatrician and a named surgical
consultant. They will all be discussed at all team handover meetings. Both
specialities will provide proactive Consultant review on a daily basis and agree a
shared management plan that will be effectively communicated to each other and
the nursing team as well as any relevant allied health professionals. This plan will
be clearly documented in the patient case notes.
4.
Patients requiring transfer to a Paediatric surgical unit.
CYP of any age requiring transfer outside WSHT should be reviewed by a
paediatrician of middle grade or above prior to transfer. This assessment should
include assessment of the need for resuscitation and appropriate analgesia.
Fitness for transfer should be assessed and documented. Any child who is
critically ill should be stabilised and discussed with the appropriate PICU retrieval
service (STRS or SORT). Early involvement of a Consultant paediatrician in the
management of critically ill children is essential and all children being transferred
outside the Trust should be discussed with the Consultant Paediatrician on call.
Arrangements for transfer should be considered. ‘Blue light’ transfer with a
paramedic crew may be appropriate but the need for nursing or medical escort
should be considered and documented.
5.
Escalation policy
Any seriously ill CYP should be discussed with the Paediatric on call consultant.
If there are conflicts or uncertainties over decisions regarding patient care,
including where the patient should be admitted or how a patient should be
transferred, this should be escalated to both relevant consultants and a
consultant to consultant conversation may be required. If the senior nursing team
are concerned they should contact the consultant directly, as per the ‘Escalation
of Concerns Flowchart’
6
6.
Medication and fluid prescriptions
The paediatric team will support all fluid and medication prescriptions as
required. This may be a junior member of the team but will be overseen on
Consultant ward rounds. The anaesthetic team will usually manage fluid therapy
peri-operatively.
7.
Safeguarding Children
The paediatric team will take overarching responsibility for the child’s
safeguarding needs, as per WSHT safeguarding children guidelines 2011, and
RCPCH Fit for the Future 2011
8.
Pain assessment and control
The paediatric team will assess the CYP’s pain control proactively during the
ward rounds using the appropriate pain assessment tool and manage it with
appropriate analgesia. All teams involved will share the responsibility for pain
management. If analgesia is problematic consider involving the pain team.
.
7