DEPARTMENT OF PAEDIATRICS
INFORMATION BOOKLET FOR LOCUM DOCTORS
NEONATAL UNIT
1
CONTENTS
Page
Information for Locum Doctors
3
Map of St. Peter’s Hospital
4
Paediatric Medical Personnel
5
Useful Telephone Numbers
6
Using the computer and ordering tests
7
The Neonatal Service
8
Major Incident Policy
18
Fire & Security
19
2
INFORMATION FOR LOCUM DOCTORS
The NICU Registrar on call bleep is 5302 (SHO Postnatal ward 5496 and SHO Labour ward
5125)
To bleep dial bleep no. - then ext no.- and replace receiver.
You also need a swipe card for access to all the wards. An emergency swipe card can be
collected from the security office. Security will need proof that you have been asked to work
here and a £5 deposit for the card, which is returned when they receive the card back. Out of
hours we cannot always guarantee the access built into the card and you should attend the
Porter’s Lodge on level 2 and provide their invitation to work at the Trust; this could be in
manuscript or as an email which they can show the shift manager
There is a list of useful ‘phone numbers in this file.
The doctors meet each morning for handover on NICU (0900 weekdays and weekends).
3
St Peter’s Hospital Site Map
4
Paediatric Medical Staffing – December 2014
CONSULTANTS (to call: pager no., wait for spoken message, call-back ext. followed by #)
5421
DR. ASHOK ARALIHOND
8137
DR. SHAILINI BAHL
8418
DR. GILLIAN BAKSH
8283
DR TARIQ BHATTI
8164
DR. KATE BROCKLESBY
8416
DR. PAUL CRAWSHAW
DR. SONALI D’CRUZ
8940
DR. ALISON GROVES
8422
DR. DIAB HADDAD
DR. CLARE HILL
8910
DR. KATE IRWIN
8821
DR. ANAY KULKARNI
8420
DR. TRACY LAWSON
8417
DR. PETER MARTIN
8428
DR. WAJDI NACKASHA
8177
DR. TOSIN OTUNLA
8429
DR. VENNILA PONNUSAMY
8220
DR. PETER REYNOLDS
DR. MEENAKSHI TANWAR
5174
DR. ALKA THAKUR
DR. SETHU WARIYAR
8419
DR. BOZHENA ZORITCH
ASSOCIATE SPECIALISTS / SPECIALTY DOCTORS
ext 2950
ext 2722
ext 2546
ext 3464
ext 2379
ext 3494
Ext 2722
ext 2397
ext 3293
ext 6640
ext 2329
8358
DR. ERIN DAWSON
5206
DR. OLAYINKA EJIWUMI
MIDDLE GRADE DOCTORS (to call: pager No., call-back ext. then hang up)
ext 3495
ext 3495
ext 2722
ext 2546
ext 2764
ext 3495
ext 3499
ext 3603
ext 2950
Ext 3603
ext 2126
DR. SUDATH ABEYWICKRAMA
CLINICAL FELLOW
DR. SAER ALMEREE
CLINICAL FELLOW
DR. MARINA BANAKA
ST5
DR. JOSE MAIA COSTA
CLINICAL FELLOW
DR. GEEDI FARAH
CLINICAL FELLOW
DR. AMY ROWLAND
ST5
DR. SARAH KENT
ST7/8
DR. SMITA KHANAL
Speciality Doctor
DR. SIDDHARTHA PALIWAL
ST5
DR. AISLING PARKER
Speciality Doctor
DR. ANNA RUCKER
ST7
DR. SUDIPTA SEN
CLINICAL FELLOW
DR. SHALIKA SHETTY
ST6
DR. GILLIAN SZITA
ST5
DR. DONNA WINDERBANK-SCOTT ST5
JUNIOR DOCTORS (TO CALL: Pager No., call-back ext. then hang up)
Neonates
Neonates
Neonates
General Paediatrics
Neonates
Neonates
Neonates
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
Neonates
DR. SAMUEL EVERETT
DR. ROSANNA BAKER-WILDING
DR. GREG JURY
DR. THOMAS WOODMAN
DR. SARAH KHOSRAVI
DR. EMMA HADLEY
DR. ANNA MARSH-OLIVER
DR. JULIANNE MOGFORD
DR. VICTORIA SIMONS
DR. NAOMI CHAPMAN
DR. HANA ANSARI
DR. VICTORIA DONKIN
DR. PETYA DRENCHEVA
DR. ELIZABETH DUNN
DR. MARIA KATSOULI
DR. HANNAH LINFORD
DR. FRANCIS MCILROY
DR. MAGDALENA OLES
DR. ZSUZSA OZGA
NICU Registrar Bleep: 5302
F1
F1
F1
F2
F2
F2
F2
GPTrainee
GPTrainee
GPTrainee
GPTrainee
ST2
ST2
ST1
ST2
ST2
ST2/3
ST2
ST2/3
NICU SHO Bleep: 5125
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
Neonates
General Paediatrics
General Paediatrics
General Paediatrics
General Paediatrics
Neonates
Neonates
General Paediatrics
Neonates
General Paediatrics
Neonates
Neonates
Neonates
Long Day Paediatric SHO: 5471
Transition Care SHO Bleep: 5496
Baby Checks: 5240
Long Day Paediatric Registrar:
5970
Paediatric SHO Urgent /
A&E Bleep: 5069
Paediatric Reg Urgent /
A&E Bleep: 5315
5
USEFUL TELEPHONE NUMBERS
CRASH
55
Adult A&E
Paediatric A&E
FIRE 2222
2140/2141/2025/3081 (nights only)
3627
WARDS:
Ash
Oak
NICU
Labour Ward
Post natal (Joan Booker)
Transitional Care Ward
ITU
2714/2395
2712/2016
2386/2015
2361/2399
2291/2378
2291
2135
Outpatient Appointments
Phlebotomy - Oak Ward
X-ray
CT
MRI
EEG
ECG
Echo - ask Shirley on ext
Clinical Measurement
Nuclear Medicine
2545/2508
2712
2501
2401
2700
2543
2310
2762
2530
2482
PATHOLOGY:
Haematology
Microbiology
Chemical Pathology
Red Star Bleep 5001
Night bleep 5021
Bleep 5070
Blood transfusion 3036
Urgent requests/results
Dr. Barnard
3060
Dr. Miller
3700
3048/3038
Sec 2120
Sec 3027
Bleep 5205
Urgent requests/results
Dr. Grundy
3032
3033/3057
Sec 3057
Bleep 5064
Urgent requests/results
3018/3066
6
Using the computers and ordering tests
Radiology requests
Radiology requests are made from the ward using the PAS system.
personal user name and password.
1.
2.
3.
4.
5.
6.
7.
8.
You will need your
Initially type PRD if only ‘username’ appears on screen.
If both ‘username’ and ‘password’ appear on screen enter these personal codes.
Enter SPH for hospital, then type in OEA and press enter.
Then type in RAD and enter.
Enter patient’s name and number.
Press 1 and enter to select current admission.
Priority: Urgent/routine.
To select procedure either type in e.g. chest, CXR or similar or press F12 and enter to
give a list of procedures and their codes. Select the procedure you want with the arrow
or page up/down keys, then press enter.
NB: F5 to exit
F12 for help.
Nuclear medicine requests are done on separate forms.
See PACS user guide below.
IntelliSpace PACS
4.4 ASPH Manual.pdf
Pathology requests
Pathology requests are made on the joint pathology form.
The laboratory should be contacted regarding urgent samples:
Mon-Fri 9am to 5pm extension 3018
Our of hours bleep:
Haematology 5070
Biochemistry 5064
Microbiology via switch board.
See ICE User guide below:
ICE User Guide.pdf
7
St Peter’s Hospital Neonatal Unit
Welcome to the Neonatal Unit! This is a designated Level 3 facility and the centre of the
Surrey Perinatal Network. The unit is located in the Abbey wing along with the maternity
service. The current cot establishment consists of 8 intensive care, 4 high dependency/12
special care cots (interchangeable) on NICU. There is a 9 bed Special Care Unit in the
postnatal (Joan Booker) ward. This provides care for babies needing more attention than
healthy term babies with their resident mothers. This can accommodate 6 Transitional Care
babies and has a further 3 “step down” special care cots.
We manage all neonatal medical intensive care problems including cooling for Hypoxic
Ischaemic Encephalopathy (33 babies in 2012) and the use of nitric oxide for PPHN. Infants
with surgical and cardiac problems requiring intervention are transferred elsewhere (for
example St. George’s Hospital/Brompton Hospital) as are those requiring ECMO. We have a
policy of early extubation to non-invasive ventilation – usually high flow nasal cannula
technology (Vapotherm) and a high number of non-invasive ventilation days.
We are a friendly, busy unit and our main aim is to ensure we deliver excellent care to
babies and their families. This requires teamwork. The following pages give a description
of the traditional roles each member of the team plays. These are not set in stone; roles
are often blurred, especially when the unit is very busy. Never be afraid to ask – all the
members of the team are very approachable.
Neonatal Transport
The Neonatal Transport Service provides a 24 hour, 7 day service for the Kent, Surrey and
Sussex regions. St. Peter’s transport service is operational 84 hours a week - running a 12
hour shift, 7 day system (day or night) operating on a weekly rotational basis with equivalent
teams in Kent and Sussex. We also have cross cover agreements with the London Neonatal
Transfer Service and undertake both emergency and elective repatriation work.
Obstetric Services
The delivery suite is located on the same floor as NICU. There are dedicated labour ward
consultants (high risk obstetrics and fetal medicine interests) with whom we maintain close
links. There is an active monthly perinatal morbidity & mortality review programme.
Specialist Services for Neonatal Unit
The neonatal unit is well supported by both local and visiting specialist services.
 There is a weekly paediatric & neonatal radiology meeting. Radiology support is
readily available with facilities for MRI, CT and nuclear medicine on site.
 Weekly cranial ultrasound review meetings.
 Fetal & neonatal echocardiography service which allows us to deliver babies with
potential prostin dependent lesions locally and then transfer out postnatally.
 Retinopathy of Prematurity screening and laser treatment (Mr Kafil-Hussain).
 Visiting consultant clinical geneticist and paediatric surgery and urology.
 Paediatric dietician.
 Physiotherapy.
8
TIMETABLE FOR THE NEONATAL UNIT
Day
Monday
Morning
9:00 – 9:30 Handover
Ward round
12:00 – 13:00 Cranial
USS teaching
Tuesday
9:00 – 9:30 Handover
Ward round
11:00 Social meeting
8:30 Journal club
9:00 – 9:30 Handover
Ward round
9:00 – 9:30 Handover
Ward round
Wednesday
Thursday
Friday
Saturday /
Sunday
08:30 – 09:00 Cons
reg meet (1st Fri
month)
9:00 – 9:30 Handover
10:30 Grand round
9:00 – 9:30 Handover
Ward round
Lunch time
13:00 – 14:00
 Paediatric meeting PGEC
 Clinical Management
Group (Guidelines)
Meeting 1st Monday
 Neonatal Mortality and
Morbidity 4th Monday
13:15 – 14:00
Radiology meeting
Afternoon
Ward work
Ward work
14:00 – 15:30
Joint Registrar and ST
teaching
Ward work
Perinatal meeting 3rd Friday
Ward work
Ward work
Attending consultant
The neonatal consultants attend (i.e. take prime responsibility for all ongoing clinical
decisions) for a period of two weeks. During this time the consultants do not have regular
daytime commitments outside of NICU so will be readily available. The out of hours on call
will be divided between the 5 consultants but patients will be admitted under the attending
consultant and stay under that same consultant for follow up.
Ward rounds
The consultant will usually lead the daily ward round, or if led by the SpR, the consultant
will meet after the round to discuss the decisions made. The grand round takes place on
Friday mornings from 10:30/11:00 onwards and is attended by the STs and registrars, and
as many of the nurses and neonatal consultants as possible. Selected patients will be
discussed in depth and it is a good opportunity to learn.
Guidelines
There are many evidence based guidelines are on the intranet – please familiarise yourself
and use them. You will be expected to actively participate in updating old and generating
new guidelines. Dr. Peter Reynolds is the lead for Guidelines, and your educational
supervisor can allocate you a guideline at the start of your post.
9
NEONATAL MIDDLE GRADES
There are 9 doctors on the NICU middle grade rota, participating in a full shift system. The
long day Registrar is based on the neonatal unit, covering intensive care (Room 1). The
other registrars share the work load of covering NICU rooms 2 and 3, the labour ward,
postnatal ward (Joan Booker) including the Special Care Unit (SCU) and 1 will be available
for transport. The role of the Registrars is to support, supervise and teach the STs and F2s
who will have varying degrees of paediatric and neonatal experience. You are also
responsible for maintaining an overview of all patients under the care of the neonatal unit,
and ensuring that the SEND database and handover sheets are kept up to date.
Registrar jobs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Ward round – daily round with/without consultant
Prescribe PN
Support STs in completing tasks from ward round
Ensure SEND database and handover sheets are up to date
Update parents and document in yellow communication sheets
Complete transfer summaries/discharge summaries for babies who received
intensive care
Perform cranial ultrasounds
Prepare cases for perinatal meetings
Hands on teaching of practical procedures, management etc
Review babies on SCU or post natal wards as requested by juniors
Long Day Registrar 09:00 – 21:30
Attend handover. Perform ward round in room 1 with junior ± Consultant. Support juniors in
completing ward round tasks. Maintain overview of all patients on NICU. Ensure database
and handover sheets are up to date. Support and teach juniors.
NICU Registrar 09:00 – 17:00
Attend handover. Perform Ward round in rooms 2 and 3 ± with junior. Ensure all notes are
kept up to date. Perform any baby checks necessary (around 34 weeks corrected).
Perform discharge exams and paperwork on any babies close to discharge. Ensure clear
plans for follow up after discharge are in place.
On Thursdays, complete weekly update sheets during ward round, chase up blood results
and prescribe necessary supplements (sodium chloride and phosphate). Babies are
weighed on Sunday and Wednesday, and weight gain in g/kg/day should be calculated.
Weight and head circumference should be plotted in the growth chart on a weekly basis.
16:30 - handover relevant babies to long day Registrar.
Transport Registrar 08:00 – 20:00 (or 20:00 – 08:00)
We are part of the KSS Transport service which provides transport for our network 24/7.
We will either be on days (2 weeks in 3) or nights (1 week in 3). The shift is 12 hours, with
a short handover period at the start and end of the shift. There is a designated transport
nurse and driver. Dr. Tosin Otunla is the Lead Consultant, and you will receive training on
induction.
10
If the day Registrar is not out on a transfer, they will be expected to participate in the ward
rounds, and this will be coordinated by the attending consultant during the handover.
During the night they will be expected to support the night team.
SCU Registrar
If you are covering SCU, please come to handover to discuss any problems with the night
team. You should then do a ward round with the junior for SCU, and support them in
managing the patients, seeing ward attenders and updating the SEND. You will also be
expected to support the postnatal ward SHO and the baby check doctor.
NEONATAL STs/F2s
There are 8 doctors on the “SHO” rota, participating in a full shift system. Each day there
will be 4 or 5 juniors available in the day and 1 night shift junior.
1.
2.
3.
Long day
Short/NICU
Postnatal and Special Care
4.
5.
6.
Extra/clinic
Night
Baby checks
09:00 – 21:30
09:00 – 16:00
09:00 – 16:00 (2 doctors weekdays)
09:00 – 18:00 (weekends)
09:00 – 16:00
21:00 – 09:30
variable times – see rota
Long day junior
Attend handover 09:00 – 09:30.
Perform ward round in Room 1 with SpR ± Consultant.
Write up any fluids/medications required and complete any other tasks generated on the
ward round. Please do this as soon as possible after the ward round to give the nurses
time to draw up the fluids.
Ensure clinical notes are up to date – growth charts, ultrasound scan charts, X-ray sheets,
results and blood gas sheets and communication with parents sheets.
Ensure handover sheet is up to date, including problem list, feeding regimen, weight gain
in g/kg/day (following Wednesday and Sunday weights). Update SEND.
15:30 - 16:00 NICU ST hands over relevant room 2 and 3 babies and labour ward bleep.
Take handover from postnatal/SCU junior, cover deliveries and postnatal ward.
21:00 - 21:30 Handover to night team. Remember to highlight any outstanding jobs to be
done or results to chase.
Night junior
Take handover 21:00 – 21:30. Perform ward round with Night SpR and complete any
tasks generated.
Carry labour ward bleep, attend deliveries and address nursing or midwife concerns on
Joan Booker ward and Special care unit.
11
Update the SEND database for rooms 1, 2 and 3, after 10pm.
Carry out any morning bloods required (e.g. sick babies, ones on PN/i.v. fluids) at approx 4
– 5 a.m. and ensure results are documented in results file for the morning handover.
Please check with your SpR if you are unsure which babies need blood tests.
6.00 a.m. – The nurses have a ward round. This is a good source of information.
Update the daily intensive care sheets and handover sheet.
Handover 09:00 – 09:30
12
Admission and transfer policies
1.
Attending labour ward – see resuscitation at birth guideline
An ST is asked to attend the delivery for the following indications.

<35 weeks gestation

Operative vaginal deliveries and emergency Caesarean sections (not
elective)

Abnormal deliveries e.g. breech, shoulder dystocia

Multiple births (one resuscitator per delivery)

Known fetal malformations likely to cause compromise at birth

Significant meconium stained liquor (thick/tenacious/lumps – attendance not
necessary for thin meconium)

Abnormal CTG

Fetal blood sample pH <7.2

Severe IUGR

Reduced fetal movements (with concerns about fetal wellbeing)

Suspected chorioamnionitis

Maternal factors including significant APH

Any other cases where there are concerns the baby may need resuscitation
If it sounds difficult ask the registrar to come with you; this is mandatory for
singletons under 30 weeks and twins less than 34 weeks however experienced you
are!
2.
Admitting to NICU
Admission to NICU should be routine for the following babies:










Prematurity <35 weeks
Low birth weight <1.8kg
Respiratory distress
Poor condition at birth requiring resuscitation (consider if the cord pH is less
than 7.0)
Congenital abnormalities likely to threaten immediate survival
Seizures
Cyanosis
Sepsis
Jaundice requiring intensive phototherapy
Any other babies where there are substantial concerns
Admit unwell babies to NICU, and well babies to SCU as appropriate. If you are
unsure where a baby should be admitted, please discuss with a senior colleague,
and the nurse in charge.
Admit from other hospitals

Returning transfers of our own

Post natal transfers for intensive care
NB Requests for in utero or post natal transfers for neonatal intensive care should
be dealt with by the neonatal registrar in consultation with the obstetricians. No
requests should be turned down without letting the attending, or on call,
consultant know. Please document in the referrals book details of any transfers
declined, and the reason for the refusal (unit full, insufficient staff etc.)
13
3. Medical Notes on the Neonatal Unit
ADMISSION SUMMARY
Notes: The following need to be in the notes on admission:
1. Printed accurate SEND admission summary details
2. Growth Chart (filled) DO NOT FORGET TO MEASURE OFC – even just a rough
measurement if baby has hat on
3. Cranial USS chart, X-ray sheet
4. Parent Communication sheet (yellow)
5. Summary of initial management of the baby by admitting doctors
All details required for intensive care admissions to help fill in the SEND are all included in
the Admission proforma (available on intranet). Please ensure you complete this fully
– do not leave gaps. It is important to collect all of the information as it is needed for
SEND but also very useful background.
You will often be asked to speak to women prior to delivery. Please use a yellow
communication sheet which you can then photocopy for the maternal notes and keep the
original yellow sheet in the patients pending file on NICU. This can then be placed in the
baby’s notes following delivery. It is a good idea to start the admission proforma early – if
you cannot find all the necessary details e.g father’s name/occupation please ask the
parents.
4. Arranging investigations in NICU
Biochemistry Haematology 5070
Microbiology -
ext 3006 or bleep 5064
ext 3048 (3046 blood transfusion lab) or bleep
ext 3032 or bleep 5205
Biochemistry and Haematology technicians both live in the hospital whilst on call but the
microbiologist goes home and you need to get switch board to call them at home. The
results can be accessed from Winpath and ICE. Biochemistry usually phone back their
results if abnormal.
If you are not sure what specimens to take or how much blood is needed either ask the
registrars or contact the lab before you take samples.
On call blood tests guideline
The workload of the on call Biomedical Scientists analysing out of hours samples is
tremendous. It is imperative that we make every effort to ensure that only essential blood
tests are ordered outside normal working hours. The following guidelines should be
used:
Intensive care patients for daily ward round (e.g. intensive care babies who are
sick, on i.v. fluids, PN) - i.e. results to be available by 08.50 a.m.: Hb, WCC, platelets,
clotting if clinically a problem. Na, K, Ca, Urea, creatinine, albumin, CRP. Codes used
are NPN (daily) and NPN2 (twice weekly). Please see the notice board in NICU. Those
patients on PN need to have twice weekly Mg, PO4, split bilirubin and triglycerides
available by 10.00 am for PN prescribing.
Non-intensive care patients can generally wait until late morning for their blood results
14
Timing
Bloods sent from NICU (usually via the vacuum system) are treated as a priority and
results will usually be available within 2 hours in the day and 1 hour at night. If you
require urgent results you should bleep the haematologist/biochemist and if necessary a
porter to take the bloods to the lab.
New admissions: Consider if PCV alone will be sufficient - this gives an accurate guide
to Hb (divide PCV by 3). Platelets and clotting needed if baby very bruised or other
evidence of bleeding or severe sepsis. Generally U&Es and creatinine and CRP not
needed for new admissions -if necessary Na, K, ionised Ca and a blood sugar can be
obtained from blood gas analyser on NICU, and a haematocrit can be checked on a
spun sample. Lab sugar required if BM <2.6
Other patients: Sick babies, e.g. with convulsions, dehydration, collapse, (either new
admissions or - existing patients), often require urgent laboratory blood tests
Other bloods can generally wait 2 hours to be run in a batch by the lab staff.
Other blood tests: Chromosomes – go to St George’s Hospital via Biochemistry (forms
are kept in the same drawer, minimum volumes and container types are listed on the back
of the form). Parental Consent is required. Please contact our lab to coordinate sending
the sample to St. George’s – consider courier transport. Complex metabolic investigations
will be discussed with the consultant and biochemistry.
X-rays: Ordered on the computer on the desk. You will receive training on induction.
When you start you will be given your own username and password – do not share
passwords with colleagues!
To order X-rays the baby needs to have a hospital number. This should be requested
urgently by the neonatal unit following admission. All NICU x-rays need to be ordered as
urgent and it is always worth phoning the department to ask them to come up (or bleeping
the radiographer overnight).
Phone extension 2501 during the day, extension 2143 in the evening, page 5021
overnight.
Babies requiring X-rays on JB may be taken to the main X-ray department between 9-5
Monday to Friday (please liaise with the radiology department).
Cranial Ultrasound Scans: You will be taught how to perform and interpret CrUSS. Most of
our trainees are able to perform CrUSS independently by the end of the post (including
Foundation doctors!) There is a weekly meeting on Monday 12:00 – 13:00 to discuss CrUSS
and update the pink reporting sheets. All babies need to have their scans entered on PAS
and linked to PACS via CRIS. You will receive training on induction how to do this.
ECG: Phone department – extension 2630. On the weekend you will need to use the
machine from NICU.
EEG: Hand-written forms faxed to department
15
SPECIAL CARE UNIT (SCU)
Layout/Staffing
SCU is a 9 bedded unit in Joan Booker Ward, staffed by neonatal nurses who are
responsible for the care of the babies. When not fully staffed SCU will be able to
accommodate less babies – please liaise with the nurses in charge of NICU/SCU. Usually
the midwives have responsibility of care for the mother, but it is possible for a mother to be
discharged and stay with her baby in SCU. She will then receive her care from the
community midwives as she would if at home. All babies admitted to the Special Care Unit
are the responsibility of the Neonatal Unit and therefore, admission is through liaising with
the Neonatal SHO, nurse in charge of SCU and Nurse in charge of NICU. Do not feel
pressurised to accept babies that you do not feel are appropriate for SCU. Babies should
be fully clerked, managed as appropriate and reviewed later (or handed over to NICU ST
to review). A full set of notes will be made up by the SCU staff. It may be appropriate to readmit babies from A+E or home in to SCU. Please discuss these cases with your Registrar
and the NICU nurse in charge.
Admissions
Babies who may be suitable for admission to SCU:
 Pre-term babies from 34/35 weeks gestation
 Babies with low birth weight (but must be >1.6 kg)
 Babies requiring two or three hourly naso-gastric tube feeds
 Well babies receiving intravenous antibiotics
 Babies with neonatal abstinence syndrome
 Babies of diabetic mothers
 Jaundiced babies requiring additional support (feeding, temperature control,
monitoring for raised PCV)
 Babies with congenital malformations e.g. cleft palate or with Trisomy 21
Daily Routine
The SCU ST will do a ward round, with a Registrar if free. The nurse in charge of SCU will
go round with you. Each baby is seen daily and a plan of care identified and documented
in the baby’s notes. Babies who stay longer than a day should be reviewed by a
senior colleague and the parents updated. Please remind the Registrars to do this. If
no registrar is available for SCU, please let the attending Consultant know. It is not
only good practice to keep parents updated but also forms part of the NNAP dataset (this
should be documented in the yellow communication sheet and on SEND).
Ensure that the baby check has been completed. Plan ahead for any discharges e.g.
TTO’s, OPA, discharge check. Check for outstanding results. Update SEND on a daily
basis. Complete discharge summaries. Check to see if there are any ward attendees for
that day. (See below). The babies notes remain on SCU until the results have been
reviewed and the family informed of the results and follow up if needed.
It is essential that each day you check any results on previous ward attendees. Contact
the family to inform them of the results and any follow up if necessary.
All babies in high risk groups will be offered BCG vaccination prior to discharge. Babies
on SCU are the responsibility of the neonatal ST/Registrar. Babies on Joan Booker may
occasionally be given their BCG by the midwives, but usually the postnatal ward doctors
will be asked to administer BCG to these babies.
16
Ward Attendees
Referrals from the community must be made to the Paed ST - bleep 5496.
There are 8 ward attendee appointments per week on SCU (Monday, Tuesday, Thursday
and Friday 14:00, 14:30). When making and appointment please enter into ward diary
details required to enable us to get the notes of either mother or baby (if they have a set)
prior to the appointment. Please document:
1.
Reason for appointment.
2.
Baby’s full name, d.o.b, Hospital number and Consultant.
3.
Mother’s hospital number and name and a contact telephone number which we will
use to phone the parents with any results or plans for ongoing management.
Ward attendees are primarily babies coming back for prolonged jaundice screens. We do
not have an upper age limit for PJS, but other babies can be reviewed on SCU up to the
age of 1 month. After 1 month they need to go to Oak Ward.
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AC 129
NICU Major Incident Action Card

The Sister in Charge will be informed of the major incident by the paediatric bleep
holder/NICU manager.

Check NICU manager is aware (out of hours ring at home).

Ask whether children are known to be amongst the incoming patients.

Check numbers of nursing staff on duty (include Community Team, CPE,
students etc) and consider if any could be deployed to paediatric areas such as
ASH, OAK, paeds A&E.

Liase with control room to see if extra neonatal/paediatric staff are needed.Liaise
by phone with paediatric manager or nurse in charge of Ash Ward and paeds
A&E to decide if neonatal staff should be sent to support paediatric areas, or to
release their staff to work in adult areas.

Release ward clerk if they are on the major incident administration team.

Consider calling in extra neonatal staff to cover NICU or paediatric areas. If this is
necessary allocate a person to make the calls, e.g. ward clerk, ward assistant or
a suitable nurse, ensuring they explain to staff the reason they are being
requested to come in and help.

Review staffing roster for the next 24 hours. Depending on further information
received on size and duration of the incident, it may be necessary to arrange for
extra staff to work the next shifts.

If the incident is prolonged, and the nurses on duty come to the end of their shift,
try to send replacement staff to the areas they are deployed to in order they can
be relieved

The sister in charge will be informed when to stand down at the end of the
incident

Ensure any neonatal staff involved in the incident has the opportunity to debrief
and get appropriate counselling if required.
Please see also Trust Major Incident Protocol.
 Have ID with you.
Hospital Control Centre
ext 3900
Nursing Control Point
ext 3139
A&E Control Point ext 2110
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FIRE AND SECURITY
Evacuation of sick babies from NICU is a potential nightmare: please read the protocol in the
NICU book carefully. All available skilled pairs of hands will be needed.
Recent concerns about the children's safety and the risk of abduction have led to a
proliferation of locks. Please be aware of any 'odd ' people around and do not let them in. If
someone is waiting by the door in Oak and Ash ask them who they are visiting before
opening to them. The psychiatric wing is just across the car park and we have had two near
misses.
Everyone should wear their name badges: this reassures parents that we are who we
seem.
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