Community Nurses’ Guidelines for
the Follow-up of Children’s Accident
and Emergency Department
Attendances And Hospital Discharges
Document Type: Guidelines
Scope: Community Nurses
Document Classification: Nursing
Contribution List:
Kate Murdock, Operations Manager, Trafford CYPS.
Jacqui Binns, Health Visitor Team Leader, Trafford CYPS
Joanne Oakes, School Nursing Team Leader Trafford CYPS
Lisa Fern, Nursing Manager, Children’s Community Nursing Team, Trafford Healthcare
Trust
Diane Bridgeman, Liaison Health Visitor, Trafford Healthcare Trust
Clare McNicholls, Named Nurse Safeguarding Children, Trafford Healthcare Trust
Ruth Speight, Named Nurse Safeguarding, Trafford CYPS
Authorising Group:
Date of Authorisation:
Trafford PCT Clinical Standards
Group
Validated by
Review Date:
Nov 2012
CONTENTS
Section
No.
Subject
Abbreviations used in this document
Page
No.
3
1
Introduction
3
2
Purpose of Guideline
3
3
Paediatric Liaison Health Visiting Team Response to
Accident & Emergency attendance of 0-18 years olds
Follow-up for Accident & Emergency attendances - Health
Visitor response
Follow-up for Accident & Emergency attendances – School
Nurse response
Barriers to Implementation
4
Notification of discharge from hospital of pre-school children
– Health Visitor response
Notification of discharge from the Neo-Natal Unit
5
Notification of discharge from hospital for school-age
children
Monitoring and Review
8
References
9
4
5
6
7
8
9
10
Accident & Emergency Policy (Children’s Services)
4
5
7
8
8
Page 2 of 9
ABBREVIATIONS USED IN THIS DOCUMENT:
CYPS
CCN
DfE
DH
GP
HV
HCA
SN
SNA
Children and Young People’s Service
Community Children’s Nurse
Department for Education
Department of Health
General Practitioner (Family Doctor)
Health Visitor
Health Care Assistant
School Nurse
School Nurse Assistant
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1.
INTRODUCTION
Each year in the United Kingdom, non-fatal injury results in more than six million
visits to Accident & 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 12 months old and a quarter of older children will
attend an Accident & Emergency Department each year. Children under 5 years
old carry a disproportionate burden of injuries from falls and fires. They suffer
nearly 45% of all severe burns and scalds. About 50% of these happen in the
kitchen and approximately 50% of all injuries to the under-5s occur in the home.
In any one year, 1 in 11 children will be referred to a hospital outpatient clinic and
1 child in 15 will be admitted into hospital.
In order to provide seamless care to children and young people there need 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),
recommendations were made that information relating to a child’s attendance at
Accident & Emergency Department or discharge from hospital should be shared
with Primary Care and Community Services to ensure an effective handover of
care and provision of services.
2.
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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.
Accident & Emergency Policy (Children’s Services)
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
3.
To reduce preventable accidental injuries in children.
PAEDIATRIC LIAISON HEALTH VISITING TEAM RESPONSE TO
ACCIDENT & EMERGENCY ATTENDANCES OF 0-18 YEAR OLDS.
The Health Visitor Liaison Team checks that they have information on children
aged 0-18 years, who have attended the Accident & Emergency Departments at
Trafford General, Wythenshawe and Altrincham Minor Injuries Unit. The Liaison
Health Visitor assesses each slip and at this point will triage the information that is
sent out in line with those attendances that require follow up/action.
The Liaison Health visitor will no longer send out information on A&E attendances
for the 16-18 year olds to the school nurse but each one will be assessed and
triaged accordingly.
If the Liaison Health Visitor decides that the Health Visitor or School Nurse needs
the information immediately they will telephone the appropriate professional.
Information from other hospitals is received in the post and sent out on the day of
receipt.
If there is no GP or school recorded the Liaison Health Visitor will endeavour to
contact the parent to ascertain the required information, but will send out the slip
geographically if they are unable to obtain this.
Any information that has safeguarding issues is referred to Named Nurse
Safeguarding Children, Trafford Healthcare Trust.
4.
FOLLOW-UP FOR ACCIDENT & EMERGENCY ATTENDANCES HEALTH VISITOR RESPONSE
All notifications of pre-school children who attend the Accident & Emergency
Department, Minor Injuries Unit, or Trafford NHS walk-in centres will be forwarded
to the relevant Health Visiting team by the Paediatric Liaison Health Visiting
Team. Information will be made available in Accident & Emergency and Minor
Injury Units to 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.
The Duty Health Visitor will assess all Accident & Emergency forms received into
the office each working day and make an assessment of the required response.
Where follow up is required Health Visitors should make contact with the
parent/carer in line with guidance below. Where responsibility has formally
transferred to the School Nursing Service, notification should be forwarded
immediately to the School Nurse.
Where child protection concerns have been identified.
Liaison
MARAT/Family Support Services should take place before the contact.
Accident & Emergency Policy (Children’s Services)
with
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NB: In certain cases that require on-going nursing care the child may have been
referred to the Children’s Community Nursing Team (CCNT), e.g. burns, scalds,
dressings, multiple attendances for asthma (please note this list is not
exhaustive). For attendances such as these it may be pertinent for the Health
Visitor to liaise with the CCNT prior to planning response.
The following will require follow up:
(a)
Examples of attendances where urgent action would be required
NB: This is not an exhaustive list.
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(b)
Suspicion of non-accidental injury
Suspected abuse
Children Subject of Multi-Agency Child Protection Plans
Significant burns or scalds
Significant road traffic injuries/trauma
Obvious signs of neglect noted
Parents’ reluctance to wait for treatment or leaving department
without informing someone before child has been fully assessed
Any history that is inconsistent with the injury
Where A&E staff have expressed concern
Examples of attendances where follow up/further review required but not
immediate
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Accidental injuries, e.g. ingestion of harmful substances
Injuries caused by accidents in the home
Some chronic illnesses, e.g. asthma, diabetes, cystic fibrosis,
epilepsy
3 or more visits to A&E in last 6 months
5 or more visits to A&E in last 12 months
Concern in view of knowledge of the family
All notifications of attendances at Accident & Emergency Department,
Minor Injuries Unit should be documented on the chronology sheet of the
child’s health record and the subsequent action and outcome fully recorded
in the case notes if a contact or home visit has been undertaken.
5.
FOLLOW-UP FOR ACCIDENT & EMERGENCY ATTENDANCES –
SCHOOL NURSE RESPONSE
Notifications of attendances at Accident & Emergency Department, Minor Injuries
Unit or Trafford NHS Walk in centre will be forwarded to the relevant School
Nursing team by the Paediatric Liaison Health Visiting team. Information will be
made available in Accident & Emergency and minor injury units to inform
parent/carer and the young person that information relating to the attendance will
be shared with their General Practitioner and School Nurse.
Accident & Emergency Policy (Children’s Services)
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The School Nurse will assess all Accident & Emergency forms received into the
office each working day and make an assessment of the required response.
Where follow-up is required a member of the School Nursing team will make
contact with the family and/or young person in line with guidance below.
N.B: In certain cases that require on-going nursing care the child may have been
referred to the Children’s Community Nursing Team, e.g. burns, scalds, dressings,
multiple attendances for asthma (please note this list is not exhaustive). For
attendances such as these it may be pertinent for the School Nurse to liaise with
the CCNT prior to planning response.
During school holidays the responsibility for follow up of priority attendances as
identified by the Paediatric Liaison Health Visiting Team will be held by the
nominated senior member of staff.
(a)
Examples of attendances where urgent action would be required
NB: This is not an exhaustive list.
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(b)
Suspicion of non-accidental injury
Suspected abuse
Children subject of Multi-Agency Child Protection Plans
Attendance of child from out-of-area
Significant burns or scalds
Significant road traffic injuries/trauma
Obvious signs of neglect noted
Parents reluctance to wait for treatment or leaving department
without informing someone before child has been fully assessed
Any history that is inconsistent with the injury
Where A&E staff have expressed concern
Self-Harm
Examples of attendances where follow up/further review required but not
immediate
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Accidental injuries, e.g. ingestion of harmful substances
Alcohol or drug ingestion
Assaults
Injuries caused by accidents in the home
Some chronic illnesses e.g. asthma, diabetes, cystic fibrosis,
epilepsy.
3 or more visits to A&E in last 6 months
5 or more visits to A&E in last 12 months
Concern in view of knowledge of the family
Lone attendance at the department by the child/young person
Injuries which are likely to affect school attendance.
All notifications of attendances at the Accident & Emergency Department, Minor
Injuries Unit and NHS Direct should be recorded on a chronology form in the
Accident & Emergency Policy (Children’s Services)
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child’s health record. The subsequent action and outcome if a contact or home
visit has been undertaken must be recorded in the records.
6.
BARRIERS TO IMPLEMENTATION
It is recognised by the developers of this policy that due to current work patterns
of the School Nursing service, the timescales for review of Accident & Emergency
attendance sheets and any subsequent follow up would only be able to be met
during school term time. School Nurses are only employed during school term
times and there is no cover for their roles during the school holidays. This is
highlighted as a potential risk area, particularly for the summer holidays when
rates of Accident & Emergency attendance by children increase and there is a six
week period with no School Nursing cover and consequently no follow up of
school age children.
In response to this potential risk, it has been agreed as an interim measure that
during school holidays, School Nurses will work on a rota basis to provide cover
for the sole purpose of picking up Accident & Emergency reports for school age
children. This will be agreed between the School Nursing team and the
Safeguarding Children Team.
It has been agreed that the long term solution to cover for school holidays needs
to be addressed via a change to work patterns for the School Nursing Service in
general so as to provide a service all year round. Such a change in work patterns
will have financial resource implications, as additional working hours will be
required.
7.
NOTIFICATION OF DISCHARGE FROM HOSPITAL OF PRE-SCHOOL
CHILDREN – HEALTH VISITOR RESPONSE
Notification of discharge from hospital for 0-5 years will be forwarded to the Health
Visitor by the Paediatric Liaison Health Visiting.
A telephone contact to the family should be made within 3 working days for the
following discharges:
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Identified child protection concerns – liaison with the duty team
Children’s Services 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
Accident & Emergency Policy (Children’s Services)
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The information should be recorded in the child’s health record and any
subsequent action or outcome relating to the contact should be documented. If
not in place where appropriate a referral should be made to the Children’s
Community Nursing Team for ongoing nursing care.
8.
NOTIFICATION OF DISCHARGE FROM THE NEO-NATAL UNITS
Health Visitors should receive notification of the discharge of babies from UHSM
and CMFT by the Paediatric Liaison Health Visiting Team 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.
9.
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 Health Visiting team.
Contact should be made within 3 working days of receipt of notification with
the parent/carer or young person for the following discharges:
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Identified child protection concerns – liaison with children’s social
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
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 senior member of staff.
The information should be documented in the child’s health record and any
subsequent actions or outcome recorded following contact.
10.
MONITORING AND REVIEW
Accident & Emergency Policy (Children’s Services)
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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 Nurse and Health Visitors 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 2007.
(http://www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandin
spections/improvementreviews/servicesforchildreninhospital.cfm)
2.
DOH. National Service Framework for Children and Young People and
Maternity Services. Department of Health, 2004.
(http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrenS
ervices/ChildrenServicesInformation/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, 2006.
(http://www.everychildmatters.gov.uk/resources-and-practice/IG00060)
4.
HMSO. The Victoria Climbie Inquiry: Report of an Inquiry by Lord Laming.
The Stationery Office, London, 2003.
(http://www.victoria-climbie-inquiry.org.uk)
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