STRATEGIC DEVELOPMENT OF PAEDIATRIC SERVICES
WORKING ACTION PLAN (first version written May 2005)
Guidance
Getting the right start:
National Service Framework
for Children
Standard for Hospital
Services, April 2003
Children and their families
need timely, relevant and
effective personal and material
support to help them cope with
illness or disability. In addition
to the generic support
provided by all members of
the multidisciplinary team, this
includes:
 Specialised support, such
as that provided by mental
health professional or
social worker for those
emotional and
psychological difficulties
Current Position
New Hospital – 2010
2005-2008
Lead Manager/Director
See attached OBC model of
care and paediatric operating
principles.
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

Support staff in place eg
social worker. There are
currently 3 sessions of
child/adolescent psychiatry.
Full time social worker
dedicated to paediatrics.
Currently exploring ad hoc
psychology cover for
identified patients.




Expansion of team.
Employment of a full time
child/adolescent psychiatrist
-Business Case April 2006
Resubmit business case for
0.5wte psychologist – April
2006 which was agreed,
recruitment process is
underway with the Tavistock
Review of social work and
psychology services Sept
‘06
Continue
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
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
Dedicated paediatric team
to include a child mental
health team
Include psychologist in
new hospital
Continue

Shane McCabe
1
Guidance
Current Position
New Hospital – 2010
2005-2008
Lead Manager/Director

Spiritual support, provided
by religious leaders or the
chaplaincy service.

Available as needed.
Chaplain in post who
contacts other faiths as
required.
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Continue
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Continue


Support provided by peers:
among children and young
people and between
families with similar
problems.
Help with transport and
travel to tertiary or other
referral centres, for
example, through hospital
transport schemes.

Information around support
groups available.

Continue.

Continue.

MDT

Provide hospital transport if
required.

Continue

Continue

Riana Horn, OPD
Manager
Children visiting or staying in
hospital have a basic need for
play and recreating that
should be met routinely in all
hospital departments providing
a service to children

Play specialist available

who visits HDU.
The Trust education
service now has a link with
a local school, Whitmore
who have been awarded
‘science’ status within
Harrow. We will facilitate
students to come to the
RNOH and visit key
departments to learn about
professions and roles in the
NHS where science is
required. This will also
include some technical type
job roles.
Following a review of
Harrow tuition service last
year, the School
Development Service (part
Increase service provided by
the play specialists,
including expanding the
team subject to business
case – April 2006 Approved
and posts x 2 (in addition to
one post) out for
recruitment.

Dedicated team of play
specialists working
throughout Trust, in all
areas where there are
children.

Shane McCabe &
Siobhan LalorMcTague
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Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
2
Guidance
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Staff, facilities and equipment
are required to meet the
ongoing educational needs of
children and young people
staying in hospital, with
reference to the Department
for Education and Skills
guidelines on the education of
children in hospital.

At every location within the
hospital where care is

Current Position
of Harrow Local Borough),
has established principal
advisers for age bands and
for implementing the
‘inclusion’ policy. We will
have links to them.
We are involved in the
healthy schools
programme.
Gail Burgess is planning to
hold training sessions on
basic non verbal
communication methods
such as makaton.
The educational service
here are working closely
with speech and language
therapy to develop patient
communication passports.
These will be in place in the
patient’s notes and set out
(possibly with pictures too),
the ways of communicating
with the patient,
preferences for meals,
likes, dislikes etc.
Education service provided 
with links to Harrow LEA.
Training available on site
for basic paediatric life

New Hospital – 2010
2005-2008
Lead Manager/Director
Further develop the
education service - e.g.
‘makaton’ signing for CP
children, communication
booklet, exchange science
classes with Harrow School,
ongoing

Further develop the
education service

Shane McCabe
All staff caring for children to
have received paediatric

All staff trained that have
contact with children.

Siobhan LalorMcTague and the
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
3
Guidance
provided to children there
must be staff trained in
paediatric life support. Basic
life support is generally
sufficient in most areas of the
hospital, to Advanced
Paediatric Life Support (APLS)
or Paediatric Advance Life
Support (PALS). In these
settings, ideally, there should
be at least one person trained
in APLS or PALS, or
equivalent on a shift at any
time.
Current Position
support, staff.
2005-2008
basic life support.
Availability of an advanced
paediatric trained member of
staff to be on site at all times
and member of the crash
team – October 2006

New Hospital – 2010
At least one staff member
on duty in each area
caring for children should
have had advanced
paediatric life support
training
Lead Manager/Director
Children’s Services
Strategy Group

Nurses undertake EPLS
training, and doctors APLS
training.

Current review nurses are
EPL instructors.

High level of paediatric
training.

Audit required
Safe recruitment practices for
all staff, including agency staff,
students and volunteers,
working with children,
including a criminal record
review on employment (see
Clothier Report (42).

Safe guarding officers in
post.
Paediatric staff all
police/CRB checked.

All staff coming into contact
with children in what ever
form should be CRB
checked. - actioned

Continue.

Mark Vaughn,
Director of HR
Protocols should be in place
across the hospital,
particularly in surgical
services, as well as on
children’s wards, and should
cover; resuscitation; pain
management and sedation;
fluid management; antibiotic
regimes; and management of
the conditions with which
children most commonly
present to hospital.

Trust policies in place e.g
the paediatric pain
assessment tool was
commenced in February
2006 and is used for all
patients etc.

Introduce more specialised
service e.g liaison mental
health team – April 2007
Provide guidelines as hard
copy and on shared network
drive accessible throughout
the hospital - Ongoing

Full schedule of paediatric
policies, protocols and
guidelines.

Siobhan LalorMcTague and
Children’s Services
Strategy Group
Multidisciplinary child specific
clinical audit should be
undertaken in all specialities to

Trust wide audits taking
place e.g. record keeping
and named nurse

Develop paediatric multi
disciplinary audit
programme. Undertake

Continue audit
programme.
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Dr Nan Mitchell,
Medical Director
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Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
4
Guidance
which children are treated.
As part of the overall trust
clinical governance
framework, arrangements
should be in place to secure
the safe and effective use of
equipment in children
throughout the hospital.

There is still evidence that
pain is inadequately dealt with
for children in hospital,
requiring better prevention,
assessment and treatment.


Current Position
particularly for children at
risk, medical staff audit of
knowledge, experience in
child protection etc.
Training available for all
equipment.
Three CNS for Pain in post.
Pain assessment tool in
place.

Children who have had
surgery and have to stay in


Verbal and written
information given to patient
with post op pain
management covered.
Play specialist in post.
All new equipment approved
by purchasing group actioned

All equipment
standardised and training
received.

Anthony Palmer,
Director of Nursing
and Clinical
Governance

Develop paediatric pain
protocol & tool. – February
2006 (completed and held at
the end of each pts bed).
Monitoring and audit of pain
assessment tool –
September 2006.
Develop a MDT approach to
pain management –
February 2006 completed.
Update and develop
information giving including
information regarding
Clinical Child Psychologist –
April 2006 (awaiting
appointment of Child
psychologist)
Expand play specialist
service – April 2006
Business case was
successful and posts are out
to advert and will cover the
whole hospital (including
out-patient areas)
Recruitment to and expand
Achieved May 2006 = 52%

Efficient use of protocol.

Alicia Thomas and
Siobhan LalorMcTague

Continue developing
evidence based practice.
To have a fully established
play specialist team

Shane McCabe
50% RSCN achieved July
2006.

Shane McCabe and
the Children’s


24 hour anaesthetic cover
available. Good links
Lead Manager/Director


Where procedures are
planned, and pain can be
predicted, the opportunity
should be taken to prepare
children through play and
education, and to plan pain
relief for use during the
procedure. The use of
psychological therapies,
including distraction, coping
skills and cognitive
behavioural approaches,
provides some benefit. .
New Hospital – 2010
2005-2008
audits with other specialist
clinical teams e.g spinal –
April 2006
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Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
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5
Guidance
hospital overnight need
nursing, anaesthetic and
medical aftercare provided by
appropriately trained staff.
These are most likely to be
found on a site with in patient
general paediatrics. For
single specialty hospitals, in
the short term, special
arrangements will be needed
for the provision of paediatric
cover. New split site
arrangements should be
avoided. Where these already
exist, and where feasible, they
should be phased out in time.
Current Position
locally and sector wide 24
hour paediatric consultant
available.
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Day case surgery can be
carried out in a safe standard
on a site where there is no
paediatric service, but only if
staff are able to deliver
paediatric life support, and if a
neighbouring children’s
service takes formal
responsibility for the children
being managed there.

Dedicated operating lists for
children are the ideal, but it
many specialities this is not
practical or feasible. In these
circumstances, children
should be put to the start of



Day cases cared for within
paediatric unit.
Standard met.

Children at start of list, pre
op starving policy available
for paediatrics.
Lack of suitably qualified
children’s nurses in
theatres, recovery and


2005-2008
of ward nurses are RSCN
(13 out of 24), one HDU
nurse is currently doing the
RSCN training and will
complete in December 2006.
specialist paediatric staff.
24 hour onsite cover for
paediatrics - April 2006
Provision of a 24/7
anaesthetic outreach service
with at least one team
member with paediatric
training – April 2008
Ensure all on call
anaesthetists have APLS
Qualification – December
2006
Provision of 9 a.m. – 5 p.m.
middle grade paediatric
cover 7 days per week –
Business Case April 2006
Continue to provide day care
surgery on the paediatric
unit - Ongoing
Review scheduling and look
at moving to paediatric only
lists – December 2006
Appoint additional child
branch nurses across
children’s pathway to
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
New Hospital – 2010
Continue
Lead Manager/Director
Services Strategy
Group

Paediatric day care
established.


Continue to move to
dedicated paediatric
operating lists (increase
the number of paediatric
lists per week from 3 up to
6).
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
Shane McCabe and
Children’s Services
Strategy Group
6
Guidance
the list with appropriately
trained staff in the reception,
anaesthetic room, theatre and
recovery areas. Policies and
protocols specific to the needs
of children are required on
issues such as preoperative
starving.
Current Position
anaesthetics and ITU.

Ideally, children should only
need to visit tertiary centre for
complex assessments and
investigations or specialised
treatment. Otherwise tertiary
care can be delivered locally
through outreach services
operating within a clinical
network, provided that the
network itself is adequately
commissioned, funded and
staffed, and that there are
clear system for information
sharing, clinical governance,
accountability and staff
development.
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Diagnoses and manages
unusual problems, delivers
unusual or complex
treatments and where
these are new or
experimental, does so in
the context of a clinical
trial.


Caring for complex and
special conditions that
cannot be performed
elsewhere using all support
networks in hospital.
Current relationships with
o GOSH
o NWL
o St Mary’s
Good relationships exist
with other relevant
hospitals.

Providing unique service
for paediatric group.


2005-2008
required standard - (up to
13 out of 24 nurses)
Ongoing
Second nurses for training
(including one nurse from
ITU/HDU)- Commenced
and due to return to RNOH
HDU Dec ‘06

New Hospital – 2010
Continue to strengthen
nursing across patient
journey.
Lead Manager/Director
Continuing to ensure safe
systems in place expanding
paediatric team - Ongoing
Review externally how
network could enhance
paediatric services Ongoing

Facility for dedicated
paediatric service.

Developing new treatments
e.g. Ibandronate subcutaneous drug therapy for
patients with metabolic bone
disease, further develop
surgical intervention using
osigraft bone regenerator for
patients with non-union
conditions, continue the
research and improved nonsurgical limb lengthening for
paediatric patients, using
data from the motion

Expanded paediatric
service will enable further
new and experimental
work.

Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
MDT
7
Guidance
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Current Position
Has sufficient staff to
provide safe, round the
clock cover for acutely ill
children, and at the same
time undertake a range of
outreach services,
including peripheral
clinical, nursing support
services, telephone
support lines, teaching
programmes and
exchanges for staff.

Admit as inpatients only
those children for whom
local hospital admission is
not a safe or acceptable
option, for instance,
because surgical
intervention might be
needed urgently, or
complex treatments,
investigations or
specialised nursing care
are required.

Has reliable arrangements
for paediatric intensive
care retrieval and other

Specialist nurses available,
multi professional team in
post. Not 24hours.

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Admission criteria assures
this currently.
Specialist nature of
services at RNOH ensures
that only relevant children
treated.

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
Use of CATS retrieval.
New Hospital – 2010
2005-2008
analysis assessment of
patients to exactly prescribe
the surgical correction
required to elicit improved
motion/gait etc. - Ongoing

Develop service and expand
paediatric and other staff
dedicated to paediatric
patients - Ongoing
Ensure 24 hour cover April
2006
Outreach services to be
further developed – April
2006 Being discussed Paed.
Matron and HDU Sister to
devise an outreach
proposal.

Promotion of work being
done within paediatrics –
update the Trust website –
May 2006-07-06
Produce an updated ward
leaflet and conduct an audit
of patients to ascertain the
usefulness or otherwise of
the leaflet. January 2007
Continue.

Extend skills continue to use
CATS - Ongoing
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
Lead Manager/Director
Dedicated paediatric
service with 24 hour onsite
cover.
Continue.



Developing paediatric
team and service
delivered.
Continue.

Continue to use CATS


Shane McCabe and
the Children’s
Services Strategy
Group
8
Guidance
emergency transfers.

Current Position
Lead Manager/Director

Ensure other specialities are
planning the transition for
their patients with long term
conditions - Ongoing

All children requiring long
term care to have planning
for transition into adult
care

MDT

Spinal team developing
their transition.
Many clinicians currently
providing orthopaedic care
to children into later life.
It will be necessary to ensure
sufficient capacity for high
dependency care. This will
prevent unnecessary referrals
to PICUs for children who do
not require intensive care.

Children cared for in HDU.


Dedicated paediatric HDU.

Siobhan LalorMcTague and
Redevelopment
Team
Children should not be cared
for on adult wards, but on
wards that are appropriate for
their age and stage of
development. In particular,
the needs of adolescents
require careful consideration.
In general, adolescents prefer
to be located alongside other
people of their age.

Paediatric unit divided into

two age appropriate areas,
under 12 and over 12 years
of age.
Paediatrics on one PPU

ward only in single rooms.
Paediatrics in ITU nursed
alongside adults unless in a
single room.
Improve training for staff
provide high dependency
nursing on paediatric ward
area when required HDU/ITU Outreach Started
November 2005. Outreach
provided bedside training for
the nursing staff and
exchange or shifts by staff in
both areas. Ventilated
patients now being accepted
and cared for on the
Paediatric wards.
Continue to ensure
paediatric service delivers
age appropriate care Ongoing
Children who are admitted to
PPU to have consistent,
equitable care and access to
the full MDT range of staff
as those admitted to the
main paediatric/adolescent
areas – currently under
review daily by the
Paediatric Modern Matron.
Create a child friendly
environment in ITU/HDU
and recovery - Feasibility
currently being explored

Purpose built paediatric
and adolescent wards.
Purpose built area
ITU/HDU for children

Redevelopment
Team
Shane McCabe
Plans transition into adult
care for long term
conditions.

New Hospital – 2010
2005-2008
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
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

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9
Guidance
Current Position

Named individual with
responsibility for planning and
delivering services for children
and young people.

Each Patient’s Forum will be
required to develop strategies
to include young people.


Multi professional planning
approach with paediatric
consultant involvement.
Exec lead for Paediatrics.


Initial project looking at
waiting times in OPD, will
include paediatric patients
and their families.


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
Consider the ‘whole child’ not
simply the illness being
treated.

Multi professional approach 
with regular meetings
(including staff from all
Trust depts. Where children
are seen e.g. out-patients,

2005-2008
Patients are being admitted
to the NHS wards gradually
in conjunction with the
admitting Consultant – June
2006. Feedback audit will
be conducted.
Continue.
Identify a Non-Executive
Director to provide
leadership at Trust Board –
December 2005 completed,
Stecia Ladie attends the
RNOH Children’s Strategic
Group meetings.
Ensure Patient Forum
projects capture children
and young peoples’ views forum has visited the
paediatric areas_ January
2006 (completed)
Use feedback to make
appropriate changes – April
2006
Request the patient forum to
conduct a re-audit in
January 2007 of patient and
parent views on the service.
Utilise audit feedback to
refine services.
Identify member of Patient
Forum to take a lead on
Children’s Services –
January 2006 (completed)
Expand the paediatric team
and ensure that
multidisciplinary meeting
continue - Ongoing
Whole tem to be involved in
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
New Hospital – 2010
Lead Manager/Director

Continue.


Continue.

Riana Horn,
Outpatients Manager

Full dedicated paediatric
multi professional team
looking at all the needs of
the child together

MDT
10
Guidance
Staff treating and caring for
children having the education,
training, knowledge and skills
to provide high quality care.

Current Position
plaster room, HDU,
theatres, OT, Physio etc.
All staff have access to
paediatric competency
course and other paediatric
specific courses. However
poor uptake of competency
course.




Children’s best interests are
served by being in hospital for
the briefest possible time.



Child protection, appropriate
advice on child protection is
available to staff 24 hours a
day, 7 days a week.

Multi professional liaison to
ensure optimum discharge
planning arrangements.
Pre-operative assessment
and discharge planning.
Pre-op assessment does
not cover all patients.
Child protection training
available to all staff, advice
available from paediatric
consultant and weekdays
from the child protection




2005-2008
the MDT meetings Actioned
Increase volume (from 30%
up to 65%) of staff attending
paediatric mandatory
training – April 2006
(completed with some
periods of rotation for key
staff such as those from the
PPU)
Audit attendance by staff
groups via the human
resources development
course booking and
attendance register.
At least two children’s
trained nurses to be on duty
each shift on the paediatric
wards - April 2006
To be monitored by the
Ward Managers and
Paediatric Matron weekly.
Review at NAC.
Development of integrated
clinical pathways December 2006
All children to attend preoperative assessment and
discharge planning to be
commenced at this point Date revised to September
2006 (to coincide with the
modernisation streams)
Continue plan of education,
all staff to have received
training - Ongoing,
Appointment of Clinical
Educator achieved
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
New Hospital – 2010
Lead Manager/Director

All staff caring for child will
have some paediatric
specific training for their
area. And at least two
children’s trained nurses
to be on duty at all times

Siobhan LalorMcTague and
Children’s Services
Strategy Group



Full established use of
pathways.
Fully established preoperative and discharge
planning service
Sheila Puckett,
Director of Service
Improvement and
Siobhan LalorMcTague

Continue.

Siobhan LalorMcTague
11
Guidance
Current Position
co-ordinator and named
nurse.
New Hospital – 2010
2005-2008
Lead Manager/Director
Young people with long term
conditions need preparation
for the move from children’s to
adult services. All young
people with ongoing health
needs should have a plan
developed with them for the
transition of their care to adult
services with is co-ordinated
by a named person.

Clinical Nurse Specialist
act as link to adult service,
consultant surgeon
continues care for patient.

Introduction of transition
pathway - Ongoing

Robust transition for all
patients from paediatric to
adult services.

Board Level children’s lead
within the Trust.

Currently Director of
Operations with Director of
Nursing covers child
protection.


Continue.

Lesley Perkin,
Director of
Operations, Stecia
Laddie, Non
Executive Director
Children’s services
included in Trust Annual
Report.

Clinical Director to take
issues to Board Lead,
develop Paediatric
Executive Team - Ongoing
Non-Executive Director lead
– December 2005
(completed)
Separate Children’s Service
Annual Report – May 2006
(Completed 28.2.06)
Continue a rolling
programme of reports on a
bi-annual basis.
Develop children and young
people addendum to be
included - April 2006

Continue.

Shane McCabe

Continuing expanding
paediatric specific policy
for new hospital.

Redevelopment
Team and MDT
Continue with good practice.
Named doctor to feed back
regularly at the RNOH

Continue.

Siobhan LalorMcTague
Annual report to the Board on
children’s services in hospital.



Health and safety policies
should be robust and explicitly
cover children and young
people. They should be
subject to regular audit to
ensure that they are being
met.

Children and young people
included in current Trust
policy.

Hospital Trust Board should
be kept fully informed about
the Trust’s performance in

Ongoing audit being
conducted, information re
training, policy being fed


Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
12
Guidance
relation to child protection.
Audit arrangements should be
in place to assure the quality
of systems, processes and
practices to safeguard
children.
Current Position
back to Board.


Specific reference to infection
control amongst children in the
Infection Control Policy,
including policies to minimise
antibiotic resistance.

Children’s Infection Control
lead nominated.

Staff have an understanding of
how to assess and address
the emotional wellbeing of
children and are able to
identify significant mental
health problems and that there
are robust liaison
arrangements in place to
secure child and adolescent
mental health services input,
including psychiatry and
psychology.

Policy for the death of a child.


Children and young people
included in current Trust
policy.
Awaiting adoption of UCH
Infection Control Policies.

Link nurse for both ward
areas, Matron nominated
lead.
Clinical sessions available
with CAHMS each week.

Specific section in Trust
policy for children.
2005-2008
Children’s Strategic
Planning meeting.
(ongoing) completed
New Named Nurse assigned
– Paediatric Modern Matron
(August 2006)
Named Nurse to produce
written quarterly child
protection update reports for
the Trust Board.
Develop children and young
people addendum to be
included – April 2006
New Hospital – 2010
Lead Manager/Director

Continue and expanding
paediatric specific policy
for new hospital.

Continue good practice.

Continue.


Expansion of service Ongoing

Dedicated paediatric team
providing robust service
including a dedicated
paediatric liaison mental
health team


Review and update as
necessary April 2006
Completed and part of the
updated Trust-wide child
Protection policy to be
reviewed annually.

Continue.

Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
Infection Control
Team
Shane McCabe
13
Guidance
Outpatient clinics where
children are seen side by side
with adults, there needs to be
some geographical
separation.

Current Position
Waiting and play facility
available for children.

2005-2008
Develop dedicated
paediatric clinic provision,
play staff available –
Business Case April 2006.
Play Specialists x 2 (in
addition to current vacant
full-time position) were
approved and will take this
action point forward.
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

New Hospital – 2010
Separate area for children
and families with
dedicated paediatric team.
Lead Manager/Director
 Siobhan LalorMcTague and Riana
Horn
14
Guidance
Audit of Paediatric
Anaesthesia Services in
London
London Specialised
Children’s Services Forum
Paediatric Anaesthesia SubGroup
Establish multidisciplinary
Children’s Committees in all
Trusts, with Trust Board
representation
Current Position
New Hospital – 2010
2005-2008

Currently we have an
established
multidisciplinary Children’s
Committee with Trust
Board Representation.

Continue.

Continue.

Provide skills updating for staff
only dealing with children in an
emergency

Providing skills updating
for staff dealing with
children in an emergency
eg APLS, Paediatric
Competency Programme.

Continue.

Continue.

Provide resuscitation training
for all anaesthetists caring for
children


Dedicated paediatric
team.



Dedicated paediatric pain
team with protocols.

Establish regular multi
disciplinary clinical meeting

Established regular weekly
multi disciplinary clinical
meetings.

Establish 24 hour paediatric
anaesthesia on call rotas in
centres with specialised
surgery - April 2008
Establish funding for
paediatric pain services –
Business Case 2006
Completed, ward trainer has
trained the nursing staff in
utilising the pain
assessment tool for
children/adolescent
patients.
Attendance at the multidisciplinary meetings to
include surgeons- January
2006 completed and occurs

Provide training and establish
funding for pain services for
children.
Providing training in
paediatric resuscitation for
all anaesthetist caring for
children.
Providing and establish
pain services which include
children.

Continue.


Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
Shane McCabe and
the Children’s
Services Strategy
Group
Alicia Thomas and
Siobhan LalorMcTague
15
Guidance
Current Position

Facilitate development of
accredited training courses
specific to theatre staff caring
for children eg recovery and
anaesthetic room

Provide training in
paediatric resuscitation for
recovery staff and
anaesthetic room staff.

2005-2008
regularly on Wednesday
pms.
Notes of the meetings are
taken and attendance is
noted
All recovery and anaesthetic
recovery room staff to have
paediatric resuscitation
training and APLS available
to them – October 2006
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
New Hospital – 2010

Continue.

GM, Clinical Support
Services
16
Guidance
Children’s Surgery – A First
Class Service
Current Position
New Hospital – 2010
2005-2008
A designated adolescent unit
is the ideal and the Forum
strongly recommends the
development of such units,
staffed by appropriately trained
nurses.

Adolescent area within
paediatric unit. Nurses
offered specialist training in
this age group.

Further develop training
opportunity for staff
wishing to nurse
adolescence Ongoing

Paediatric teams for
paediatric service.

Surgical treatment of children
with developmental delay or
multiple disabilities should
generally be undertaken in
specialist centres.


Promote the high quality
service in caring for
children with learning
disabilities - Ongoing

To ensure appropriate
facilities and staff to
support this patient group.

Every death should be the
subject of meticulous audit.
This should be the
responsibility of the named
surgical consultant caring for
the child.

The unit has been
assessed by the
universities to take learning
disability students. Large
number of patients have
special needs.
Every death of a child has
an individual review (one
death in last 3 years)

Continue.

Continue.

Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
Shane McCabe, the
Safeguarding
Committee and the
MDT
17
Guidance
Guidance on the provision of
Paediatric Anaesthetic
Services
Children should be nursed on
a ward where there are at least
two registered children’s
nurses on duty for every shift
that the child is present.
There should be pharmacy
staff with specialised paediatric
knowledge available to provide
advice and ensure safe and
effective management of drugs
in children. Where
appropriate, intravenous
injections and infusions for
children should be prepared in
the pharmacy under controlled
conditions. Copies of a
recognised paediatric
pharmacopoeia should be
widely available and used in all
ward and theatre areas.
Current Position



Paediatric off duty
incorporate this guideline.
Pharmacists visit wards
daily.
RNOH formulary.
New Hospital – 2010
2005-2008

Increase the number of
registered children’s
nurses (up to 50% achieved may 2006) –
Ongoing recruitment to
replace and succession
plan.

Offer paediatric nurse
training - Achieved
Dedicated paediatric
pharmacist- Business
Case required April 2006
(date revised to
September 2006).


Copies of medicines for
children and develop an
RNOH paediatric
formulary which should be
in all areas where children
are cared for – December
2006

Pharmacy to develop a
wider paediatric drug store
on site and to have an
efficient system to obtain
required drugs within one
working day – December
2006
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

To have established a
dedicated paediatric
nursing team.

Siobhan LalorMcTague and Shane
McCabe

Dedicated paediatric
pharmacy team.

Anthony Palmer
18

Resuscitation equipment
should also be available in all
other sites where children
undergo treatment.

Resuscitation team always
bring paediatric
resuscitation equipment.

All patients should be
assessed before their
operations by an anaesthetist.

All paediatric patients seen
by an anaesthetist pre-op.

There should be systems to
ensure the safe use and
prescription of drugs in
children.

Trust Medicines Policy and
daily visit from pharmacy.

Guidance
Paediatric Intensive Care ‘A
Framework for the Future’
1997
The National Co-ordinating
Group recommends that in
future the paediatric intensive
care service should be
delivered.
Now

The RNOH currently
provides an Intensive Care
Service to support
specialist orthopaedics.
All areas treating children
to have paediatric
resuscitation equipment
and staff trained to use it –
April 2006 (completed and
staff have been trained).
Continue.

All areas treating children
to have paediatric
resuscitation equipment
and staff trained to use it.


Continue

Copies of medicines for
children and paediatric
formulary when written
should be in all areas
where children are cared
for - December 2006

Continue.

Anthony Palmer

Redevelopment Team
New Hospital – 2010
2005-2008

Develop within current
ITU/HDU a dedicated
paediatric area Feasibility already being
explored


One of sector providers for
PICU
Dedicated separate
PICU/HDU
1. District General Hospital
2. Lead Centres
3. Major Acute General
Hospitals
4. Specialist Hospitals
providing some intensive
care in support of the
speciality eg cardiac,
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
19
Guidance
neurosurgery basis
Now
New Hospital – 2010
2005-2008
Skills and Experience of Staff

Additional support training
for ITU staff eg Paediatric
Competency Programme,
APLS.

Recruit RSCN/RN Child to
vacancies and provide
additional training for high
dependency and ITU
nursing (one nurse from
HDU is on secondment to
complete the RSCN course
in December 2006) Ongoing

Fully established paediatric
ITU/HDU nursing team.
NURSES
Core Training
Nurses – RSCN

Paediatric ITU course
available to ITU staff.

Employ RSCN’s with
paediatric ITU course Ongoing

Intensive Care
Training – ENB 415 in
Paediatric Intensive Care

All nurses working in PICU
to be RSCN’s with
paediatric ITU course
ENB 415 no longer exists
and its replacement can
only be accessed by staff
that already have their
RSCN.
Intensive Care Training
Approved UK training in
paediatric intensive care
medicine

Training provided as
required.


Staff with paediatric
training in post


Service level agreement
locally.

All staff to receive
paediatric training Ongoing
Increase complexity and
throughput of cases Ongoing
Staff should retain and develop
their knowledge and skills in
caring for critically ill children

Working to maximum bed
capacity for paediatrics.

Increase efficiency, reduce
length of stay therefore
increasing throughput –

Dedicated paediatric ITU
with increased capacity

Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

GM, Clinical Support
Services and Siobhan
Lalor-McTague
GM, Clinical Support
Services
20
Guidance
by ensuring that they manage
sufficient numbers to keep
their skills up to date.
Now
New Hospital – 2010
2005-2008
December 2006
Availability of the tertiary
services on site (depending on
the type and severity of the
child’s illness).

Liaising locally and within
sector for tertiary advice.

Plan to uplift some tertiary
service posts and continue
to liaise externally –
December 2006

Continue

Shane McCabe and
Children’s Services
Strategy Group
Child friendly accommodation
and facilities

On site accommodation
available although needing
upgrading.

Building of Ronald
McDonald House for
parent accommodation Completion December
2006 (capital monies have
been identified £100,000
and it is part of the Trust’s
capital programme for 06 –
07).

Ronald McDonald House in
use and some on site
facility.

Redevelopment Team
Facilities for the family to visit
and stay with the child.

Open visiting,
accommodation on site.

Dedicated family room next
to ITU.

Specialist equipment for
children of different ages.

Specialist equipment
available.


Modern and up to date
equipment available.

Support services, such as
paediatric pathology,
laboratory services and
paediatric radiology.

Facility on site.


Microbiology on site.

Anthony Palmer
Provision of safe transport to
other appropriate facilities if
needed.

Ad hoc expert advice taken
on individual basis.


Provide all care on site.

Shane McCabe and
Siobhan LalorMcTague
MEDICAL STAFFING
 A paediatric consultant
should be closely involved
in the care of each child


Paediatrician available to
be involved in care of all
children 24 hour on call.

Increase volume of
equipment for growing
capacity - Ongoing
Review SLA re increasing
capacity - April 2006 (this
is out to tender and the aim
is to conclude this process
by September 2006)
Develop up to date transfer
protocol – April 2006
Extend ITU skills for
Paediatric Consultant. Full
time paediatric consultant
staff - Business Case
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

Shane McCabe
Expand service
21
Guidance

Now
While children are being
treated in intensive care,
each clinical session and
the on call rota should be
covered by a consultant
who has training and
continuing experience in
paediatric intensive care
Specialist Registrar (or
equivalent) immediately
available at all times with
advanced paediatric
resuscitation skills

Paediatric experienced
anaesthetist available.

Training available to all.


Access to advice from a
consultant with paediatric
intensive care training in
the Lead Centre

Access to advice from
consultants in paediatric
sub specialities eg
neurology, nephrology and
radiology

NURSE STAFFING
 Registered children’s
nurses with experience in
intensive care will provide
continuous monitoring and
observation

A senior registered
children’s nurse with
New Hospital – 2010
2005-2008
April 2006

Recruit specialist paediatric
staff, offer training to
current staff Ongoing

All staff trained with regular
updates available.

Ensure training completed.
Specialist Registrar
available at all times.


Good links with GOS.


Specialist Registrar with
advanced paediatric life
support – April 2006. Date
revised to October 2006

Paediatric Anaesthetic SpR 

Employ an RNOH
paediatric intensivist –
Business Case required

Team of paediatric ITU
staff

Links with GOSH.
Links locally and within
Sector. Advice from local
tertiary services sought.
No SLA for advice, it is a
professional to professional
discussion.

Develop SLA to provide in
these areas.

Continue

Shane McCabe

Recruitment drive following
uplift of nursing
establishment, use of
temporary staff in interim.

Recruiting further
registered children’s
nurses, developing their
skills - Ongoing

Dedicated paediatric team.

Liaison between Matrons.

Appointment of senior
paediatric ITU trained


Dedicated paediatric team.
24 hour senior ITU

GM, Clinical Support
Services

Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

GM, Clinical Support
Services
Children’s Services
Strategy Group
22
Guidance
training and experience in
paediatric intensive care
available for support and
advice
FACILITIES
 Appropriate equipment to
enable artificial ventilation,
invasive cardiovascular
monitoring, intravenous
nutrition, renal support,
intracranial pressure
monitoring etc for all ages
of paediatric patients
Now
New Hospital – 2010
paediatric nurse onsite
2005-2008
nurse – Ongoing (A senior
staff member returns from
the RSCN course
December 2006)

Appropriate equipment
available but not in all
areas.

Increase volume of
equipment - Ongoing

Dedicated nurse lead and
deputy. Up to date and
modern paediatric
equipment
Immediate access to
radiological and imaging
facilities
Access to appropriately
trained professionals allied
to medicine, in particular
paediatric physiotherapists
with intensive care
experience

24 hour availability.

24 hour availability.

24 hour availability.


24 hour availability.

24 hour availability.

24 hour availability.


Access to psychological
and emotional support
including social workers,
clergy and play specialists

Available for session during
the week.

Increase level of provision
– Business Case April
2006 (approved and out to
recruitment in conjunction
with the Tavistock)

Dedicated paediatric team.

Shane McCabe

A child orientated
environment, physically
separated from adults

Use of side rooms where
possible.

Explore the possibility of a
designated area within
ITU/HDU Feasibility
being explored

Separate paediatric
ITU/HDU space.

Redevelopment Team

Facilities for families
including lounge, kitchen,

Available on site.

Improved facility with
Ronald McDonald House –

Adjacent facility.

Redevelopment Team


Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)
23
Guidance
toilet facilities and a
telephone adjacent to the
unit and restaurant facilities
and accommodation with
the hospital

The family must have
access to the child at all
times
QUALITY AND
MANAGEMENT
 Critical incident reporting
Now
New Hospital – 2010
2005-2008
Due for completion
December 2006 (on target
within the Trust’s capital
programme)

24 hour access.

24 hour access.

24 hour access.

System in place, Ulysses
data base being used,
centralised reporting to
NPSA

Ongoing.

Ongoing advancing with IT
development.
Paediatric Strategy (VERSION 7), June 2006 (ORIGINAL VERSION FIRST WRITTEN IN JUNE 2005)

24