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Working as a team to meet the needs of critically ill children

In this blog we hear from Karen Perring, Lead Nurse for the Yorkshire and Humber Paediatric Critical Care Network, who shares how her role has supported hospitals in the area to make sure critically ill children get the care they need, even at the busiest times of the year.

We often hear talk about the NHS needing to ‘work differently’, and my job is one that gives a great example of how introducing a new role can make a difference in addressing some of the challenges for health services.

I am Lead Nurse for the Yorkshire and Humber Paediatric Critical Care Operational Delivery Network (PCC ODN) supporting 14 NHS trusts, over 19 sites, across the whole pathway of paediatric critical care from hospital admission through to Paediatric Intensive Care (PICU). There are several aspects to my role – all relating to how we better co-ordinate care for critically ill children in our area. A key part of my role in winter is to manage pressures on critical care services for children, and over the past three years I have played a major part in the delivery of a working Surge and Escalation plan.

Managing critical or emergency care is always going to be more difficult than organising routine care such as outpatient appointments or planned hospital admissions. We know if a child will need intensive support following major surgery, but we can’t predict when a child will become critically ill and need to be cared for in a PICU. However, we do know that more infants and children require intensive care in winter when respiratory infections and other illnesses increase, and that disabled children or those that are vulnerable because of existing health conditions, are at a much higher risk of becoming very unwell. If a child becomes critically ill then they need to be admitted, but if their local paediatric intensive care unit is full – then what next? That’s where I come in.

As I’m sure you can imagine, at this time the clinicians caring for the child are extremely busy, so to spend time ringing around and negotiating with other teams to find the best place for a child to be just takes them away from patient care. I help by taking over this role. Sometimes I work with the PICU matrons to free up a bed by supporting children well enough to go to a ward, which can be held up just because arrangements need to be made setting up equipment or organising patient transport. The real advantage I have is to be able to see the bigger picture. I have daily access to information about bed numbers and patient flows across the whole region, and can see where problems are likely to arise to be able to work with colleagues and plan in advance.

When capacity is really a problem, and children require transfer outside Yorkshire and Humber, I am able to use my links with the other PICUs in the North of England to inform the clinical teams making decisions about the closest appropriate location for each individual patient.

Co-ordinating winter pressures across the network is just one aspect of my job. Alongside my ODN colleagues, we also have an important training and education role to support all the hospitals in our patch to manage the care of critically ill children. We provide a variety of free training days to meet the needs of all staff caring for critically ill children. These include multi disciplinary simulation days on recognition of the deteriorating child, stabilisation and preparation for transport. This includes looking at effective team working and communication. We also hold free study days for paediatric and adult nurses focusing on their specific learning needs. We are constantly reviewing and updating our training programme, to meet the needs of our colleagues. Our clinical forum meetings provide an opportunity to share learning or focus on a particular topic identified by colleagues working in the region such as recognising sepsis, managing children with prolonged seizures or cardiac arrest.

The real value of my role is that I can help manage the flow and address blockages across multiple sites without taking clinical staff away from caring for children, while supporting everyone working within the network to maintain and develop the skills needed to care for our most severely unwell children and young people.

The Yorkshire and Humber Paediatric Critical Care Network is one of a number of operational delivery networks (ODNs) across the country coming together to better co-ordinate care and resources in each region of the country. NHS England has been reviewing paediatric critical care and specialised surgery in children, and the development of ODNs which bring together local commissioners, providers, patients and their families is key to a more co-ordinated approach to meeting demand.

You can follow the network on Twitter @YHPCCODN.

Karen Perring

Karen Perring is the Lead Nurse for the Yorkshire and Humber Paediatric Critical Care Operational Delivery Network (Y&H PCCODN). She qualified as a general nurse in 1992 and subsequently specialised in paediatrics gaining her RN (Child) in 1994. Karen has spent the majority of her career working in the field of Paediatric Intensive Care in both Newcastle and Leeds. She also spent 4 years working as a Senior Transport Nurse with the Yorkshire and Humber Infant and Children’s Transport Service (Embrace).

Karen spent a two year secondment as Network educator for the Y&H PCCODN prior to being appointed as Lead Nurse in August 2015. She is an instructor for APLS and is involved in the Network multi-professional simulation days offered to all hospitals within her region.

She is a member of the Paediatric Intensive Care Society (PICS) and regularly attends the PICS Managers Group Meetings.

Karen’s role as Lead Nurse involves projects including Surge & Escalation, guideline development, Long Term Ventilation, High Dependency Audit and Service Evaluation. She works closely with other networks including adult critical care, trauma, neonates, children’s congenital cardiac and paediatric neurosciences.

Throughout her time in the network she has worked hard to develop effective working relationships with provider units and to give professional support and advice, promoting best practice in the care of the critically ill child.

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