CHIRPs: An adaptation of Enhanced Recovery for Paediatrics. Julie Jolly Modern Matron

The ER Programme is designed for Adult services Based on four main principles Involves Multi agency working/workin g in partnership Look at consistency in techniques and approaches within the theatre setting Advocates minimal invasive procedures and removal of drains etc Looks at maximising nutritional status prior to surgery Communication plays a major role within the preparation and recovery of patients Standardises pain management Encourages patients to take responsibility for their recovery What is it? Can it be done in Children’s?

Its never been done before! We are the first Children’s Hospital to adapt the ER Programme to the needs of the Child and family We have maintained the principles but adapted them to meet our service needs and to ensure our behaviours and values play a major role. We have implemented within Surgery and Medicine for both elective and emergency admissions We changed the name to incorporate all divisions with children’s services and to make it more acceptable to the parent and child.

What are the benefits for RMCH? More structured approach to care. Insure CMFT behaviour and values along with the 6Cs are embedded. More involvement from community services. Patients better prepared (where possible). Better informed patients and families. Less time waiting for medical teams for next phase of treatment. Better quality of service and experience for the patients and families incorporating PiC In some cases patients will spend less time as a in- patient on the ward. For surgical and some medical patients treatment will start in their own home via community services. Smoother discharge to community services.

Where did we start Nurse Led Project Define the aims of the project Working groups from individual specialities Each task was time restricted with short deadlines Project implementati on board meeting held monthly Training programme implemented for Nursing staff Posters displayed Presentation at Audit Days Date set for Implementati on News Letter produced Further training CHIRPS stand

Good indication of the reduction of LOS There to many variables in this emergency pathway for the standard set of questions? So we devised a second audit tool.

This time we have looked at compliance with the principles of CHIRPS by speciality.

The audit has highlighted which areas we need to concentrate on to ensure we can met are aims.

Where Do We Go From Here? Nurse Led Discharge. Critical Care Bed Requests. Further training and embedding of the 6Cs in pathways. New innovative programmes. Development of current roles. Parent and patient in put. Communication Strategy with Partnership in care document Compile new audit tool. AND