1. LisaFernTraffordCCNT/12.05.10 PCT Education Forum TRAFFORD CHILDREN’S COMMUNITY NURSING TEAM

2. LisaFernTraffordCCNT/12.05.10 The Team Nurse Manager / Advanced Paediatric Nurse Practitioner Band 6 Children’s Community Nursing Sisters (X7) Band 5 Staff Nurses (X6) Band 3 Children’s Community Support Workers Team Administrator

3. LisaFernTraffordCCNT/12.05.10 The CCN service Safeguarding; Safety & effectiveness; Centred on the child and family; Involvement of and respect for the child/young person’s view; Parental empowerment; Promotion of health and well-being; Promotion of independence and self care; Accessibility and provision closer to home; Partnerships across professional groups and agencies. The CCN service is underpinned by the following principles:-

4. LisaFernTraffordCCNT/12.05.10 Aims of the CCN Service Deliver care closer to home for CYP who have mild acute illnesses within the home or other community setting Reduce hospital admissions and length of stay for CYP with ongoing and chronic needs Provide support within the home for CYP with complex and additional needs Reduce avoidable hospital admissions for CYP with acute illness by working in partnership with the POAU at TGH

5. LisaFernTraffordCCNT/12.05.10 Aims of the CCN Service Facilitate early discharge from hospital following elective and non elective surgical admissions Provide accessible nurse led clinics within the community setting Provide education and training to families and our CYPS colleagues involved in providing care to the CYP of Trafford Promote health and well being for all CYP in Trafford by reducing health inequalities for those who are most vulnerable

6. LisaFernTraffordCCNT/12.05.10 Multi-agency Working Primary Care GP, HV, SN, including specialist services Secondary Care Trafford Children’s Resource Centre, A & E & POAU Wythenshawe F8, Children’s Day Surgery, Outpatients, A & E Other district general hospitals Tertiary Care Royal Manchester Children’s Hospital - including specialist services Alder Hey Children’s Hospital Social Services Education Voluntary Agencies CYPS colleagues

7. LisaFernTraffordCCNT/12.05.10 Service Provision Available 08.30am – 10pm, 7 days a week, including bank holidays Trafford resident Children and Young People 0-16 years, up to 19 th Birthday if have Complex and Additional Needs POAU attendance 2-8pm Home visiting service for acute, chronic or complex health needs Nurse led clinics Asthma Eczema Enuresis & constipation Education and training for parents/carers/CYP and multi-agency colleagues Maintenance and delivery of equipment and supplies Home phlebotomy service – Complex and Additional needs

8. LisaFernTraffordCCNT/12.05.10 Role of the CCN team Provide direct nursing care, support, training and advice for a wide range of conditions. Some examples are:- Enteral feeding – NG, gastrostomy, jejunal ConstipationEnuresis Wound care – general, post op, burns/scalds, ROS Asthma Care – Acute and Chronic Acute minor illness Post operative care Orthopaedic and Trauma Care Palliative Care / End of Life Care Oncology support & chemotherapy administration Tracheostomy Care & Training Home IV Antibiotics Eczema and other skin conditions Epilepsy SupportDiabetes Support Cystic Fibrosis Support Rheumatic Conditions Complex and Additional Needs Maintenance of Hickman Lines and Portacaths Respiratory Care Home Oxygen Bronchiectesis

9. LisaFernTraffordCCNT/12.05.10 Referrals Permission must be sought from the CYP and carers before sending referrals Open Referral System Fax Telephone Letter Face to face

10. LisaFernTraffordCCNT/12.05.10 NURSE LED ASTHMA CLINIC “Making it Better” More CCNT nurse led clinics Asthma identified as a priority Partington Children’s Centre January 2010 Future clinics ?Old Trafford

11. LisaFernTraffordCCNT/12.05.10 “Drop in” Advice if unwell Advice on inhaler techniques Advice on management of symptoms Short term care – refer back to GP/Practice nurse for ongoing asthma management Home visiting service

12. LisaFernTraffordCCNT/12.05.10 The Future We are moving:- Children’s Resource Centre at Trafford General Hospital Summer 2010

13. LisaFernTraffordCCNT/12.05.10 Contact Details CCN Team Altrincham General Hospital Market Street Altrincham WA14 1PE Tel - 0161 934 8333 Fax – 0161 934 8319

14. LisaFernTraffordCCNT/12.05.10 Children’s Resource Centre and Paediatric Observation and Assessment Unit Day Case surgery Children’s Outpatients Ward attendees - phlebotomy Section 47 Medicals CCNT Health Visitor Liaison Safeguarding Children Nurse

15. LisaFernTraffordCCNT/12.05.10 POAU Located within A & E Operational 9am – 10pm 7 days per week 2 assessment / treatment rooms 2 observation beds 2 Paediatric Nurses Paediatric Registrar & FY2 CCNT present 2pm-8pm

16. LisaFernTraffordCCNT/12.05.10 Consultant Paediatrician still on site up to 5pm – via on call system out of hours CCNT – liaison, discuss and direct referrals All children wait in the POAU May be seen by either Paeds Registrar or A & E team A & E will refer to Paeds Reg if opinion required GP medical referrals – direct to Registrar on call via TGH Switch All GP accepted referrals are seen directly by Paeds team not A & E May stay as ambulatory patient or be admitted to POAU POAU

17. LisaFernTraffordCCNT/12.05.10 If a period of observation required Can stay in POAU for up to 6 hours e.g. Monitor medication response Fluid challenges Referral to CCNT for support and care – quicker discharge, “care closer to home” Severely ill children will be transferred to Wythenshawe Hospital or tertiary care once stabilised ADMISSION TO POAU

18. LisaFernTraffordCCNT/12.05.10 Acute Referrals To CCNT Child requires same day / evening visit i.e. urgent, acute referral Child must NOT be discharged prior to verbal acceptance of referral by CCN. Referral to be made a minimum of 2 hours prior to the end of the CCNT late shift which is 8pm Referrer makes telephone contact with CCNT: office phone or CCNT duty mobile 07795541410 CCNT is UNABLE to accept referral to undertake same day / evening visit Medical re-assessment / decision:  Child remains in clinical care of referrer  Child is discharged with routine next day CCNT visit as per agreed plan of care  Child can be contacted for telephone review CCN ACCEPTS referral to undertake same day / evening visit The referral is verbally accepted by CCN and patient’s details / reason for referral are given. Referrer to confirm if there are any known associated risk elements HOME VISIT

19. LisaFernTraffordCCNT/12.05.10 Thanks!! Any Questions?