1. Neonatal Nurse Consultant role in Surgery New ways of working 2005

2. Nurse Consultant- Neonatal Surgery- Yorkshire Neonatal Network

3. Background Pressure from surgeons, obstetricians, nurses Pressure from surgeons, obstetricians, nurses Media pressure, mothers transferring out of region. Media pressure, mothers transferring out of region. Audit trail 2002, Jan – July, babies who could have been transferred to local hospital if support was available. Audit trail 2002, Jan – July, babies who could have been transferred to local hospital if support was available. 466 days, from 300 - 900 pounds per day. 466 days, from 300 - 900 pounds per day.

4. Background 63 miles each way 63 miles each way Resident / work Resident / work Expressing milk Expressing milk Finances, food, car parking, drinks, washing clothes, Finances, food, car parking, drinks, washing clothes, Relationships Relationships Multiple professionals Multiple professionals

5. Policy documents DoH (2000) The New NHS Plan DoH (2000) The New NHS Plan Neonatal strategy working group (2002) Neonatal strategy working group (2002) DoH (2003) The Green Paper, Every Child Matters DoH (2003) The Green Paper, Every Child Matters DoH Childrens Act (2004), DoH Childrens Act (2004), NSF for Children (2005) NSF for Children (2005)

6. Remit Increase cot capacity - 50 babies transferred Increase cot capacity - 50 babies transferred to hospital near home to hospital near home Decrease refusal rate - collecting data. Decrease refusal rate - collecting data. Decrease out of region transfers– collecting data Decrease out of region transfers– collecting data Safe transfer, care and management of surgical babies to a hospital near the home – 1 re admission for oesophageal dilation, 1 bronchoscopy. Safe transfer, care and management of surgical babies to a hospital near the home – 1 re admission for oesophageal dilation, 1 bronchoscopy.

7. Nurse Consultant Expert clinical practice Expert clinical practice Leadership Leadership Politics Politics Education Education Research and audit Research and audit

8. Leadership Lead Nurse neonatal surgery Lead Nurse neonatal surgery Pain management Pain management Sensory relaxation and stimulation Sensory relaxation and stimulation Wound assessment Wound assessment

9. Leadership as CN Guidance for medical and nursing staff on management of transferred infants who have had surgery Guidance for medical and nursing staff on management of transferred infants who have had surgery Guidelines, protocols, trouble shooting information Guidelines, protocols, trouble shooting information Parental information, discharge planning Parental information, discharge planning

10. Education Surgical teaching- medical, nursing, PAM’s. Surgical teaching- medical, nursing, PAM’s. Study days Study days Universities Universities Blackboards Blackboards Book review Book review Self ProfessionalsParentsPublic

11. Audit Pain Pain Rectal washouts Rectal washouts Surgery numbers at Hull and Leeds. Surgery numbers at Hull and Leeds. Refusal data, delayed discharge data Refusal data, delayed discharge data No of babies transferred, complications, re - admissions No of babies transferred, complications, re - admissions

12. Research Evidence based practice Evidence based practice e.g Central line management Sucrose Sucrose Dressings post surgery Dressings post surgery Feeding regimes Feeding regimes Gastro oesophageal reflux management Gastro oesophageal reflux management

13. Research Study to identify the concerns for parents who had to travel long distances to visit their baby. Study to identify the concerns for parents who had to travel long distances to visit their baby. A three point evaluation on the outcomes of a surgical support role for infants who are transferred to their local hospital or discharged home. A three point evaluation on the outcomes of a surgical support role for infants who are transferred to their local hospital or discharged home.

14. What do I do? Teaching and planning for transfer before it happens Teaching and planning for transfer before it happens Close regular contact with nurse caring for infant Close regular contact with nurse caring for infant Liaise with medical staff, dietician, physio etc Liaise with medical staff, dietician, physio etc Physical examination Physical examination Recommend ongoing management Recommend ongoing management

15. Problem solving Diarrhoea Diarrhoea Constipation Constipation Reflux Reflux Medications Medications Immunisations Immunisations Passing naso- jej tube Passing naso- jej tube without x-ray. without x-ray. Prolapse vesicostomy Prolapse vesicostomy Removal of percutaneous feeding jejunal tube Removal of percutaneous feeding jejunal tube Blood in stools Blood in stools Abdominal mass Abdominal mass

16. Good things that have happened Parents visit more often Parents visit more often Parents spend less money Parents spend less money Parents feel they can take siblings to special care Parents feel they can take siblings to special care Special cares are less noisy the Surgical ward Special cares are less noisy the Surgical ward Primary care teams are involved earlier, visit nnu and support for discharge home appears to be good. Primary care teams are involved earlier, visit nnu and support for discharge home appears to be good.

17. What else has happened Referrals about babies who have transferred out of region and come back to local hospital Referrals about babies who have transferred out of region and come back to local hospital Referrals about inguinal hernias, increasing head circumference. Referrals about inguinal hernias, increasing head circumference. Referral of a baby for tender loving care - planning Referral of a baby for tender loving care - planning

18. Working together with parents and professionals

19. Enhancing communication to improve patient care I did tell you that if you fed me properly I would grow!!!! Bye for now, safe journey.