CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word “Guideline” (not protocol, policy, procedure etc)
Guideline On Cot Availability and Admission to the Neonatal Unit
Two Version one
Supersedes Contact Name and Job Title (author)
Jane Cowne, Andrea Noble, Martine Storey (Midwives)
Date of submission
Date on which guideline must be reviewed (this should be one to three years) Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis)
This guideline describes the cot availability process and the transfer of babies from maternity service to the NNU.
Neonatal cot, NNU, admission, CenTre, regional transport service
Statement of the evidence base of the guideline – has the guideline been peer reviewed by colleagues?
Evidence base – state highest level from (1-5) 1a meta analysis of randomised controlled trials 1b at least one randomised controlled trial 2a at least one well-designed controlled study without randomisation 2b at least one other type of well-designed quasi-experimental study 3 well –designed non-experimental descriptive studies (ie comparative / correlation and case studies) 4 expert committee reports or opinions and / or clinical experiences of respected authorities 5 recommended best practise based on the clinical experience of the guideline developer
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Babies requiring admission to the NNU
Senior Midwives/Nurses, Consultant Obstetricians/Neonatologist Nottingham Development Guideline Group
Midwives, nurses, neonatologists
This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. NHS Nottingham City and Nottingham University Hospitals NHS Trust are committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. The Trusts are committed to ensuring that the public and staff are given information in a clear and concise way and in a manner that people understand. In situations where there are concerns about an individual’s ability to understand information or consent to treatment because a medical condition has affected their cognitive functioning and mental capacity please refer to the Mental Capacity Act intra-agency guidance and complete appropriate documentation.
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Guideline On Cot Availability and Admission to the Neonatal Unit Cot availability on the Neonatal Units at NUH In order for accurate information to be given to ‘CenTre’, (the regional transport service) the nurse in charge of the Neonatal Unit at both the Queens Medical Centre Campus (QMC) and the Nottingham City Hospital Campus (NCH) will need to know the activity on their site. This means campus specific activity on the Neonatal Unit itself, the Labour Ward and the antenatal wards. It is the role of the nurse in charge of the campus Neonatal Unit to telephone the Labour Ward Co-ordinator at 08.00hrs and 20.00hrs to enquire about any potential births that may require a neonatal cot. The nurse in charge will inform the Labour Ward Co-ordinator of the cot status on the Neonatal Unit to allow her to plan the management of the Labour Ward activity. The nurse in charge of the Neonatal Unit will additionally phone the campus inpatient antenatal wards, following the conversation with the Labour Ward Co-ordinator, to determine if there are any inpatients whose babies may require imminent delivery and a neonatal cot. The nurse in charge of the campus neonatal unit will complete the activity proforma, including the traffic light system (red, amber and green) to determine whether the campus neonatal unit is open to admissions or not. The nurses in charge of the neonatal units at QMC and NCH share campus data on a 12 hourly basis. They also share campus specific data with the transport service on a 12 hourly basis. It is the responsibility of the Labour ward Co-ordinator to inform the nurse in charge of the campus Neonatal Unit of the admission of any women whose babies may require neonatal services outside of these times.
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Reasons for admission to the neonatal unit This information is contained in the NUH neonatal Service Clinical Guideline No A3 ‘Indications for admission to the neonatal medical and surgical units. Transfer of the sick newborn to the Neonatal Unit from the maternity service The sick newborn that requires admission to the Neonatal Unit should be transferred to the Neonatal Unit on the resuscitaire once the infant’s condition is stable. Prior to transfer from the place of resuscitation it is the attending neonatal staff / midwife’s role to: Inform the neonatal unit of the admission Ensure the baby is labelled Ensure the air and oxygen cylinders are turned on and have sufficient contents for the transfer to the Neonatal Unit Summon additional help if required i.e. to open doors or call for the lift Unplug the resuscitaire Once the neonatal team are ready to move the baby to the Neonatal Unit the air and oxygen supply should be removed from the wall and secured to the resuscitaire Arrange for the parents to be taken to the neonatal unit as soon as is reasonably possible It is the attending neonatal team’s roles to: Escort the baby during the transfer Complete the resuscitation records as soon as reasonably possible Document an ongoing management plan Talk to the parents to explain the events and what has happened. Explain the implications in terms of prognosis for the baby and what further treatment or interventions will be necessary.
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It is the responsibility of the nurse in charge of the neonatal unit to: Identify a bed space for the baby Allocate a nurse to admit and care for the baby Ensure the level of care provided is appropriate to the baby’s needs Review the work load and dependency issues within the neonatal unit and escalate as appropriate Transfer of the newborn from the maternity wards to the Neonatal Unit for ongoing care or treatment eg. phototherapy, septic screen. A baby who requires admission to the Neonatal Unit for more advanced neonatal care or a specific treatment may be transferred in a cot if the infant’s condition allows. Prior to transfer it is the attending neonatal staff / midwife’s role to: Inform the nurse in charge of the neonatal unit when the baby will be transferred so that an incubator / cot will be ready Keep the parents informed Ensure the medical records accompany the baby Ensure the baby is labelled Arrange for the parents to be taken to the neonatal unit as soon as is reasonably possible The baby should be transferred to the Neonatal Unit by the nurse or midwife responsible for it’s care, and must document the date, time and reason for transfer in the medical records. It is the admitting neonatologist’s roles to: Discuss the admission with the senior registrar Document an ongoing management plan Explain to the parents the plan of care Explain what treatment or interventions may be necessary.
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It is the responsibility of the nurse in charge of the neonatal unit to: Identify a bed space for the baby Allocate a nurse to admit and care the baby Ensure the level of care provided is appropriate to the baby’s needs Review the work load and dependency issues within the neonatal unit and escalate as appropriate Clinical Incident reporting A clinical incident form must be completed for any baby that is unexpectedly admitted to the Neonatal Unit following a term birth. These cases are reviewed and if appropriate are discussed at the multidisciplinary Encephalopathy meeting. Lessons learnt from this meeting and any trends are identified and shared at the appropriate forums. Any cases not discussed at the Encephalopathy meeting will be reviewed independently. Monitoring plan The cot availability and admission to the neonatal unit guideline will be monitored as detailed in the NUH Maternity Services Clinical and Operational Monitoring Plan.
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