PAEDIATRIC DEPARTMENT NEONATAL UNIT 0151 430 1511

WINSTON

HELEN

Welcome Booklet For Parents & Families

WHISTON HOSPITAL Warrington Road Prescot L35 5DR

INTRODUCTION WELCOME All the staff on the Neonatal Unit here at Whiston Hospital would like to welcome you to the Unit and to reassure you that we fully appreciate that this is a very difficult and worrying time for you and your family. We will do everything possible to provide you with all the information we can to minimise your worries and to reassure you that we will offer the best care possible to your baby or babies. We are here to support you and work in partnership with you. Our aim is to ensure that you can take your baby home as quickly as possible, when both you and the staff feel it is appropriate and safe to do so. This booklet has been created by the staff on the Neonatal Unit for families as a source of written information to support the information that you will be given on your admission day. If you do have any further questions after reading this booklet, or any concerns at all, please do not hesitate to speak to the staff on duty; or the Unit Manager who is on duty Monday – Friday 9.00am to 4.00pm.

Your baby’s Consultant is: _______________________________________________ 1

LET US KNOW YOUR VIEWS To ensure that we continually provide a service that meets the needs of both babies and their families, we welcome and value all comments about your experience whilst your baby is on our Unit.

Comments & suggestions forms are available on the unit which you do not have to put your name on, but it helps if we need to speak to you to sort anything out

Creation Date – November 2006 Next Review Date – November 2015 Produced by Neonatal Unit, Paediatric Department

30

CONTENTS

PATIENT ADVICE AND LIAISON SERVICE (PALS) Introduction

The service aims to:    

Page 1

Help with any concerns you may have about the care provided On-the-spot help, advice and support Listen to your concerns, suggestions or queries in confidence Guide you through the different services in the Trust

If you have any concerns or issues that you have not been able to resolve with the help of ward staff, PALS staff may be able to help. A member of staff will be happy to contact them on your behalf. Please do not be afraid to ask. If you prefer to, you may call directly on the numbers below: PALS are situated on the ground floor of Whiston Hospital to the left of the lifts at the main reception.

Monday to Friday 10.00 am – 4.00 pm Except bank holidays 0151 430 1144

29

About the Neonatal Unit Admission to the Neonatal Unit The Neonatal Nursing Team Other Members of the Neonatal Team Medical Staffing

4 5 6 7 7

Security Baby Tagging Visiting Policy

8 8 8

Communicating with Families Telephoning the Unit Communication Sheet for Parents Parent Sheet Parent’s Notice Board Consultant Update Sharing Information Your Baby’s Individual Care Plan

10 10 11 11 12 12 12 12

High Standards of Neonatal Care

13

Information Breast Feeding Premature Infants i. Ophthalmology Clinic ii. Audiology Screening iii. Babies Requiring Surgery

14 14 15 16 17 17

2

Information (continued) Equipment on the Unit (Alarms) Infection Control Discharge Planning National Voluntary Support Groups

Page 18 18 19 21

Looking After Yourself

21

Other Hospital Facilities Interpreter Services Consent to Treatment No Smoking Fire Policy for Patients and Visitors Spiritual, Religious and Cultural Needs Car Parking and Public Transport Restaurant Vending Machines Shop Mobile Phones Mail Cash Machine Health Records Gifts

22 22 22 23 23 23 24 24 25 25 25 25 26 26 27

What to do if you have concerns about your baby’s care

28

Patient Advice and Liaison Service (PALS)

29

Let us know your views

30

WHAT TO DO IF YOU HAVE CONCERNS ABOUT YOUR BABY’S CARE If you have any concerns please tell us as soon as they arise so that we can assist you with them as soon as possible. The following information is displayed on the parents’ notice board.

CHILDREN’S & NEONATAL UNIT WINSTON

HELEN

It is our aim to deliver quality care to you and your child. If you are pleased with our service, we would like you to let us know. If you are unhappy with this service please tell us as soon as possible. Listed below are the staff you can speak to. Please ask the nurse in charge if you need any help with this. ► Nurse in charge of the shift ► Ward Manager ► Your child’s consultant/consultant paediatrician on Duty ► Lead Nurse/Directorate Manager ► Clinical Director ► Assistant Director of Operations ► Chief Executive We also have a team of dedicated staff who will be only too happy to assist at any stage The Patient Advice and Liaison Service (PALS) can be contacted on 0151 430 1144

3

28

They will advise you of the procedure, your rights, and any charges that may be incurred.

ABOUT THE NEONATAL UNIT AT WHISTON HOSPITAL

GIFTS Staff are not permitted to accept personal gifts or money. However, gestures of appreciation are very welcome.

Clinic Appointments Following discharge, babies on the Special Care Baby Unit (SCBU) may be asked to attend a Well Baby Clinic, which would either be on the Whiston or St Helens site. Not all babies need a follow up visit to this clinic. Some babies will need a speciality clinic eg cardiac clinic

The Neonatal Unit at Whiston Hospital admits babies from the Hospital’s own Delivery Suite, the Post Natal Ward, and transfers from other hospitals; such as the Liverpool Women’s Hospital Neonatal Unit; or from other units around the region. Our Unit has 15 cots, and like all Neonatal Units in the country, the staffing on the Unit is organised according to national guidance. Our team of neonatal nursing staff on the Unit consist of:  Registered Midwives  Registered Nurses – all have undergone further specialist training in Neonatal Nursing  Nursery Nurses  Enrolled Nurses  Health Care Assistants  Students There is always a Neonatal Nurse who has a specialist neonatal nursing qualification, in charge of the Unit Once your baby is well, with stable physiological observations (such as heart rate, respiratory rate, etc), and is feeding and gaining weight appropriately; then following discussion and agreement with you, a decision

27

4

can be made about when your baby can be discharged home.  The Neonatal Unit is part of the Paediatric Department at Whiston Hospital. It has 6 Consultant Paediatricians, all of whom work on both the Children’s Wards and the Neonatal Unit.  On admission, one of our Consultant Paediatricians will have overall responsibility for the care of your baby throughout your entire stay on the Neonatal Unit.  Working together with the Consultant Paediatricians is a team of junior doctors and medical students to provide the most up to date and best care possible to your baby.

ADMISSION TO THE NEONATAL UNIT Whether your baby is brought to the Neonatal Unit from the Delivery Suite, Post Natal Ward, or transferred in from another hospital, your admission procedure will be very similar. At a suitable time, the Neonatal Nurse responsible for your baby will ask you some questions relating to your baby and fill in some forms. They will tell you who your baby’s consultant is, and what the plan is during the first day of your baby’s stay on the Unit. You will be asked whether you wish to breast feed your baby and if you would like to express milk; or use formula feeds. We always recommend breast feeding as breast milk has the best nutritional value for your baby. There is more on breast feeding support later in this booklet.

5

Outgoing mail, appropriately stamped, may be given to ward staff. There are daily Royal Mail collections from the hospital. There is a post box for outgoing mail near the main reception on the ground floor at Whiston Hospital.

CASH MACHINE There is an automated cash machine near to the main reception on the ground floor.

HEALTH RECORDS If you would like to look at your baby’s Health Records, please speak to a member of your nursing team who will advise you and make any necessary arrangements. If you would like to see your baby’s Health Records after your baby has been discharged from the Unit please write to: Access to Health Records Legal Services Department Whiston Hospital Warrington Road Prescot L35 5DR OR Telephone 0151 430 1549

26

Out of Hours:

Vending service by Steamplicity

The nurse admitting your baby will create a care plan for your baby, which will be evaluated and updated at the end of each shift.

SHOP THE NEONATAL NURSING TEAM There is a shop at Whiston Hospital situated on the ground floor near the main entrance selling:    

Newspapers, magazines, cards, books Drinks, sandwiches, confectionery Flowers, balloons Stamps and other miscellaneous items



The team of Neonatal Nurses working on the Neonatal Unit, either full time or part time, may all care for your baby at some time during your stay



The consultant paediatrician is the clinical lead for the Neonatal Ward



We have two Clinical Nurse Specialists working on the Unit, who take on an advanced specialist nursing role when caring for babies on the neonatal unit; and have received extra training to be able to do this



Our team also has Sisters, Staff Nurses, Enrolled Nurses and Nursery Nurses who work a mixture of shifts to ensure your baby is cared for 24 hours a day, either:

MOBILE PHONES It is strictly forbidden to use mobile phones in ward areas or outpatient department areas. Their frequency can interfere with essential hospital equipment such as heart monitors etc. Please make sure that your mobile phone is switched off before you enter the hospital, and remember to inform other visitors who may come to see your baby.

o o o o

MAIL Mail is delivered to the ward each morning. Please ask your relatives and friends to clearly write your baby’s name and ward on the envelope.

25

Early shifts - 7.00 am – 2.30 pm Late shifts - 1.45 pm – 9.15 pm Nights - 8.45 pm – 7.30 am Some of the nurses work long days which start at 7am and finish at 9.15 pm.

The Clinical Nurse Specialist and Unit Manager more frequently work 8.00 am – 4.00 pm

6

On each shift a named member of staff will be responsible for your baby’s care throughout that shift. Each day on the medical ward round, all the babies in the Neonatal Unit are reviewed, and a plan is devised and documented in your baby’s case notes. This plan is shared with you by your baby’s nurse when you visit or telephone the Unit. You are welcome to stay for your own baby’s review on the ward round. The Lead Nurse/Directorate Manager for the Paediatric Department works Monday – Friday 9.00 am – 5.00 pm and is available on ext 2478 or bleep 0246.

OTHER MEMBERS OF THE NEONATAL TEAM      

Pharmacists Physiotherapists Dietitians Hospital Social Workers Clinical Nurse Specialists for Diabetes, Epilepsy and Respiratory problems Other Health Professionals who may need to be involved with your baby’s care.

If you would like to speak to any of the above team members please ask your baby’s nurse for assistance.

There is a chapel or a prayer room at Whiston Hospital. Please ask staff if you would like to know where it is. Information about the Spiritual Care Team and times of services is displayed on all wards.

CAR PARKING AND PUBLIC TRANSPORT Please speak to a member of staff about car parking. All visitors must park in the multi-storey car park. There is a drop off zone outside the Maternity Unit entrance. Reduced parking fees are available, please speak to one of the SCBU team to see if you are eligible for these. If you receive Income Support, you may be able to reclaim your travel expenses. A Patient Travel Form needs to be completed at the General Office. This is situated on the ground floor just beyond main reception (Tel: 0151 430 1145 / 1646).

RESTAURANT There is a restaurant on the 5th Floor at Whiston Hospital which is available to visitors, patients and staff.

MEDICAL STAFF   

minister or a religious leader of your own faith may be contacted if you wish.

Paediatric Clinical Director Consultant Paediatricians Specialist Registrars – rotate through our unit every 6 to 12 months as part of their consultant training. 7

Spice of Life Restaurant – Opening Times Monday – Friday

8.00 am – 8.00 pm

24

family history which might affect your baby’s general health.

NO SMOKING In line with Government legislation smoking is not permitted in any Trust premises, or within or next to building entrances, exits or window openings. Thank you for your co-operation

FIRE POLICY FOR PATIENTS AND VISITORS All staff are trained in fire and evacuation procedures. In the unlikely event of a fire, nursing staff will take control of the situation and co-ordinate any necessary action. Patients and their visitors are requested to follow instructions given to them by staff in the event of any emergency.

SPIRITUAL, RELIGIOUS AND CULTURAL NEEDS Whilst you are in hospital your spiritual, religious and cultural beliefs will be respected. Staff will do their best to respect your wishes. Members of the Spiritual Care Department are available to visit you and are on call day and night. The Spiritual Care Team are assisted by volunteers, and they are here to care for the spiritual, as well as the religious and cultural needs of all faiths, and no faith. Your own priest,

23

SECURITY Baby Tagging Your baby may have a computerised tagging device attached to their ankle to prevent the unlikely event of a baby abduction. The device will be removed just before your baby is discharged by a member of the nursing staff. If anyone who is not a member of the neonatal staff, tries to remove your baby from the Unit without your permission, the computerised tagging device will sound an alarm at the door of the unit, alerting the staff to the abduction. This baby tagging system is in place throughout the whole of the Maternity Unit and if it goes off, all the external doors close and lock.

VISITING POLICY The unit has a buzzer entry system to ensure the safety of all babies and staff. We request that you always use this system. Please DO NOT follow others into the unit simply because the door is open Let the door close and press the buzzer. We need to keep a close check on who enters the unit. DO NOT let anyone else into the unit as you enter We apologise if it takes some time for the door or phone to be answered, this is because the staff are busy with the babies.

8

  



  





All visitors must wash their hands on entering the ward Parents and siblings are allowed to visit their baby/babies on the Unit at any time Grandparents and other visitors can visit during maternity ward visiting hours, between: 4.30 pm to 5.30 pm 6.30 pm to 7.30 pm In exceptional circumstances other times can be negotiated with the nurse in charge Only three visitors are allowed to each cot at any one time. One of these must be a parent unless written or verbal permission has been obtained from the parent Visitors may be asked to leave during clinical procedures or busy periods Visitors may be asked to leave the Unit if doctors are present doing ward rounds etc. Consideration should be given to sick premature babies in the Neonatal Unit. Parents/visitors must be quiet when visiting Parents/Visitors must not ask questions about, or touch other babies, whilst on the Unit; and must not go into other nurseries Any parent/visitor acting in a threatening, aggressive or inappropriate manner will be asked to leave the Unit

Security staff ensure the safety of patients and staff within the hospital and its grounds. All staff should wear an identity badge. If you do not know who someone is, please ask. The hospital is equipped with closed circuit TV cameras which are monitored from the security control 9

OTHER HOSPITAL FACILITIES INTERPRETER SERVICES If your first language is not English and you need an interpreter to help you speak to doctors and nurses, ask a relative or friend to tell your nurse as soon as possible. (Your GP may already have told us that you need an interpreter.) The nurse in charge of your ward will do their best to make arrangements to provide an interpreter service.

CONSENT TO TREATMENT Your doctor, nurse, or other health professional will explain to you what your baby’s treatment will involve. If your baby’s treatment involves an operation or certain other procedures you will be asked to sign a consent form. If you change your mind later, you are entitled to withdraw consent; even after signing. The important thing to remember is that it is your decision. It is up to you to choose whether or not to consent to what is being proposed. Ask as many questions as you like, and remember to tell the healthcare team about anything that concerns you; or about any

22

Before discharge you will be offered the opportunity to stay with your baby in the parent overnight room, just outside the Neonatal Unit, in preparation for going home the next day.

room. Security staff patrol the hospital, grounds and car parks.

COMMUNICATING WITH FAMILIES NATIONAL VOLUNTARY SUPPORT GROUPS Staff will give you contact details or information leaflets of organisations that may be able to offer support and information to you and your baby.

We fully appreciate that we all have busy, complicated lives, and that sometimes it is not possible to visit your baby as often as you would like. Please do not worry about this. You can always telephone the Unit for an update.

TELEPHONING THE UNIT

LOOKING AFTER YOURSELF All newly delivered mums will receive on-going care from the community midwives. If you have any concerns please do not hesitate to inform a member of staff who will contact a midwife on the postnatal ward on your behalf.

The direct line into the Neonatal Unit is:

0151 430 1511 The Hospital Switchboard number is:

0151 426 1600 Ask for the Neonatal Unit. Our Ward Clerk is on duty Monday – Friday and answers the telephone between 8.00 am – 12.00 noon We always aim to ensure that we only hand out appropriate, confidential information to you during your stay. As a matter of policy we DO NOT hand out information to other family members, except the parents. You should, therefore, advise other family members NOT

21

10

to ring the Unit, but to contact the parents or the named carer. To ensure we only give detailed confidential information to parents, we have a security system in place. When you telephone the Unit to ask about your baby’s progress, you will be asked who your baby’s consultant is. Therefore you should NOT give the consultants name to anyone you do not want information going to. When you tell us the consultant’s name, we will be more reassured that we will be talking to you, the baby’s parents, and can then proceed to give confidential, more detailed information only to you.

THE COMMUNICATION SHEET FOR PARENTS The Clinical Nurse Specialists complete this sheet during the ward round on the Neonatal Unit every day in order to pass on all relevant information to you, if you are not at the ward round. You can use this sheet to ask questions, and arrange a suitable time for you to discuss these with your baby’s consultant.

THE PARENT SHEET This is a page in your baby’s care plan that is at the end of your baby’s cot. You can use this as a diary of your baby’s progress, or to inform staff of the names of visitors that you will allow to visit your baby even if you are not present.

11

in this process, and all necessary arrangements will be made with you. Any support and education that you need before discharge will all have taken place before the expected date of discharge. Before discharge, the nursing staff will contact either your community midwife or your health visitor, (depending on the age of your baby), to inform them of your discharge. You will be given a leaflet to give you further information on preparing for your baby’s discharge from hospital. There is a discharge check list within your baby’s care plan which will be completed before the day of discharge. A discharge letter will be sent to your General Practitioner (GP) and Health Visitor informing them of the reasons for your baby’s admission to special care. It also includes information about any medication your baby is taking at the time of discharge, and any other information which may be relevant for the care of your baby in the community. If your baby needs re-admitting to hospital for any reason, they would be admitted to the Children’s Ward, and NOT to the Neonatal Unit. This is because once a baby has been discharged home, or out into the community, there is a greater chance of that baby bringing an infection into the Unit, which may have the potential to spread to other babies in the Unit. There are appropriate isolation cubicles on the children’s wards for such babies and also community nursing support through the children’s Hospital at Home Team.

20

Each of our nurses carries an alcohol hand rub gel which they will use in between seeing each baby, if they do not have time to wash their hands at the sink. Please be reassured that they will wash their hands if they become contaminated in any way. We ask that all parents and visitors to the Unit …… use the alcohol gel situated outside the main entrance to the Unit, and also wash their hands every time before touching their baby. If you see anyone approaching your baby without washing their hands ……..please feel free to gently remind them to wash their hands or to use the alcohol gel before touching your baby. Our domestic staff clean the Unit every morning, and empty the bins in the evening. If a baby has an infection they will be nursed in an incubator, and possibly in a room on their own if available. This is an effective barrier method of nursing babies with infection, and preventing the spread to other babies in the Unit. Not all babies nursed in incubators have infections.

PARENTS’ NOTICE BOARD In the waiting room of the Neonatal Unit there are notice boards that contain lots of useful information for families. Please feel free to look at these notice boards at your leisure.

CONSULTANT UPDATE If you wish to see your Consultant or another member of the team at a time other than the ward round, please speak to the nurse in charge, who will arrange a convenient time for both you and the consultant.

SHARING INFORMATION We will share information about your baby with others who may need to become involved in the care of your baby; either whilst on the Neonatal Unit or when your baby goes home. This may be with health professionals in the hospital and professionals from other agencies, such as Health Visitors.

YOUR BABY’S INDIVIDUAL CARE PLAN These are located at your baby’s cot side and we encourage parents to read them on a daily basis.

DISCHARGE PLANNING Planning your baby’s discharge from the Neonatal Unit begins shortly after admission. You will be fully involved 19

12

HIGH STANDARDS OF NEONATAL NURSING CARE

EQUIPMENT ON THE UNIT The nurses will explain to you what each item of equipment around your baby’s cot is, and what it does. Please do not be afraid to ask any questions

Our Neonatal Unit is part of a Regional Neonatal Managed Clinical Network, which all Neonatal Units and Neonatal Intensive Care Units in Merseyside and Cheshire attend. It is this network group that meets quarterly and has different subgroups that look at: 

Audit



Training and education



Monitoring standards



Parent information



Benchmarking standards (i.e measuring them against different units), to ensure that all babies throughout the region have the same standard of care wherever they attend.

We work very closely with our colleagues at Liverpool Women’s Hospital and Alder Hey Children’s Hospital where most of our babies would be transferred to if they need a prolonged period of help with their breathing.

13

The most common items of equipment in the Unit are:  Incubators  Infusion pumps  Syringe pumps  Saturation monitors If you would like to know more about these particular items of equipment please ask the nurse responsible for your baby.

ALARMS The alarms on certain items of equipment are set appropriately for each baby on the Unit and may go off intermittently. The nurses and doctors will be aware of this and may not always respond to intermittent alarms, but they will respond to continuous alarms.

INFECTION CONTROL You may have heard about infection rates in hospitals. On the Neonatal Unit we do everything to ensure that our infection rates are the lowest throughout our Hospital; and remain the lowest in the North West.

18

he/she will be referred to our Consultant Ophthalmologist, who will monitor your baby’s eyes every month. The neonatal nursing staff will inform you of your appointment date. More information is available in the BLISS booklet on Retinopathy of Prematurity. ii.

Audiology Screening Before screening, the audiology team will explain the procedure and ask for your consent to proceed. You will be informed of the findings immediately and a written report will be given to you to keep in your baby’s Developmental Record (red book).

iii. Babies Requiring Surgery If your baby needs a surgical procedure, your baby will be referred to the most appropriate consultant surgeon at the Royal Liverpool Children’s Hospital, Alder Hey. Often your baby will be transferred back to us following any surgery, for us to continue with their care. If your baby is transferred from our unit to another unit in the hospital, either for more intensive support for their breathing, or for a surgical procedure, we will always welcome your baby back once they are well enough.

17

INFORMATION Shortly after your admission to the Neonatal Unit you will receive an information booklet from BLISS, the premature baby charity. This parent information guide contains lots of information and support for the families of sick and premature babies. The information below supplements what is already available in the BLISS Parent Information Guide.

BREAST FEEDING Breast is Best!! We actively encourage breast feeding. Even if you choose not to breast feed, we would encourage you to express breast milk that can then be given to your baby using another method. A leaflet on breast feeding will be given to you shortly after your admission to the Neonatal Unit. There is a Breast Feeding Co-ordinator in the Maternity Unit, who can be contacted through the ward staff if you would like to discuss anything about breast feeding. All the staff are able to support you with breast feeding at any time.

If you would like to speak to the Breast Feeding Co-ordinator, please call: 0151 430 4166

14

PREMATURE INFANTS This section is only for families whose baby has been admitted to the Neonatal Unit because they have been born earlier than expected, ie prematurely. If your baby is born prematurely their lungs are immature and they may have breathing difficulties. There is no way of predicting the severity of the breathing problems according to how early the baby is born, as it differs in all babies. We are able to support your baby’s breathing in different ways. For the more severe cases we would intubate (pass a tube into your baby’s lungs through their mouth), and ventilate (attach a ventilator/breathing machine that will take over the work of breathing for your baby) until such a time as they are able to breath on their own. If your baby requires this type of support with their breathing for a long period of time, they will be transferred to a Regional Neonatal Intensive Care Unit at either Liverpool Women’s Hospital or another neonatal intensive care unit in the Region, or Manchester. Initially feeding will be by either a nasogastric or orogastric tube. This is a tube which is passed down your baby’s nose or mouth, into their stomach and milk is given by a syringe. Premature babies require the least amount of handling to ensure that they are able to grow and rest.

15

Please remember gentle soothing contact such as hand holding or stroking is always actively encouraged Your baby, if premature or sick, will have his/her head scanned using an ultrasound scanner. The doctors will discuss the findings with you after this procedure has taken place. Should your baby wet their nappy this will often be left until the baby’s care is due, i.e when your baby is washed, receives mouth care, eye care, has their position changed and has their nappy changed. Please do not be upset by this as a wet nappy won’t necessarily upset a baby. If your baby has opened their bowels they may have their care and nappy change earlier as having a soiled nappy may affect the baby by making them uncomfortable, which may upset them. If they are settled they are best left undisturbed. The immaturity of the systems of premature babies (heart, breathing etc), means they may have episodes where their heart slows down fleetingly (bradycardia), and their saturations falls (the oxygen percentage within their blood). These episodes are known as ‘fleeting bradycardias’ and ‘desaturations’. The alarms on your baby will detect these episodes, which is why your baby is monitored. These episodes may happen intermittently and require no intervention. Should the alarms sound continuously then the staff will intervene appropriately. i.

Ophthalmology Clinic If your baby was born before 32 weeks gestation, or weighed under 1.5 kg at birth, 16