Caring for children receiving home intravenous antibiotic therapy

1

The development of a community nursing service
for children with an acute illness. Carolanne
Getty Community Childrens Nursing Sister
2

• Aim
• To describe the development of an acute CCN
  service.

3
Objectives

• To understand the journey of service development
  for an acute CCN team in Northern Ireland.
• To appreciate benefits of such a service to
  acutely ill children and their families.
• To consider the dimensions of care the CCN can
  bring to children who are acutely ill.

4
Structure of Presentation

• Evidence supporting acute CCN service development
• Setting up the acute CCN Service in Homefirst
• Dimensions of care CCN can bring.

5
GEOGRAPHICAL AREA

• Population 330,000
• Area 1,200 square miles
• Mixed urban and rural
• Largest community trust in Northern Ireland
• Divided into 3 sectors
• Antrim/ Ballymena
• East Antrim
• Magherafelt/ Cookstown

6

• Childrens Community Teams including Community
  Childrens Nursing Services need to provide
  appropriate support to children, young people and
  their families which responds to local needs and
  takes account of the need to prevent hospital
  admission, facilitate early discharge, and care
  for children with complex needs
• NSF (2004) standard 6 13.2

7
Evidence Supporting Service Development

• World Health Organisation (1978) Health for all
  by the year 2000.
• United Nations Convention (1989) Un Convention on
  the rights of the child.
• House of Commons Select Committee (1997) Health
  Services for Children and Young People in the
  Community Home and School. Third Report.
• RCN (2003) Community Childrens Nursing
  effective team working.
• Department of Health, Social Services and
  Personal Safety (1999) Nursing services for the
  acutely ill child in Northern Ireland.
• Department of Health, Social Services and
  Personal Safety (2004) A healthier Future a 20
  year strategy
• Department of Health (2004) The National Service
  Framework for Children

8
Model for components of care CCN services can be
expected to deliver. (Adapted from DH, 2002 RCN,
2002)
First Contact Acute assessment, diagnosis,
treatment and referral of children
9
Composition of Homefirst Community
Childrens Nursing Service
Community Childrens Nurses Continuing care
team Trust wide
Regional Childrens Palliative Care
Nurse Northern Board
Acute Community Childrens Nursing
Team Antrim/Ballymena
Childrens Diabetes Nursing Service Trust wide
10
MULTI-PROFESSIONAL STEERING GROUP

• ROLE OF STEERING GROUP
• Advise on setting up of the service
• Devise operational guidelines
• Report to the Inter-Trust
• Child Health Forum
• Produce and disseminate
• information / consult with all relevant groups

11
Questionnaire of potential service
users
12

• Team recruited
• 1 G grade with childrens qualification and
  Health Visiting community experience (1 WTE)
• 3 E grade Staff Nurses with hospital based
  experience (2 WTE)
• Model of CCN service delivery
• Community based generalist team

13
Stages of Service Development

• 1. Preliminary/ preparation stage
• 2. Implementation stage
• 3. Evaluation of service role

14
Preliminary stage

• Develop aims and objectives
• Develop operational policy
• Develop evidenced based policies and procedures
• Develop documentation
• Logistical issues

15
Implementation Stage

• Establishing links in hospital and community
• Raising awareness
• Identifying staff training needs
• Staff development

16
Evaluation

• This is an excellent service. It was offered
  at the right time in the hospital and gave us
  confidence to bring our son home where he made a
  quicker recovery but with the appropriate care
  and support. It should be available more widely
  and publicized as a model of good practice.

17
Challenges

• Not 24 hour slow rate
  of service referrals
• Role Protectionism Staffing
  levels

18
Dimensions of care

• Formal knowledge and skills
• Coordinating knowledge and skills
• Skills for managing workload
• Relational, interpersonal and support skills
• Teaching skills
• Thinking skills
• Proctor et al. 1998

19
SERVICE DEVELOPMENT

• Amalgamation of Continuing Care and acute CCN
  service.
• Senior Nurse Practitioner
• Rolling out of acute CCN service and nurse bank
  to other sectors
• Expanding teams to provide a skill mix
• Staff development

20

• A thousand mile journey starts with a single
  step
• Lao-tsu, 604 - 531 BC

21
References

• Callery, P. (1997) Paying to participate
  financial, social and personal costs to parents
  involvement in their childrens care in hospital.
  Journal of Advanced Nursing. 25 746-752
• Casey, A., Gibson, F., Hooker, L. (2001) Role
  development in childrens nursing dimensions,
  terminologyand practice framework. Paediatric
  Nursing. 13(2)36-40
• Department of Health (2002) Liberating the
  talents, helping primary care trusts and nurses
  to deliver the NHS plan. London The Stationary
  Office
• Department of Health (2004) The national service
  framework for children, young people and
  maternity services. London DH www.publications.do
  h.gov.uk/nsf/children
• Department of Health and Social Services (1999)
  Nursing services for the acutely ill child in
  Northern Ireland. Report of a working group.
  Belfast The Stationary Office.
• Eaton, N. (2000) Community Childrens Nursing
  services models of care delivery. A review of
  the United Kingdom literature. Journal of
  Advanced Nursing. 32(1)49-56
• Euwas, P., Chick, N. (1999) On caring and being
  cared for. In Madjar, I., Walton, J.A. (eds.)
  Nursing and the experience of illness. London
  Routledge (pp170-188)

22
References

• House of Commons Select Committee (1997) Health
  Services for children and young people in the
  community home and school. 3rd report. London
  The Stationary Office
• Johnston, P. (2004) Community Paediatric Nursing
  Service Ballymena/Antrim Review of Service.
  Unpublished
• Neill, S. (2005) Caring for the acutely ill child
  at home. In Sidey, A., Widdas, D. (eds.)
  Textbook of Community Childrens Nursing (2nd
  Ed.).Edinburgh Elsevier.
• Poulton, B. (1999) User involvement in
  identifying health needs and shaping and
  evaluating services is it being realised?
  Journal of Advanced Nursing. 30(6) 1289-1296
• Procter, S., Campbell, S., Biott, C., Edward, S.,
  Moran, M., Redpath, N. (1998) Preparation for the
  developing role of the community childrens
  nurse. Research highlights. London English
  National Board for Nursing, Midwifery and Health
  Visiting
• Royal College of Nursing (2002) Childrens
  community nursing information for primary care
  organisations, strategic health authorities and
  all professionals working with children in
  community settings. London RCN (publication code
  001 959)
• Secretary of State for Health (1999) Saving
  lives Our healthier nation. London The
  Stationary Office

23
References

• Slevin, O. (2003) Nursing models and theories
  major contributions. In Basford,L., Slevin,O.
  (eds.) Theory and practice of nursing an
  integrated approach to caring practice. (2nd ed.)
  (pp255-280) Cheltenham Nelson Thornes
• Smith, F. (1995) Childrens nursing in practice
  the Nottingham model. Oxford Blackwell Science
  Ltd
• United Nations Convention (1989) Un Convention on
  the rights of the child.
• Volprecht, A. Flannagan, N. Livingstone, A.
  (2001) What parents think about an acute
  community paediatric nursing service. unpublished
  report
• While, A.E., Dyson, L.(2000) Characteristics of
  paediatric home care provision the two dominant
  models in England. Child Care Health Development.
  26(4)263-275
• Whiting, M. (2005) Needs analysis and profiling
  in community childrens nursing. In Widdas, D.
  Sidey, A. (eds) Textbook of community childrens
  nursing (2nd ed.). (pp180-194) London
  Bailliere Tindall / RCN
• World Health Organisation (1978) Health for all
  by the year 2000.

24
Caring for children receiving home intravenous
antibiotic therapy

• Dianne Cook - Childrens Community Specialist
  Practitioner
• Central Manchester Primary Care Trust
• Elaine Salmons Childrens Community Team Leader
• Queens Medical Centre, Nottingham

25
AIMTo have an increased awareness of
administering IV antibiotic therapy in the
community

• OBJECTIVES
• To discuss advantages of IVs in the community
• To explore issues relating to administration
• To have a basic awareness and understanding of
  anaphylaxis

26

• The administration of IV drugs by Community
  nurses has become more widespread in recent
  years. The practice, having initially been
  classed as an extended role of practice has now
  become part of the core skills for general
  nursing practice. This therefore allows an
  holistic approach to care.

27
Advantages of IVs at home

• Reduction and prevention of hospital admissions
• Reduced length of stay
• Increased independence from hospital
• Less disruption to family routine
• Continued schooling
• Reduced risk of cross infection
• Reduction of winter bed pressures
• Cost effectiveness
• Payment by results
• Autonomy and empowerment

28
Range of Access routes

• Peripheral Lines Cannula, Longlines
• Central Venous Routes - Hickman Lines
• Subcutaneous Implantable Venous access
  devices Portacaths

29

• The administration of medicines is an
  important aspect of the professional practice of
  persons whose names are on the Councils
  register. It is not solely a mechanistic task to
  be performed in strict compliance with the
  written prescription of a medical practitioner.
  It requires thought and the exercise of
  professional judgement..
• Guidelines for the administration of medicines
• NMC 2004

30

• Children are not miniature adults as they have
  different pharmacokinetic profiles, which require
  specialist knowledge, awareness and expertise

31

• The safe administration to children is a key area
  of responsibility for practitioners in child
  care, and warrants extra vigilance in order to
  safeguard each childs safety

32

• Clinical responsibility for a child receiving IV
  therapy at home lies with the GP. If a GP is
  unwilling to accept responsibility, the
  Consultant will normally continue this role

33

• It is the nurse who is responsible for the
  correct administration of the prescribed drugs.
  Therefore, they should know the therapeutic uses,
  dosage, side effects, precautions and
  contra-indications
• (Guidelines for the administration of medicines
  2004)

34

• The NMC welcomes and supports the
  self-administration of medication by carers
  wherever it is appropriate.
• (Guidelines for the safe administration of
  medicines, NMC 2004)

35

• If responsibility is delegated then we need
  to ensure that the patient, family or carer is
  competent to carry out the task
• Education
• Training
• Assessment
• Support
• Reviewed and reassessed periodically

36

• Check that the patient is not allergic to the
  medicine before administering it
• NMC 2004
• but

37

• An allergic reaction does not usually occur the
  first time a person is exposed to a drugIt is
  only after the body learns to recognise the
  substance that an immune system reaction is
  triggered

38

• It therefore, is essential, that more diligence
  be taken throughout the second and subsequent
  administration of drugs given via the IV route,
  especially as these are often administered in the
  community

39

• Drug allergies occur as a result of a variety of
  complex immune system responses to specific
  medications.

40

• In most cases, the reaction involves relatively
  mild symptoms, e.g. minor skin rashes and hives,
  itching, generalised flushing of the skin

41

• However, in some cases a life threatening, acute
  reaction can occur progressing quickly to more
  severe symptoms, massive swelling of the
  respiratory tract, constriction of bronchial
  smooth muscle and extreme vasodilation

42

• Anaphylaxis is a severe allergic reaction, the
  extreme end of the allergic spectrum. No
  universally accepted definition exists because
  anaphylaxis comprises of a constellation of
  features (Ewan 1998)
• (Anaphylaxis, BMJ, 316,
  1442-1445)

43

• Anaphylaxis occurs in an acute and unexpected
  manner. The true incidence is unknown.
  Epidemiological studies have shown differing
  results owing to differences in both definitions
  of anaphylaxis and the population groups studied.

44

• Anaphylaxis seems to be increasingly common,
  almost certainly associated with a significant
  increase in the prevalence of allergic disease
  over the last two or three decades

45

• Adrenaline (Epinephrine) is the first line
  treatment for anaphylactic reactions.

46

• Early intramuscular administration of adrenaline
  is essential for optimal action

47

• Adrenaline (Epinephrine) is greatly under-used
• Although widely available in the community, it is
  not given in a timely manner when required
• (Resuscitation Council UK 2005
• The Emergency Medical Treatment of Anaphylactic
  Reactions for First Medical Responders and for
  Community Nurses)

48

• Anaphylaxis is poorly managed

49

• Treatment Algorithm for Children in the Community
• Resuscitation Council (UK) 2006
• (www.resus.org.uk/siteindx.htm)

50
(No Transcript)
51

• Although anaphylactic reactions are rare, they
  cannot be predicted and have the potential to be
  fatal without treatment
• (Martin
  2000)
• (Immunisation, Nursing Standard, 14, 30, 47-52)

52

• Ideally therefore, no one should give IV
  treatment without access to adrenaline and
  assistance
• Discuss with management
• Discuss within own Trust