Back to the Floor – Neonatal Intensive Care
I go back to the floor twice a month to find out what it’s like for our patients to be treated here, what it’s like for our staff to work here and to see if there is anything I can do to make it better place for both patients and staff. Our hospitals are enormous places and not all of our staff knows what happens in different departments so part of my blog is also aimed at making it a bit easier to understand for our staff, our governors, our volunteers and anyone else who reads it! I hope my blog gives you a tiny flavour of the fabulousness that I see!
Our Neonatal Intensive Care (NICU) is one of two NICU’s in the Lancashire and South Cumbria Neonatal Network offering a 24/7 service. It currently has a total of 28 cots open (7 intensive, 6 high dependency and 15 special care). The NNU at LTH provides all required medical intensive care and high dependency therapies for babies from across Lancashire including:
- Conventional and High frequency Ventilation
- Non-invasive breathing support ( CPAP, Bi-Phasic Positive airway pressure) and humidified high flow oxygen
- Medical support for circulation problems
- Access to Cardiology expertise for diagnosing Congenital heart disease
There are 6 Neonatologists supported by 70 nursing staff across bands 5-7. They have seen a real increase in activity across intensive (4.75% )and high dependency care (29.8%) over the last three years.
Working in intensive care can mean that even with the best care sometimes tragedy is inevitable. However, it is inspirational to me how even in the most tragic of circumstances bereaved families have been doing tremendous work in fundraising for NNU and recently the unit has purchased an additional ventilator with the funds raised.
The Unit also provides advanced technologies such as inhaled Nitric oxide therapy - this medical gas improves oxygen levels in the blood in babies with severe lung problems or circulation problems - and therapeutic cooling which has been shown to reduce death and severe brain damage in babies experiencing disruption to oxygen levels to the brain around the time of birth.
Our Neonatal Service works closely with maternity services providing care to babies on the post-natal ward, keeping babies with their mums whenever possible. We also have a neonatal outreach nursing service facilitated from the unit and the team provides support to at risk babies on maternity wards, referrals from community midwives and those discharged from LTH and outlying hospitals. There is a dedicated family liaison worker, helping to co-ordinate transition to paediatrics for babies with complex needs and a dedicated 0-2 year Speech and Language Therapist for feeding and swallowing problems. All these services provide the best quality of care to our patients and their parents and this requires collaborative teamwork from LTH Children’s OPD, Children’s Community nursing teams, Neonatologists and Pharmacy.
The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The staff on the unit are proud of achieving two neonatal CQUINS in 2014 (improved access to breast milk in preterm infants and timely administration of total parenteral nutrition of preterm infants) as well as being on track to achieve a third this year around delivery of retinal screening for premature babies. Achievement of these CQUIN’s awards demonstrates the commitment of staff to deliver high quality care.
Without question every member of staff I met during my back to the floor was so committed to the care of these tiny babies, some were so small they could fit in the palm of your hand. These little ones tended to be looked after by 1:1 care in the intensive care area. The rooms were kept very quiet to prevent startling the baby and their cots tended to be shielded from any bright lights creating an ambience of peace and quiet. The nurses shared some of the stories of why these babies had been born too soon and I could only imagine how difficult it was for the parents. Some of the babies had been in hospital for many weeks and indeed months while they tried to catch up with their own development and growth in order to leave hospital sometime in the future. Sadly, some of these babies don’t make it home.
I was asked to help Sister Karlina Gorst looking after the older babies who still looked terrifyingly small to me and I was given the very pleasurable role of bathing, feeding and generally in charge of cuddling! And can I say how much this catapulted me back to the days when my own children were babies – except mine were NEVER that small (my youngest weighed in at 10lb 13oz!) The little ones I was looking after had tubes and wires and alarms attached to various parts of their bodies so getting them dressed and undressed was not as simple as I thought it would be. After 20 minutes of trying to get a vest off without setting the alarm off I finally mastered it before taking a further 15 minutes to put on a nappy and a baby grow. I can only imagine what a huge help I was to the nurses that day!! I had the grand total of two babies to look after whilst Karlina was looking after many more. As soon as she had finished feeding, washing, changing, medicating, and doing observations then it was time to start all over again. On top of that she was also dealing with babies being brought up from the maternity unit to have special medications, the phone never stopped ringing and either parents or me were asking her questions. She took it all in her stride in fact the only thing to faze her was when I asked her for a picture for the blog!
The team have made a great start in developing a sensory room but it needs so much more than the equipment they have at the current time. We also talked about how we could provide better i
nformation for parents using more up to date technology like iPads – parents can spend extraordinarily long hours on the unit either alone or with the baby’s siblings and there is precious little for them to do while the baby is sleeping. It was saddening to learn that the unit staff have done similar things in the past but regrettably iPads and equipment have ‘gone missing’. The parents’ sitting room has a pretty unsightly view so they are going to look at how it can be improved. One of our adult wards had a similar problem and they installed a stained
glass window with a scene on it – dramatic and immediate improvement! I’m really pleased to say that Facilities has followed up some suggestions with the Unit and I’m hopeful that we will be able to improve parents and relatives facilities and also provide some security for equipment.
There are so many apps that new parents can now access on line its rather bewildering! There was nothing like this when I was expecting my children but now you can create a ‘buddy’ which is an app that uses avatars and they are superbly interactive. As well as sending regular messages with timely reminders, daily alerts and engaging video clips, they also help to set goals, manage health appointments and find local groups and services via a map. Isn’t that fabulous? My first question 20 years ago would have been ‘what on earth is an avatar!’ That’s probably no surprise because 20 years ago I didn’t even have a mobile phone let alone a smart phone!
On the day I visited 5 members of staff had come in specially to learn how to teach parents of babies due for discharge how to resuscitate but unfortunately it was cancelled. Some of them were on annual leave but instead of going home just got changed and got stuck in. It’s what they do! The unit decided they had the capability to do this themselves through cascade training on the unit and Katie Noble, Neonatal Facilitator has subsequently advised me that this is now in place. Excellent news!
I always get such a lot out of my visits; they’re definitely my favourite part of the working week. I never cease to be amazed by the resilience, dedication and passion of our staff. I never cease to be proud of how they support each other in times of distress. Our Neonatal Intensive Care Unit should be rightly proud of their outcomes and achievements. I know we are.
Thank you for letting me be ‘chief cuddler’ for the shift!