Themes of the Month
1 Paediatric clerking - Doctors and practitioners, please ensure that you complete the boxes including family and anyone else who lives at home with the patient e.g. Parents partner (the home family-tree). You must also record the details of the accompanying person and who has parental responsibility. This is all essential safety and safeguarding information.
2 Statements of fitness for work - Doctors and practitioners, if you anticipate that patients are potentially unable to work or there needs to be alterations for them, complete a fit note accordingly. Patients can self-certify sickness for one week, but we can help them if the period of altered work capability (or incapability) is longer e.g with a fracture or severe sprain. It is not appropriate for them to be making a further appointment with their GP to merely get an extension of leave when we could have provided it. If you are unsure Dr Wallman is happy to offer general advice around completing the document.
3 Insulin - Very important, following a recent incident in the trust. When prescribing insulin the quantity in figures must be clear. Do not abbreviate the word units as the letter U this can be mistaken for a zero and hence multiplying the prescribed dose by 10. Nursing staff are not to administer any prescribed insulin that is not clear and legible – if you can’t read it, do not give it. This is regardless of the grade of doctor prescribing and is not negotiable. Insulin administration in the emergency department is a well-recognised, documented and evidenced area of potential clinical risk.
4 Paediatric pathway to NMGH paeds A&E - Please familiarise yourselves with the laminated copy of this on the walls in the resuscitation room (Resus cubicle 5). It is a very useful reminder of when and which unwell children you may just need to make immediate arrangements to transfer out of the FGH A&E to a safe environment with a range of paediatric capability around the clock (Paeds EM and nursing, paeds anaesthesia etc.). Doctors don’t hesitate to stop and send. Nurses don’t hesitate to ask the question of the doctors – do we need to send this child NOW? Document clearly your decisions and whom / when (first name and surname preferably) you have handed over to at NMGH A&E.
5 Paediatric injuries - All children under the age of one year attending the Emergency Department, with an injury (including head injury, burns, bruising, bleeding or fracture) and all children who cannot walk independently who are diagnosed with a fracture, must be referred to the Paediatric Registrar (ST4 or above) on call for paediatrics who will see the child and then discuss with the Consultant Paediatrician on-call prior to discharge.
In departments such as the walk in centre or urgent care centre, where there are no paediatricians on site, all cases of children under the age of 1 year with an injury (including head injury, burns, bruising, bleeding or fracture) or the child cannot walk independently and presents with any fracture, or any child where there are child protection concerns, must be subject of a discussion between the doctor/ENP and the on-call paediatric middle grade or consultant at the most appropriate hospital base. This discussion must take place prior to discharge.