Service Overview
Women's Health:
More than 3800 births per year
Cesarean Rate 28%
More than 250 births per year under 37 weeks
Special Care Nursery:
Level 5 nursery
16 funded beds - flex up to 24 beds
4 High Dependency beds
Newborn / Antenatal Up-Transfer Threshold:
GA 31 weeks, Birth Weight 1500 grams
Infants born at LMH below these thresholds will be transferred to WCH for initial care
Newborn Admission Threshold:
GA less than 36 weeks, OR Birth Weight less than 2300 grams
Are to be admitted to SCN unless otherwise discussed with the Neonatologists or Paediatrician
(About 15% of newborns 2200 - 2300g will avoid admission)
Down Transfer Criteria:
CGA ≥ 31 weeks
Current weight ≥ 1350 grams
Full enteral feeds
Resp support no greater than High Flow 25%
Resuscitation Training
NLS / NALS course:
We run regular NLS and NALS sessions.
Please book into NLS or NALS courses via your iLearn account
NLS & NALS course schedule
Neonatal Shifts
Special Care Day Shift
Hours: 08:00 - 16:30
Tasks:
Handover in Special Care Nursery at 08:00
Followed by SCN Ward Round
Wednesday Ward Round is led by the Registrar
Reg and RMO share clinical duties in nursery. Infants examined at least twice per week (once each by Reg and RMO) with exam results documented.
Plot growth charts every Monday
Brief consultant afternoon round usually about 15:30 - 16:00
20:30 Handover to Night Registrar. Highlight possible discharges for next day.
Special Care Night Shift
Hours: 20:30 - 08:30
Tasks:
Handover from Registrar in SCN
Review unwell infants in nursery
The registrar is expected to take an active role in reviewing infants admitted in the last few days: Common issues to consider include:
- Identify infants with significant jaundice
- Review blood cultures / antibiotics
- Advance enteral feeds and reduce iv fluids
Attend cesareans and resuscitations on Birthing Unit
Update EMR handover and any pending discharges
In the morning present new admissions to the Handover Round
Finish at 08:30
Post-natal RMO
Hours: 08:00 - 16:30
Tasks:
Handover in Special Care Nursery at 08:00
Attend to newborn checks / reviews in birthing unit first
Check list of discharge checks and reviews on Women's Health Ward
Do checks for imminent discharges first to help with patient flow
Get help from Resus Reg if busy
Consult with Resus Registrar for any queries
Resus Registrar Shift
Hours: 08:00 - 21:00
Pager: 47392
Tasks:
Handover in Special Care Nursery at 08:00
Get the Resus pager from the night registrar
Notify Co-ordinator & Neonatologist on SCN re anticipated admissions
Attend relevant cesareans and newborn resuscitations
Help with postnatal ward and birthing unit discharge checks when possible
Neonatal Teaching / Meetings
Paediatric Journal Club
Monday 12:30 - 13:30 (alternate weeks)
Dr Sthavan will notify you of your turn to present.
Topics alternate beween Paeds and Neonatal
Discuss with one of the neonatologists if you need help with article selection
Or look at Keith Barrington's Neonatal Research blog if you want inspiration
Neonatal MDT Meeting
Wednesday 13:00 - 14:00 in Tutorial Room
On first Wednesday of the month the SCN Day Shift Registrar will be presenting
Week 2: Nursing presentation
Week 3: Safety & Quality presentation
Week 4: Consultant presentation
Paediatric Department Meetings
Friday 13:00 - 14:00 in Tutorial Room
Paediatric Radiology Meeting
Friday 14:00 - 14:30 (alternate weeks)
The Paediatric Senior Reg will arrange the list of cases
Discharge Summaries
Use the "Discharge Summary, Medical" document template rather than the "Neonatal Discharge Summary" for creating discharge summary for infants discharged from the Special Care Nursery.
Our goal is to complete all discharge summaries on the day of discharge
All Registrars and RMOs on all shifts can assist with updating and completing discharge summaries
Registrar Clinics
Schedule
Tuesday morning from about 10:00 (with Dr Varghese)
Thursday morning from about 10:00 (with Dr Hewson)
Details
Held in Family Clinic
SCN Day Registrar attends
Or Resus Registrar if no reg in SCN
Discuss any queries with the neonatologist in clinic
Discuss follow up requirements with neonatologist
Or if clinic neonatologist is on leave, the on-service neonatologist is available to provide supervision
Please send copy of clinic letter to parents if possible
Virtual Clinics
Background
A daily clinic for follow-up of investgations such as hip ultrasounds, renal scans or blood results
Where the physical attendance of the infant / family is not required
Process
Infants are booked in using the booking form available in SCN and on Women's Health
You will also need to book or arrange the required ultrasound or blood test
The SCN ward clerk will chase up the timing of the scan and then schedule the Virtual Clinic appointment for the day after the scan (to allow time for reporting).
The SCN ward clerk will print a copy of the Virtual Clinic list every day, and place it in the red tray in the SCN Clinical Handover Room
The SCN Reg/RMO must review the Virtual Clinic appointment list each day (Monday - Friday) and chase up the relevant investigation, and plan further management
Telephone the parent and discuss results and any further follow up
Discuss any concerns or uncertainties with the on-service Neonatologist
Document your plan in the EMR using a Neonatal Clinic Note
After-hour Codes & Consultants
Code Cat One
The on-call Consultant for Neonates will be called (by switch) for EVERY Cat One Section
Please let the consultant know if delivery occurs before their arrival and attendance is no longer required
Code Blue Newborn
Neonatal Consultant is NOT called to Code Blue Newborn
You will need to specifically call the consultant in if required
Tips, Tricks & How-to videos
Sending x-ray images
When you need to send an xray image to the consultant off-site:
Don't just take a photo of the screen with your phone - the image quality will be poor
Instead, copy the image from the computer:
- Click in Carestream window
- CTRL / Alt / PrintScreen together
- Open a new email
- Paste the image (from 2)
- Send email to recipient
- Or to your phone then SMS onward
Hospital Paging System
To page someone:
Dial #89
Enter the pager number then * key
Hang up and wait
Airway with i-Gel LMA
Needle Thoracentesis
Safe-T-Centesis chest drain
Answer a page on your mobile
Rather than going through switch you can call the extension directly:
Extension |
You dial |
20xxx |
08 828 20xxx |
21xxx |
08 828 21xxx |
29xxx |
08 818 29xxx |
83xxx |
08 813 83xxx |
35xxx |
08 839 35xxx |