the tanner report 42 recommendations skills, training &maintaining competence ambulance...
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The Tanner ReportThe Tanner Report
42 recommendations Skills, training &maintaining competence Ambulance service Resuscitation Stabilisation HDU Care Planning Governance Surgery in children Support for the family
42 recommendations Skills, training &maintaining competence Ambulance service Resuscitation Stabilisation HDU Care Planning Governance Surgery in children Support for the family
The Tanner ReportImplementing the recommendations in
Scotland(Are we ahead of the
game?)
The Tanner ReportImplementing the recommendations in
Scotland(Are we ahead of the
game?)Neil S. Morton RHSC Glasgow
(with thanks to Maria Rollin)
Neil S. Morton RHSC Glasgow
(with thanks to Maria Rollin)
RecommendationsRecommendations
• Competencies not professional labels
• Team working
• Networks of care
• From initial presentation to PICU and beyond!!
• Competencies not professional labels
• Team working
• Networks of care
• From initial presentation to PICU and beyond!!
Generic skillsGeneric skills
1. To recognise the ill child
1. To recognise the ill child
Spotting the Sick Child. Spotting the Sick Child. Ffion Ffion Davies Davies DH Sept 2004DH Sept 2004 http://www.ocbmedia.com
Skills, Training and Maintaining CompetenceSkills, Training and Maintaining Competence
1. Generic skills
2. To initiate appropriate immediate treatment
3. To act within a team
4. To maintain and enhance skills
5. To be aware of issues of safeguarding children
6. Effective communication with children and carers.
1. Generic skills
2. To initiate appropriate immediate treatment
3. To act within a team
4. To maintain and enhance skills
5. To be aware of issues of safeguarding children
6. Effective communication with children and carers.
Skills, Training and Maintaining CompetenceSkills, Training and Maintaining Competence
• Opportunities to maintain skills
• In-service training and scenarios
• Forward planning of resuscitation and stabilisation teams
• Intensivists with PICU experience
• Opportunities to maintain skills
• In-service training and scenarios
• Forward planning of resuscitation and stabilisation teams
• Intensivists with PICU experience
Skills, Training and Maintaining CompetenceSkills, Training and Maintaining Competence
Where an anaesthetist is, through unexpected circumstances such as a very ill child inappropriately presenting to a hospital without paediatric expertise, required to act beyond his or her practised competencies it is his duty to make the care of the patient his first concern and his employing trust’s duty to support him’.
Recommendation 7 (iv).
Tanner report
Where an anaesthetist is, through unexpected circumstances such as a very ill child inappropriately presenting to a hospital without paediatric expertise, required to act beyond his or her practised competencies it is his duty to make the care of the patient his first concern and his employing trust’s duty to support him’.
Recommendation 7 (iv).
Tanner report
Ambulance ServiceAmbulance Service
• Transfer plans • Retrieval service• Drive-by policies?• Paediatric training and expertise?
• Transfer plans • Retrieval service• Drive-by policies?• Paediatric training and expertise?
ResuscitationResuscitation
• Advanced paediatric life support skills
• Led by clinicians with appropriate skills and knowledge to identify life-threatening illness and start emergency treatment
• Suitable environment and resus facilities and drugs
• Advanced paediatric life support skills
• Led by clinicians with appropriate skills and knowledge to identify life-threatening illness and start emergency treatment
• Suitable environment and resus facilities and drugs
StabilisationStabilisation
• Team= paediatrician, anaesthetist or intensivist, nurse +others as appropriate
• Lead senior clinician
• Location
• Routine (daily) check of drugs and equipment
• Develop common standards across the hospital
• Team= paediatrician, anaesthetist or intensivist, nurse +others as appropriate
• Lead senior clinician
• Location
• Routine (daily) check of drugs and equipment
• Develop common standards across the hospital
High Dependency CareHigh Dependency Care
All hospitals providing in-patient care for children should have arrangements for High Dependency Care
Ref: High Dependency Care for Children-report of an expert advisory group for Dept of Health 2001
All hospitals providing in-patient care for children should have arrangements for High Dependency Care
Ref: High Dependency Care for Children-report of an expert advisory group for Dept of Health 2001
PlanningPlanning
• Network DGHs + tertiary centre with PICU
• Good communication
• Guidelines on admission to adult ITU.
• Where A and E but no paediatrics, consideration must be given to cover
• Network DGHs + tertiary centre with PICU
• Good communication
• Guidelines on admission to adult ITU.
• Where A and E but no paediatrics, consideration must be given to cover
Surgery in ChildrenSurgery in Children
• Networks
• Proper training and updating
• Emergency surgery only where there is elective surgery and inpatient facilities
• Networks
• Proper training and updating
• Emergency surgery only where there is elective surgery and inpatient facilities
SurgerySurgery
Protocols for:• Airway obstruction• Shock• Head injury : -requiring intubation - not requiring surgery - requiring surgery - with other injuries• VP shunt malfunction• Acute scrotum• Fractures • Burns
Protocols for:• Airway obstruction• Shock• Head injury : -requiring intubation - not requiring surgery - requiring surgery - with other injuries• VP shunt malfunction• Acute scrotum• Fractures • Burns
ResponsibilitiesResponsibilities
IndividualKeep up to date and practised• courses• continuing experience• simulators (Sim-Baby)• refresher training• Hands-on weeks• Accompanied lists in local centre• “DGH lists” in paeds centres?• telemedicine
IndividualKeep up to date and practised• courses• continuing experience• simulators (Sim-Baby)• refresher training• Hands-on weeks• Accompanied lists in local centre• “DGH lists” in paeds centres?• telemedicine
ResponsibilitiesResponsibilities
Team
Practise together
- real time, real environment
scenarios
Team
Practise together
- real time, real environment
scenarios
ResponsibilitiesResponsibilities
Organisation
• Equipment and facilities for resuscitation and stabilisation
• Time and resources for training and
practice
Organisation
• Equipment and facilities for resuscitation and stabilisation
• Time and resources for training and
practice
ResponsibilitiesResponsibilities
Consultant paediatrician
Must maintain personal involvement in and responsibility for the care of the child.
Tanner 2006
Consultant paediatrician
Must maintain personal involvement in and responsibility for the care of the child.
Tanner 2006
ResponsibilitiesResponsibilities
PICU/ Tertiary Centre
• Timely advice: one call system, telephone advice, telemedicine links
• Support
• Practical help in securing a bed
PICU/ Tertiary Centre
• Timely advice: one call system, telephone advice, telemedicine links
• Support
• Practical help in securing a bed
Everything OK then?Everything OK then?