Admission of patients under the age of 16 to Adult Critical Care Units - Adult Critical Care

Publication: 26/04/2018  --
Last review: 01/01/1900  
Next review: 26/04/2021  
Standard Operating Procedure
CURRENT 
ID: 5507 
Approved By: Adult and Paediatric Critical Care 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard Operating Procedure
Adult Critical Care
Admission of patients under the age of 16 to Adult Critical Care Units

Aims

  • To standardize the admission of patients under the age of 16 to Adult Critical Care (ACC).
  • To facilitate access to specialist care.
  • To ensure that patient safety is prioritised and maintained.

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Background and indications for standard operating procedure

Under exceptional circumstances, it may be necessary to admit a child under the age of 16 to an adult critical care environment for a limited period.

This might happen when a child requires immediate specialist treatment and there is a temporary lack of Paediatric Intensive Care (PIC) beds.

In such circumstances PIC may request that ACC stabilize and initiate treatment whilst a PIC bed is organised.

A risk assessment should be undertaken and documented in the patient records or on PPM to determine what is in the patient’s best interests.

The following should be taken into consideration:-

  1. Availability of ACC beds
  2. Specialist care required, Neuro, General, Cardiac
  3. Clinical condition of the patient.
  4. Risks associated with transfer to the nearest Paediatric Intensive Care Unit (PICU)
  5. Time frame for organising transfer back to PIC or relevant paediatric service.
  6. Patient’s physiology, does the patient require paediatric ventilation/medication protocols?

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Procedure method (step by step)

Admission to Adult Critical Care

  1. All patients should be referred directly to the On-call Paediatric Intensivist and not Adult Critical Care.
  2. A risk assessment should be undertaken and documented in patient records or on PPM to determine if admission to ACC is in the best interests of the patient.
  3. The On-call Paediatric Intensivists should liaise directly with the Consultant covering ACC.
  4. Feasibility of admission should be discussed with ACC Unit’s Nurse in charge, the Matron of the day (Bleep holder out of hours) and the PICU Matron (Paediatric Bed Manager out of hours).
  5. The bed manager must be informed in hours.
  6. A projected time frame for transfer back to PICU or relevant paediatric service should be discussed within 24hrs of admission to ACC.
  7. Any potential paediatric admissions from outside of the trust should be referred from PIC to ACC to ensure the appropriate support services are provided during transfer.

Adult nurses in the PICU

The use of ACC nurses to staff PIC beds (to prevent a child being cared for within the ACC environment) should not be excluded.
However consideration should be given to the fact that the nurse;

  1. Will be unfamiliar with the staff and environment.
  2. May not have competencies related to equipment.
  3. Will be unfamiliar to the senior nurse on the unit in relation experience and capabilities.
  4. Is likely to be stressed by moving from their environment as well as looking after a child.

To mitigate these risks, if possible,  the patient should be admitted to  ACC

Major Incident Planning

In the event of a major incident involving paediatric patients, ACC may be required to support the PIC service.

Adult and Paediatric services should liaise to ensure patients are placed in the most appropriate environment considering their clinical needs and the resources available. The following should be taken into consideration.

  1. Major incident plans
  2. Moving appropriate stable patients from PIC to ACC.
  3. Repatriation of acute admissions from ACC to PIC as soon as practically possible.
  4. Provision of a trained paediatric nurse 24/7 when more than one paediatric patient is within the ACC bed base. This may be in a dedicated area or as a floating support nurse across C floor.

Ongoing support

  1. The patient should be considered a Paediatric outlier and see on a ward rounds by the PIC and specialist paediatric teams.
  2. The PICU nurse in charge will be available to provide advice and support on a 24/7 basis.
  3. Daily review of ongoing need to stay within ACC
  4. The support offered to families of paediatric patients should be ensured using the following algorithm

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Supporting families of Paediatric Patients admitted to Adult critical care

Provenance

Record: 5507
Objective:
Clinical condition:
Target patient group: patients under the age of 16
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Not supplied

Approved By

Adult and Paediatric Critical Care

Document history

LHP version 1.0

Related information

Not supplied

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