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Survival tips

Survival

Tips

Quick Links

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Map of the unit 

Hand hygiene policy

Roles and Responsibilities

Survival tips

Postnatal ward induction

Tricks and tips on IT apps

Structure of the day

Meetings

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General

Admission swabs

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Every baby needs admission swab stickers printed (EPR- ‘Neonatal admission’ MRSA and gram negative, fill in dates, add sample site for the 2 extra swabs and then click alerts, click ok to have the order accepted the exclamation mark will disappear)

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PDA ligation pathway

 

Please familiarise yourself. There’s an audit form to complete. We now do many PDA ligations on NICU.

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Cardiac babies

 

Some cardiac babies need genetic bloods if not done antenatally. Ensure parental consent taken prior to taking blood and send blood sample and request form straight to CSR. Form on EPR.

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Intubation drugs

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All babies should have intubation drugs prescribed PRN on admission (quicklist) 

Neonatal antimicrobial variable dosing for Gentamicin (Medchart Protocol-neonatal- levels taken pre-3rddose)

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Prostin

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Pre-made Prostin syringes for duct-dependent babies. Prescribe as ‘50ml 10% glucose, Dinoprostone 50 micrograms to run at 5-20 nanograms/kg/min’. Need 2 x iv cannula or central line

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Drug labels

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Morphine infusions prescribed using ready made sticky labels just behind computers

Lumbar puncture for neurotransmitters- 3 bottles to be collected from Savannah ward (4thfl Evelina) and dry ice from viapath or well child lab (1stfloor Evelina). Request form printed off from here

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Lone line dressings

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Long line re-dressings can be/usually are performed by nurses who have undergone specific training. Please liaise with charge nurse.

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Finally

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There is a vending machine on level 7 which takes cards….

BadgerNet tips

Admissions

 

For multiple births- enter maternal common details and copy sibling info over

Creating babies- liaise with nurse to ensure it is clear who is creating a baby on Badger.

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Duplicates cause confusion! If one is created change the surname in the record to DELETE ME so administrators can easily identify which record to take off.

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Transfers from other units

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Check that a record appears at the bottom of our home Badger screen ‘awaiting transfer to unit’. If not, first phone the referring unit to ensure they have definitely discharged the baby off their system.

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Otherwise, enter NHS number (or temporary NHS number) from transfer letter in ‘create new baby’, this should prompt a message from Badger asking if you want to admit this pre-existing baby

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If the NHS number doesn’t immediately prompt continue to add the name, and check NHS number correct. Be a bit patient. Don’t create a new baby from scratch. If this doesn’t work call Clevermed.

 

Labour ward admissions

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Helpful to gather mothers NHS number when on labour ward so can copy information over from Maternity Badger

 

 

NNAP data (National Neonatal Audit Programme)

 

please ensure all admission temperature values and time taken are entered, timing of first conversation with parents (must be on the neonatal unit postnatally).  Zee and Oli, our data experts will send weekly reminders on missing data!

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Initial examination to be done within 72 hours and entered in Badger/NIPE

 

Discharge and NIPE examination to be completed prior to discharge from unit

 

Procedures/Events

 

please document (yourself) all intubations, line insertions (cannulas too), x-rays, head scans, blood cultures and parent conversations.

 

Tasks/ management plans are really helpful

Community Refferals

A&E and Community midwives will bleep 0682 for babies <7 days old who may need admitting for poor feeding or weight loss > 12,5%. Please review baby in SCBU middle bay, admit to SCBU or PNW where appropriate.

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A&E and Community midwives will bleep 0682 for babies <7 days old who may need admitting for jaundice.

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Current pathway where community midwives MAY take an SBR in community and just sent in the blood not the baby. They will still have to call you to make you aware that you need to chase results.

 

If bloods are not taken they should at least do a transcutaneous bilirubin in the community. If Tc bili was not done then the baby has to be assessed by midwife in PNW, not us.

 

Ongoing audit, please complete book at reception for each referral and encourage attendance by 4pm.

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For all community babies seen- please place EPR order ‘neonatal rapid access referral clinic’ otherwise we don’t get paid!!! This is sent to the GP

 

All documentation to be entered on BadgerNet Maternity under baby record

 

All babies> 7 days to A&E or paediatrics as appropriate.

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If you have any concerns from the referral that the baby may be unwell, please direct them straight to A&E, as they may have to wait to be seen when coming to our unit, which is clearly not appropriate for a potentially sick/septic baby

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Please note that we DO NOT go down to A&E to assess babies unless there is an exceptional circumstance.

Labour ward

For all deliveries, pick up a sats monitor from behind NICU station.

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Nurse to bring blue bag if complex delivery with anticipated need for intervention (in which case the Reg will be in attendance)

 

Please DO NOT open blue bags or trolleys unless genuinely required- they then have to be fully rechecked which is time-consuming for the nurses. (ie DON’T USE for cannulation!!)

 

Ensure babies have labels on before leaving labour ward; get mother’s NHS no for Badger

 

Ensure baby number generated by maternity team immediately – ideally before leaving birth centre. Speak directly to midwife in charge if any delay

 

ITUc reg has special key on bleep to expedite lifts

 

Purple trolleys are on labour ward to perform septic screens without separating from mothers. Please can DA doctors check and restock. 

 

There are pre-filled cefotaxime syringes in HBC and SCBU fridges. If they are not available, please datix this.

Preterm Delivery

 

Ongoing preterm quality of care audit- complete checklist, ensure details are in resuscitation and admission notes on Badger.

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Reference lanyard cards available for managing babies<30 weeks, you should receive in induction-please ask.

 

Start SCAMP PN day one if <31w and/or <1250g as soon as access is obtained – no need to start glucose infusion.

 

Extreme preterms- unnecessary to cannulate if double lumen UVC access gained promptly

PN- SCAMP

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SCAMP to be given to:

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Babies born <31weeks GA and/or birthweight <1250g

 

Any baby unable to tolerate feeds for ≥ 72 hours at any point should be considered

 

PN should be started as soon as IV access is obtained. Aim for central access.

Prescribe using stickers behind NICU desk. All information on the PN leaflet

 

Bespoke PN should be ordered prior to 10am in the morning (minority of babies with long term issues).

Blood Transfusion

Two separate samples needed – ordered, taken and signed by 2 different people

Phone blood bank to order product 

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Print out EPR form for porters (EPR Order àdocuments printer icon àblood products). Tick volume required – Packed red cells/FFP or Octaplas/ cryoprecipitate. Place in box near computers for porters to collect. 

 

Bleep porters to collect blood 

 

Prescribe blood on fluid chart 

 

Complete blood products form (Separate one for packed red cells vs platelets) for nurses to document observations and batch numbers. 

 

Platelets are ordered specifically on EPR as well as speaking to lab.

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