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Nursing outreach service saves paediatric bed days

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A ground-breaking children’s home nursing service has helped save more than 1,000 bed days since it was launched 18 months ago, Nursing Times has been told.

The Children’s Outreach Service was developed by King’s College Hospital Foundation Trust with home nursing provider Healthcare at Home.

“You get the best of both worlds, because you get the input from the hospital and work with the ward nurses and then personally transition the child from the word go”

Zoe Tribble

The service, which is staffed by five specialist paediatric nurses, means children with serious infections can leave hospital much sooner and continue treatment in the comfort of familiar surroundings.

Nurses can make up to four visits a day to one family to administer intravenous antibiotics to treat infection, sepsis or meningitis and may also see children at school.

The service runs from 7am to 11pm, seven days a week and works with children of all ages from newborn babies up to 18.

“It has made an immeasurable difference to the children we see,” said paediatric lead nurse Zoe Tribble.

“When children are in hospital they get down and miss their friends, family and home comforts,” she said.

“At home they are like different people – they have all their things and can eat the food they want. They are generally happier and recover more quickly as a result,” Ms Tribble told Nursing Times.

She highlighted that the service was set up to run like a “virtual ward” and was very much part of the hospital service. Nurses on the team, which is based at King’s, work closely with ward nurses and doctors and attend daily morning handover meetings to report on the progress of their young clients.

“This is the best job I have ever had,” said Ms Tribble, adding that she particularly valued the chance to build trusting relationships with children and families.

“You get the best of both worlds, because you get the input from the hospital and work with the ward nurses and then personally transition the child from the word go,” she said.

“I would assess them on the ward and then go out later in the day and see them at home, so it is not a different person or a different team – that continuity of care is there.”

The virtual ward set-up means that during out-of-hours periods families can contact ward staff for advice and, if their child’s condition deteriorates, can come in – bypassing A&E as they are effectively still inpatients.

“It has made an immeasurable difference to the children we see”

Zoe Tribble

The nurses use tablets to record observations and share other key information, which can be accessed in real-time by hospital staff.

The team has also worked closely with community nurses to deliver joint care to some children.

Nurses make up to 10 visits per day and see around three different families on average. To date the service has worked with 215 children and teenagers.

Patient satisfaction surveys reveal 100% of those who have used it would recommend the service to family and friends.

Ms Tribble said a key factor was the fact the team was not limited to working within set geographical or GP practice boundaries.

“If a child is transferred to King’s then we can go pretty much anywhere to see them as long as we can get there,” she said.

“This flexibility means we can treat more challenging families who may not be registered with a GP,” she said. “Our patients have included refugee children staying in hostel and one child living on a fairground from a travelling family.”

The model builds on an existing outreach service for adults and could be easily replicated by other hospitals and trusts, added Ms Tribble.

“It is a model that can absolutely be replicated elsewhere and that is something we are looking into,” she said. “We’re going to other trusts and scoping out need and we’ve had some good feedback already.”

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