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?