Community Children’s Nursing Team

• A child/young person must be aged between 0 and 19-years-old
• The child young person must have a clinical nursing need (See Core function below)
• The child/young person must be living and registered with a GP within the DGS Locality
• The child/young person must have a medical lead who maintains clinical responsibility for the child/young person and their treatment either within GP or Secondary or Tertiary care.

Core function

• Facilitation of early discharge from hospital through participation in discharge planning processes, and transfer of care meetings
• Community based care to prevent hospital admissions or readmission
• Advice and practical support to reduce parental anxiety and empower parent carers / young people in the self-management of their condition.

Service scope

The service will operate Monday to Friday, 9am to 5pm.

The following table illustrates clearly which clinical pathways which are in and out of scope:

Who can refer?

Referrals are accepted from local hospitals, tertiary centres, community hospitals, the primary healthcare team, Social Services, Education and self-referrals.

How to refer

There is one referral form for the Community Children’s Nursing Team (CCNT). There are 2 parts to the form.

Part 1 MUST be completed for all referrals.

Part 2 only needs to be completed for those children who are referred for Intravenous antibiotic administration.

Receipt of a completed referral form is essential prior to service delivery in order that the CCNT collates all the relevant information required to make a decision as to whether the referral is accepted.

Referrals should be emailed to kchft.ccntdgs@nhs.net and referrers can expect to hear back from a member of the team within 1 working day.

Expected referral to intervention timescales

All accepted referrals will be allocated according to clinical need. Urgent referrals will be seen within 1 working day, non-urgent referrals will be seen within 3 working days.

Criteria for intravenous antibiotics referrals for bolus injection

• Clinical observations must be stable for a minimum of 4 hours prior to discharge
• Appropriate intravenous access must be established prior to discharge (i.e. peripheral cannula, peripheral long line, central line) and this must be clearly documented within the referral
• The second dose of antibiotic therapy regime is to be given on the Children’s ward and any adverse reactions are documented and changes to the regime made as indicated
• Antipyretic therapy (if appropriate) should have been commenced and be observed to be effective prior to discharge
• Parents are to be given written instructions on how to care for the device used for intravenous access prior to discharge and made aware of the side effects of the medications, any medication licencing issues etc
• Drug chart, medication and diluent need to be prescribed correctly and supplied with the patient

The child or young person must:

• be aged between 0 and 19 years
• have a clinical nursing need (see core function below)
• be living and registered with a GP within the DGS Locality
• have a medical lead who maintains clinical responsibility for the child/young person and their treatment either within GP or secondary or tertiary care.

Core function

• Enabling early discharge from hospital through involvement in the discharge planning processes and transfer of care meetings.
• Community-based care to prevent hospital admissions or readmission.
• Advice and practical support to reduce parental anxiety and empower parent carers/young people in the self-management of their condition.

How do I refer to this service?

To refer patients please complete the Community Children’s Nursing Team referral form. There are two parts to the form.

• Part 1 must be completed for all referrals.
• Part 2 only needs to be completed for those children who are referred for intravenous antibiotic administration.

If you would like guidance on how to complete the form, please contact the team.

Receipt of a completed referral form is essential so the CCNT can make a decision as to whether or not the referral is accepted.

Urgent referrals will be seen within one working day, non-urgent referrals will be seen within three working days.

Referrals should be emailed to kentchft.cscowestkent@nhs.net and referrers can expect to hear back from a member of the team within one working day.

We work Monday to Friday, 9am to 5pm and our phone number is 01795 597292.

In scope:

• routine tracheostomy care – non-urgent
• home phlebotomy for long term conditions (e.g. pre-infusion bloods)
• home enteral nutrition – home based support with trouble shooting in conjunction with the HEN team: nasogastric tube changes, gastrostomy and jejunostomy feeding device management
• home oxygen children over 1 year
• IV antibiotics
• wound care
• catheter and stoma initial support
• severe cerebral palsy
• long term ventilation needs (invasive and non invasive)
• neuro-muscular conditions
• degenerative conditions
• support post surgery that requires nursing intervention
• provision of continence product review and assessment pathway if on the CCN long term caseload
• methotrexate administration and coordination of prescriptions
• palliative care and end of life care.

Out of scope:

• weekend and out of hours information, advice and support
• children with the following long term conditions/pathways:
• asthma, allergy and wheeze
• epilepsy
• eczema
• children requiring support for challenging behaviour or ASD
• risk assessments for children requiring escorts to school
• schools requesting risk assessments for school based health care plans – unless the child is under the direct care of the CCNs
• training to schools, voluntary groups on management of long term conditions which are not in scope
• children with short term acute conditions unless specified as in scope
• oncology
• continuing care health assessor functions
• bladder and bowel assessments and intervention
• neonates requiring home oxygen up to 1 year of age
• diabetes
• cystic fibrosis
• young people aged 16 to 18 not in full time education, covered by adult services.