3. The 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

4. The Tanner Report Implementing 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)

5. Recommendations 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!!

6. Generic skills 1.To recognise the ill child 1.To recognise the ill child Spotting the Sick Child. Ffion Davies DH Sept 2004 DH Sept 2004 http://www.ocbmedia.com http://www.ocbmedia.comhttp://www.ocbmedia.com

7. Skills, 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.

8. Skills, 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

9. Skills, 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

10. Ambulance Service Transfer plans Retrieval service Drive-by policies? Paediatric training and expertise? Transfer plans Retrieval service Drive-by policies? Paediatric training and expertise?

11. Resuscitation 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

12. Stabilisation 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

13. High 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

14. Planning 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

15. Surgery 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

16. Surgery 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

17. Responsibilities Individual Keep 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 Individual Keep 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

18. Responsibilities Team Practise together - real time, real environment scenarios Team Practise together - real time, real environment scenarios

19. Responsibilities 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

20. Responsibilities 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

21. Responsibilities 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

22. Everything OK then?