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PATIENT CARE UNIT:

Scope of Service: 

Pediatric Clinic is a hospital-based ambulatory center providing non-emergency care to pediatric patients, ages infancy to 14 years, the exception to this age restriction is the Metabolic and Genetic Services who continue to see their patients regardless of age.  Patients from all over the Kingdom and parts of the Middle East are seen in this facility.  Patients enter the system by physician referral or by meeting the eligibility criteria for this tertiary care hospital.  The patient will be referred to one of the sub specialties within the Pediatric Medical Services, Medical Genetics, Cardiology, Cardiovascular, Neurology, Urology or Neuropsychology.

We are generately governed by hospital policies and procedures which are standardized in line.

Frequent Procedures/Services/Functions: 

• Sick Child Exams – follow up
• Newborn screening
• Family counselling
• Genetic counselling and screening
• Immunization
• Change of Gastrostomy “Mickey” tube
• Diagnostic procedures egg. skin biopsy, joint aspiration, etc.
• Dressing changes
• Injections on a routine basis (e.g. Neonatology Pulmonology and Rheumatology patients)
• NG tube replacement/change
• Catheterization (intermittent or indwelling)
• Pre-cardiology clinic and pre-cardiac catheterization work-up
• Medication and take home supply re-fill
• Teaching for self-catheterization (CIC) and self-injections
• Blood Pressure monitoring

Neurology Nurse Clinic

·         Manages several phone clinics weekly to review laboratory results and make medication     adjustments with the patients and parents in conjunction with the physician.

·         Medication refills

·         Develops Epilepsy teaching methods and materials.

·         Weekly clinic scheduled for Epilepsy teaching

·         Teaching given in other clinics and inpatient units

·         Family counselling and teaching concerning medications, treatment and disease process

Cleft Palate Nurse

• Develop teaching methods and materials.
• Teaching i.e. how to feed the infant
• Counselling – feeding, nutrition issues and treatment planning
• Co-ordination of care/Case management
• Assisting with data collection and data management of Cleft Palate registry
• Clinical pathway implementation
• In-services given to nursing staff

Neuropsychology Technicians

• Administer and score neurophyschology tests
• Behavioural assessment
• Family counselling with the physician
• Teaching for toilet training, pamphlets and advice

·         Guide parents to specific school suited for certain type of disorders:  ADHD, Autism, LD (learning disabilities)

Hours of Operations:

5 days per week – Saturday – Tuesday, 0800 – 1800 hr

                               Wednesday                  0800 – 1700 hr

CRITERIA FOR ADMISSION TO THE SERVICE

• Patients who meet the eligibility criteria for this Tertiary Care hospital

• Referrals from Emergency Room and other Outpatient Clinics
• Referrals from Inpatient area requiring discharge follow-up

STAFFING PLAN

Number and mix of staff:

Total FTE’s

HN                                                         -               1

SNI                                                         -               12

SNII                                                       -               7

Ward Clerk                                          -               1

Neuropsychology Technician       -               2

PCA                                                       -               1

Nursing Clinical Coordinator       -               2

Interpreter                                            -               1

Shift assignments are made by the charge nurse and based on the following:

In the Nurse Clinics, patients are assessed and managed primarily by a nurse upon initial referral from a doctor and with prescribed initial physician orders. 

All clinics are staffed with one primary nurse and 1 or 2 Associate nurses depending on staffing, volume and complexity of patients. The Primary Nurse co-ordinates all activities in the clinic and co-ordinates with other departments that may be involved in the care of the patient.  She/he checks the charts for any tests and follow-up, orders any missing charts and x-rays carries out doctors orders and generally ensures the smooth flow of patients. The Associate Nurse prepares the rooms, calls the patients, performs or assists with procedures done by the physicians in the examination room.  This nurse also assists the Primary Nurse and inputs data into the computer.

The Neuropsychology Technicians work closely with the Neurophyschologist and do all of the neural developmental testing

The staffing needs for each area are determined by patient volume, patient care requirements and staff competencies.

Method of adjusting to staffing variances: 

The Head Nurse/Charge Nurse makes adjustments to staffing based on patient acuity and on the staff skill mix.  Another important consideration is the need for an Arabic Interpreter.

Pediatric Clinic nurses generally float to the following units:

• Any Clinic within Ambulatory Care Nursing

To ensure quality of care:

• A cross-training program has been implemented to assure quality of care.

QUALIFICATIONS OF STAFF: 

·         SNI & SNII and Clinical Coordinators

·         Current Nursing license        

·         BCLS

·         Mandatory Education:  Fire & Safety

·         Infection Control – Online module

·         Competency based check-offs

·         BPPA (Basic Pediatric Assessment)

·         Customer Service

·         Age specific

Ward Clerk

·         Unlicensed

·         Community CPR

·         Mandatory Education: Fire & Safety, Infection Control

·         Customer Service

PCA

·      Unlicensed

·         Community CPR

·         Mandatory Education: Fire & Safety, Infection Control

·         Customer Service

Neuropsychology Technicians

·         In-house Training

·         Community CPR

·         Mandatory Education: Fire & Safety, Infection Control

·         Customer Service

Interpreter

·         Unlicensed

·         Medical terminology

·         Mandatory Education: Fire & Safety, Infection Control

·         Customer Service

HOW ARE INSERVICES/CONTINUING EDUCATION PROGRAM PROVIDED TO MAINTAIN STAFF COMPETENCY?

• Staff meetings held monthly and as needed
• Collaborative practice meetings are held quarterly
• Staff are required to present two in-service annually
• Nursing Education and Research provide ongoing in-services/courses and notices are posted in the clinic areas and staff are encouraged to attend
• Training and Development offer courses and staff are encouraged to attend for performance improvement
• Competency based practice check-offs are an annual requirement
• Staff learning needs are identified and relevant in-services are arranged
• All new equipment and procedures are introduced through mandatory orientation and 

ongoing education as needed

• Weekly medical staff Grand Rounds – staff encouraged to attend
• Symposium and workshops sponsored by Academic Affairs.
• Telemedicine conferences

Required Competencies:

• Pediatric Physical Assessment Course
• Emergency Care
• Oxygen Therapy
• Medication Administration
• Aseptic Technique/Standardization Precautions
• Pulse Oxymetry
• Catheterization
• Computer skills
• Growth clinic calculations
• POCT
• Customer Service
• Age specific

METHOD OF COMMUNICATION WITH OTHER DEPARTMENTS:

Internal and External Methods of Communication:

• Direct/verbal communication with other members of the health care team
• Bulletin board
• Internal mail, memos, e-mail, cc-mail, fax
• Intranet and internet
• Interdepartmental Collaborative Practice Meetings
• Nursing Management Committee
• Open Forums
• Planning Days for nurse managers
• Hospital Standing Committees
• Communication Book
• Meeting Minutes available
• Computer hook-up to allow viewing of the actual Echocardiogram and Cardiac Catherization
• Life Scan Datalinks for Glucometer

Describe Collaborative Relationships With Other Departments: 

• Full-time Social Worker and Patient Relations in the area
• Dietitian has clinics in the area and works closely with the physicians
• Physical/occupational therapist attends all Rheumatology and SLE clinics
• Part-time Pharmacist works in the clinic processing the prescriptions, counselling patients and facilitating medication re-fills.
• Diabetic Co-ordinator attends the Diabetic clinic
• Development of Clinical Pathways
• Nurse attendance with physician to clinics held at the Al-Nadha School for Down Syndrome
• Renal Transplant Coordinator or designee and a Clinical Pharmacist attend the Renal Transplant clinic
• Genetic counsellor
• Case manager to facilitate admission

PLAN TO IMPROVE QUALITY OF SERVICE

·         Utilize PI methods to focus on processes and systems to improve patient flow and care

·         Work closely with Appointments to accurately facilitate patient appointments

·         Clinical Pathways – completed:   Cystic Fibrosis

        Cardiac Cathertization

        Work with physicians to develop more

·         Attend courses to improve computer skills.

·         Participate in Arabic classes.

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