Appropriate Care for Children and Young People in all Hospital Settings Risk Assessment and Care Pathway Guidance
‘In some areas across Scotland children between 14 and 16 years are admitted for care in environments that are not specifically suitable or designed for their age group. Young people in these settings become more vulnerable than those receiving care in child specific (paediatric) environments and special consideration is required by service providers to ensure their patients’ safety, protection, health and wellbeing. Clinicians within the field of children and young people’s health care believe that there is an increased risk of physical and emotional harm to young people who do not receive their care in age appropriate settings and by appropriately trained staff. When children are admitted to adult care environments they may witness distressing events, sights and sounds that could negatively impact on their current care episode, subsequent recovery and on their future health and wellbeing.
Children and young people’s experiences of care and services throughout their life course can have a significant impact on their health and wellbeing. The European Association for Children in Hospital (EACH) Charter of 1988, the United Nations Convention on the Rights of the Child (UNCRC) (1989), the NHS Quality Strategy (2010) and The Children and Young People (Scotland) Act 2014 are agreed benchmarks to ensure children and young people’s rights and safeguards and are used to commission and deliver excellent care and services for babies, children and young people.
Recognition of the issue
Within my own area of practice in NHS Ayrshire & Arran I was aware of instances, although infrequent, of children between the ages of 14 and 16 years receiving care and treatment in areas not designed and designated for paediatric care. As the Clinical Nurse Manager for Paediatrics it is my responsibility to ensure best standards of practice for children and young people attending for healthcare.
It was important that the issue was promptly addressed and the situation provided an opportunity to develop a risk assessment and care pathway for young people aged 14 years and over receiving care and treatment in areas not designed and designated for paediatric care (Appendices 1 & 2). The guidance was written specifically for, and made available to, frontline staff working with children but who do not hold recognised qualifications in children’s care. The aim was to ensure that children and young people receive age appropriate care in a suitable environment from staff with the knowledge and skills to meet the needs of children, families and carers.
Working together to ensure safe practice
ASCS provides a resource and support for all those involved with the care of children and young people in Scotland and the NHS Ayrshire & Arran risk assessment and pathway documents were discussed with the ASCS Trustees during one of their meetings.
It was felt that the risk assessment and pathway could be a useful tool in the care and management of young people aged 14 to 16 years and a decision was made to share the work with any interested colleagues who provide care for this age group outside of designated paediatric settings.
ASCS had received an enquiry from Gerard Gahagan, Head of Service at The William Quarrier Scottish Epilepsy Centre (WQSEC) in Glasgow, about their views on the standards of care that would be required if a young person aged 14 to 16 years old was to be admitted to the centre. WQSEC’s current lowest age of admission is 16 years and their present policies and standards relate to the care of adult patients. Dagmar Kerr of ASCS met with Gerard at the WQSEC and had a tour of the excellent facility. Gerard explained how patient care is delivered at WQSEC and Dagmar was particularly interested to see how the centre provides a good, age appropriate service for the younger patients who are in the sixteen to early twenties age group.
When admitting younger patients WQSEC works very closely with the Children’s Epilepsy Team based at the Royal Hospital for Children in Glasgow. The hospital team is able to support young patients in the William Quarrier Scottish Epilepsy Centre and to ensure great continuity of care.
Dagmar and Gerard talked about the advice and support available from ASCS and the guidance in the European Association for Children in Hospital (EACH) Charter to ensure appropriate standards of care for young people in clinical settings www.each-for-sick-children.org. The Centre already meets most of the EACH Charter points, but staff were unaware of a child’s right to education during times of illness. Dagmar agreed to provide an information and professional development session on the EACH Charter for the staff at the centre.
There was further discussion about the possibility of young people between the ages of 14 and 16 being admitted to WQSEC. Dagmar mentioned that a risk assessment and care pathway had already been developed in NHS Ayrshire & Arran for the few patients that might occasionally have to be treated in an adult setting. The documents were shared with Gerard who adapted them for specific use within WQSEC and arrangements were made for me to visit WQSEC to discuss progress.
I was pleased to meet Gerard at WQSEC not long after Dagmar delivered the EACH session. The staff’s dedicationand commitment to provide safe, effective, person centred care at the Centre was very apparent during my visit. We continued the discussion about age appropriate care and the safeguards that must be in place for young people aged between 14 and 16 years admitted to WQSEC. It was evident during our discussion and through observation of the care environment, that Gerard and his staff are able to meet the needs of patients in the younger age groups. They also understood very well the impact on health and wellbeing that an admission for an episode of care can have on young people, their education, their friends and families.
Taken from Action for Sick Children Scotland Newsletter Winter 2015/16