How to find us: Directions
How to find us: Directions From North and West: exit M60 at junction 5, head south on A5103. From South, exit M56 at junction 3a. From East, exit M60 at junction 3, follow M56 to junction 2. Then, from all directions, take A560 towards Altrincham. Turn left into Southmoor Road and continue to follow this until you reach the hospital. www.uhsm.nhs.uk Compiled by: Kelly Harvey Lydia Bowden Michelle Parr Sue Stockton Fran Probert With thanks to all parents, babies and staff who allowed their photographs to be included. Welcome to our unit. Your Baby Name: Date of Birth: Time of Birth: Weight: Congratulations on the birth of your baby and welcome to the neonatal unit. This booklet aims to introduce you to the neonatal unit here at Wythenshawe hospital and we hope it will help you to understand what we do here and give you an insight into what your time here will involve. Important Information: Unit Phone Number: 0161 291 2932 Address: Neonatal Unit Wythenshawe Hospital Southmoor Road Wythenshawe Manchester M23 9LT 2 Neonatal Unit Philosophy It is the belief of all staff on the neonatal unit that every baby admitted should receive the highest standard of family-centred nursing care. In order to achieve this we strive to provide a sensitive, caring environment in which all babies’ maximum development is achieved, whilst cultural and religious beliefs are respected. All parents have the right to be fully informed of about their baby’s care, enabling them to be involved in making realistic choices and informed decisions for their individual family needs. We trust that by providing the necessary guidance and support, we enable parents to meet the needs of their baby both on the neonatal unit and at home. 3 Staff You Will Meet. You will meet many different people with different jobs to do while you are here, it may feel a bit overwhelming at first but you will get to know the team very quickly. All staff on the unit will be wearing an ID badge with their name and a picture; if they are handling your baby they should also have a red stripe on their badge. Medical Staff: This includes specialist registrar’s (SPR) and senior house officers (SHO) and Advanced neonatal nurse practitioners (ANNP’s) who work in the role of the SHO but come from a nursing background. The SPR’s and SHO’s change every 6-12 months and are present on the neonatal unit all the time. The ANNP’s are on the unit permanently. Consultants: We have five consultants who lead the team of medical staff. Each week a named consultant will be responsible for the day to day care of babies on the unit, this is called the hot week consultant. Your baby will also have a named consultant, who will be responsible for the overall care of your baby on the unit and in the future. Your baby’s named consultant is: .................................................. 4 Nursing Staff: The nursing team is much bigger led by our manager and includes senior sisters, sisters, staff nurses and assistant practitioners. These are the faces you will see and speak to most and we pride ourselves on working as a team to provide the highest level of care not only to your baby but also to your whole family. 5 We also have a number of staff who support the running of the unit and are an integral part of our team including our ward clerk, our support workers and our cleaners. Many other staff may be involved in your baby’s care whilst on the unit including physiotherapists, dieticians and pharmacists. Whenever you have any worries or questions please do not hesitate to ask the nurse caring for your baby. They will update you or organise an update with the medical staff. Our Unit. On admission babies are placed into the most appropriate room for their care, and this will change throughout their stay. Occasionally babies require specialist services that our unit does not offer, for example surgery. If your baby required surgery they would be transferred to another hospital that offers specialist neonatal surgery. Other Facilities: We have a breastfeeding room which is a comfortable environment in which to express milk for your baby with a number of breast pumps. More information on expressing milk can be found in the breastfeeding section. Clinical areas: Our unit has three rooms: Intensive care (room 1), High dependency (room 2) and special care (room 3), totalling 19 cots. 6 Parent facilities: The parents’ kitchen, with a fridge and a microwave and tea and coffee making facilities so if you are spending the day with your baby you can eat and drink. The Parents sitting room, with comfortable sofa’s and some children’s toys so if you need a break or you have another child with you then you can relax in comfort. 7 We would ask you to respect all the facilities on the unit and to leave areas as you find them. Understanding that space is restricted and all parents need access to these facilities. The Parents bedroom, this is for use when your baby is almost ready for home and we encourage you to spend a night in hospital with your baby. More information on this can be found in the ‘getting ready for home’ section. Developmental Care. When caring for neonates it is very important to understand developmental care. On our unit we work very hard at trying to offer good developmental care for all the babies. Most of the babies on our unit should not be born yet and if not they are very sick. This means that when caring for all of their needs, we should think of their development. of your baby. It is also excellent at encouraging your milk supply for breastfeeding and expressing. It is one of the best ways for you to bond with your baby and is very positive for your baby too. The baby comes out with only a nappy on and then lies on mum’s chest down her top or with a blanket covering baby so that baby’s skin is against mum’s skin. They keep their temperature from you and the sound of your heart beat is very comforting for baby. Minimal Handling - Premature and sick infants require minimal handling and so we try to handle them a little as possible. Often when they are poorly they will need lots of interventions that make this difficult. We try to make sure that if your baby needs lots of things doing, we will do them all at the same time and then give baby a period of rest. 8 Containment Holding – It is important that you touch your baby as this is positive touch. Containment holding is the best way of handling your baby without disturbing them at a time of rest. Place your hand firmly on the top of the head and over the back/bottom or tummy and hold your baby in this way. It is comforting for your baby and does not disturb them. It is also very positive for you and baby. Try to make sure you do not stroke baby as this can disturb them. Quiet Time – A two hour period of time on the unit 1pm to 3pm, where lights are switched off, handling is discouraged unless urgent, noise is kept to a minimum and only parents are permitted in the rooms. This time is protected for your baby’s development. Skin to Skin/Kangaroo care – We encourage this way of holding your baby when they come out for cuddles as it is very positive for the development For more information on strategies of developmental care please ask staff for further information leaflets. What to expect on admission Following delivery your baby will be stabilised by the neonatal team on delivery suite and then transferred immediately to the neonatal unit. If your baby requires intensive care s/he will be admitted to the intensive care room into an incubator. If your baby requires less support s/he may be admitted into the high dependency or special care rooms into a cot. You will be given an admission pack when you arrive which has a number of leaflets for you to read at your leisure. These will give you lots of information about neonatal care and the support that you can access. You will also receive a notebook to use as a diary throughout your baby’s stay, you can use this to keep a record of your time on the unit and the nursing staff may also write in it. 9 You will receive two photographs of your baby on admission. As soon as you are well enough your midwife will bring you to visit your baby and dad is welcome to come and visit as soon as possible. If you would like anyone to visit that is not dad before mum is fit then written permission from mum or dad is required. Your baby may require lots of equipment to support their needs, all of which will have alarms attached and this makes the neonatal unit a very noisy environment. The alarms are very sensitive and designed to alert staff to look at your baby and then only intervene if necessary. It is often a very scary environment and many parents are worried by the alarms. We encourage you to focus on your baby and not the monitors and to ask any questions about the monitoring to the nurses caring for your baby. What will my baby look like? Depending on how much support your baby requires and how premature your baby is will depend on how your baby will appear. Extreme prematurity: Red, shiny skin; eyelids may be fused; 500800grams; all limbs and fingers formed. CPAP: Continuous positive airway pressure; your baby is breathing, but this machine supports your baby’s breathing by giving a pressure up the nose to keep the lungs slightly inflated so that each breath for your baby is not such hard work. Your baby will often get secretions in the mouth when on CPAP due to the flow of air at the back of the throat. It is important to understand that so long as your baby is not distressed this may be left until care times to be cleaned so that your baby is not over handled. Ventilation: This involves putting a tube down your baby’s throat into the lungs, which is then attached to a ventilator breathing for your baby. This is secured to a hat. Your baby will not be able to make a noise when ventilated as the tube is through the vocal cords. 10 Low Flow Oxygen: This is a flow of oxygen up your baby’s nose via small prongs up baby’s nose, to maintain acceptable oxygen level in the blood. Phototherapy: Your baby will be nursed under an ultraviolet light to help with jaundice. Your baby will need to be nursed only in a nappy and will have some goggles on to protect their eyes. Feeding: In order to feed your baby when they are too small to fed themselves and when they are only taking very small amounts your baby will need a naso-gastric or oro-gastric tube in. This tube goes either up the nose or through the mouth and sits inside your baby’s tummy. 11 Involvement in care. The philosophy of care on our neonatal unit is family centred care. We encourage mums and dads to be as involved in their baby’s care as possible. On the unit we have a policy of not keeping anything from parents and the nursing and medical staff will always be open and honest with you about your baby. We encourage you to ask questions whenever you have them and not to go home with worries that we can help with. nappy changes on your baby. Even when your baby is very sick and requiring lots of support it is ok for you to change their nappy. It is positive for you and for your baby and you will always have the support of the nurse caring for your baby. We also encourage you to have cuddles with your baby when they are stable enough and the nurse caring for your baby will support you with this. The nurse caring for your baby each shift will update you on your baby’s condition and any changes and the medical staff are available if you have further questions. The consultant in charge of your baby’s care is always happy to meet with you at an arranged time, please speak to the nurse caring for your baby and they will be happy to organise this for you. 12 We encourage all parents to ring as often as they need too. We understand how difficult it is to go home and leave your baby in hospital and so we want you to feel at ease that you can phone anytime day or night and speak to the nurse caring for your baby. Please make us aware of any cultural needs you or your baby may have and we will try our best to adapt to them. If you have any language barriers please inform us as we can happily arrange for translator services when you are being updated on your baby. You will quickly get used to the neonatal unit environment and to your new baby and so when you feel ready we encourage you to perform The best way a mum can be involved in your baby’s care is to express breast milk. This is discussed further in the feeding section. The next page tries to explain what an average day in your baby’s life can involve. These include: A Day in the Life X-ray’s Blood gases 07.30-07.45 – Nursing handover – the day shift take handover from the night shift involving a detailed discussion of your baby’s condition. If you are here at this time you will be asked to step out of the room for 5-10minutes for confidentiality of other baby’s. 09.00-11.00 - 11.00-1300 - Ward Round. An important time for us is our morning ward round, this usually happens between 9.00 – 11.00am in the Intensive Care (Room 1) and 10.30 – 12:00 in High Dependency (Room 2) finishing in Special Care (Room 3). This ward round is a time when a Consultant or Specialist Registrar will review what has happened to your baby over the last 24 hours and will make a plan of management for the next 24 hours. This is a medically challenging part of practice where sensitive and detailed information is discussed and requires full concentration and commitment; we therefore prefer that limited visiting takes place at this time unless there are exceptional circumstances. Updates are always available from nursing and medical staff throughout the day and therefore you do not need to be present for the ward round to see a doctor about your baby. Following the ward round very often tests and interventions are necessary for your baby, the sicker your baby the more interventions are likely. Insertion of lines Drugs For more information on the above please see the Bliss booklet in your admission pack. Cares – This is the term used for nappy changes and meeting any other hygiene needs for your baby. We encourage mum and dad to perform baby’s cares and the nursing staff will teach you as soon as you feel ready. Cares include changing the nappy, cleaning your baby’s mouth and eyes, changing bedding if necessary and generally ensuring that your baby is clean and comfortable. Cuddles – You will be encouraged to have cuddles with your baby during the day and the nurse will advise you the best time to do this. 13.00-15.00 - Quiet Time – Quiet time is an important time in the day for your baby as it is a time when all the lights are down and the staff and encouraged not to touch the baby’s unless it is urgent. Talking is kept to a minimum and only mum and dad are permitted into the room to visit. 13 A Day in the Life 15.00-16.30 - Further interventions and cares as between 11.00 – 13.00. 16.30-17.30 - Evening ward round – a more informal ward round and general handover between medical staff from the day team to the evening team. You may be asked to leave the room briefly whilst this is done. 17.30-18.30 - Fluid Changes – If your baby is having fluid infusions due to being unable to feed or infusions of drugs these must be changes every 24 hours by the nursing staff. This is a sterile procedure. 18.30- 21.00 - Further interventions and cares as 11.00-13.00. Lights are turned down to prepare for night time. 21.00 – 21.30 - Nursing handover - the night shift take handover from the day shift involving a detailed discussion of your baby’s condition. If you are here at this time you will be asked to step out of the room for 5-10minutes for confidentiality of other baby’s. 21.30 – 07.30 - Care continues as through the day. Although parents have open visiting 24 hours a day we ask that no other visitors come after 21.00. We try to encourage night time for your babies to get them into a normal routine. 14 Procedures common on the neonatal unit. During your baby’s stay on the unit s/he may undergo a number of procedures. All of these will be fully explained to you by the nursing and medical team but we have tried to explain a few of them here to prepare you. Lumbar Puncture Eye Tests – Test on the neonatal unit are required for all babies born at less than 32/40 and less than 1.5kg. They are performed by a specialist Ophthalmologist – an expert in looking at premature babies eyes from Manchester Royal Eye Hospital. This can be on different days each week put the nursing staff will know when this test will happen and will inform you when it is time for your baby’s test. Heel Pricks/Capillary blood sampling Long Lines/Central lines Cannulas Blood Transfusions Cranial Ultrasound X-Rays Nasogastric/Orogastric tubes More details on these procedures are available in the Bliss booklet available in your admission pack. 15 Visiting Policy decrease the chance of spreading infection. To respect other parents and their babies it is important that siblings behave appropriately. My baby has been admitted to the Neonatal Unit, what happens now? How many people can come to see my baby? We want you to feel as welcome and comfortable as possible and really encourage you to let us know if you are feeling uncomfortable or we can make the experience better in any way. For parents that have never been to a Neonatal Unit it can be quite an intimidating place to be. We are aware that this is a time when parents feel very vulnerable and can feel a loss of control and we would like you to feel as involved as possible in your babies care. To be able to look after your baby to the best of our ability we ask that under normal circumstances no more than 3 people are at the side of a cot, space is limited in the rooms and more visitors can make the rooms very uncomfortable and increase the risk of infection. If the room is very busy this may be reduced to 2 people. We have parent/relatives facilities and other family members can wait in this area. When can I see my baby? Are there any times when we cannot visit? We have an open policy for parents in that they can visit at any time, though it is also important for you to rest and try to continue with structure such as meals/drinks especially for mothers who are breast feeding. There are times when the Neonatal Unit is very busy, we ask for your help in letting us care for your baby and the other babies to the best of our ability. An important time for us is our morning ward round, this usually happens between 9.00 – 11.00am in the Intensive Care (Room 1) and 10.30 – 12:00 in High Dependency ( Room 2) finishing in Special Care ( Room 3). Can other relatives/friends come to see my baby? Relatives and close friends are allowed to visit if you wish. We will ask you to write a list of family members who you give your permission to visit, if you have given your permission it is not necessary that you are here when they visit. We ask that visiting other than by parents is before 9 pm. To protect your privacy we will not permit visitors on the unit without a parent if they do not appear on your list. Small and sick babies are very vulnerable to infection so we would ask that no one visits who has a viral illness, (cold or upset stomach) or been exposed to an infection such as chickenpox. Brothers and sisters can visit but we ask that no other children are brought onto the Neonatal Unit; this again is to try to Since this is an intensive care unit and babies can be born or become unwell at any time sometimes it is difficult to stick to set routines and we may need to ask you to step out of the room for X - rays or for performing a procedure. Do I have to stop feeding for the ward round? We are very aware how important establishing feeding is and if it coincides with the ward round will try to accommodate this using the breast feeding room or screens. 16 Who can I talk to about my baby? We have quite an informal approach and a Consultant / Specialist Registrar is usually available for a detailed discussion/update later in the day after the ward round. We work very much as a team on the unit and encourage parents to discuss progress or concerns etc with our nursing staff and the rest of the medical team. As your baby moves through the Unit his/her care will change from intensive medical care to supportive care most of which will be by yourselves as parents and the nursing staff. This is why we work as a team so as to reflect this, when a baby is admitted and needs a lot of medical input you will have a lot of contact with the medical team but as a baby becomes better it is the nursing team who are more closely involved. If you wish to speak to a consultant at any stage then please let the nurse looking after your baby know and we can meet at that time or arrange a time that is convenient. Can I have any special time with my baby? We have also been trying to develop more ‘quiet time’ for families where we are trying to enable parents to spend time with their babies in as calm an atmosphere as possible. During this ‘quiet time’ we will try to cut down noise and disturb the babies as little as possible. This is between 13 pm and is a time when we encourage parents only visiting. We very much want to work in partnership with parents and need your help to make this happen, we of course understand that this can be a very emotional time and though we believe that the above policy is in the best interest of yourself and your baby there are of course circumstances when we make exceptions, for example if a baby is very unwell. We aim to treat you with respect at all times and expect the same in return, though we understand that this is a very emotional and stressful time we will not tolerate violent or aggressive behaviour towards staff members and may ask visitors to leave if their behaviour is deemed inappropriate or offensive. Please speak to the nurse looking after your babies if you have any further questions about visiting. We understand that during the stressful time that your baby is on the neonatal unit you will require support from family and friends. We try not to restrict who visits but we do have some rule for infection control reasons. Nobody but mum and dad and siblings are able to touch baby when they are in intensive care or in an incubator. When baby is in a normal cot and almost ready for home then it is at mum and dad’s discretion whether they allow other family members to touch baby however we do discourage this for infection control reasons. 17 Summary Infection Control Parents have open visiting Brothers and sisters can visit but no other young children (unless exceptional circumstances). Family members and close friends can visit with written permission of parents and before 9pm No more than 3 people should be at a cot side at the same time. Daily ward round Room 1 9am – 11 am Room 2 10:30 – 12:00 Room 3 11:30 – 12:00 Visiting discouraged during the ward round, unless exceptional circumstances and then only at the time your baby is being discussed. During ‘quiet time’ between 1-3pm we encourage parent only visiting. All team happy to update about progress at any time – more formal meetings can be arranged at convenient times. Infection prevention on the neonatal unit is extremely important. All the babies on the unit are vulnerable to infection and any infection can be devastating to an infant. Hand washing is the single most important way to prevent infection. On entry to the unit there is an alcohol gel dispenser, please rub your hands with this gel on entering and leaving the unit. When entering any of the nurseries (ICU/HDU/special care) you and any visitors must wash your hands at the sink. If you are going to handle your baby you must then put more alcohol gel on your hands. You must wash your hands following any nappy change and gel your hands if you have moved away from your baby and then returned, even if you haven’t touched anything else. Outdoor coats must not be worn in the nurseries and must be left on the coat stand on the corridor – please ensure you do not leave any valuables in your coat. One soft toy per baby is allowed in incubators or cots. This must be taken home and washed each week. 18 Feeding your baby You can ask any of the nurses to show you how to express your milk, and if you have any questions please just ask one of us. When your baby is admitted to the neonatal unit you will be asked how you want to feed your baby. Even if you eventually want to bottle feed with formula milk when you go home we will ask if you would like to express breast milk for your baby whilst he/she is in hospital. This is because breast milk: is easy to digest and is absorbed more easily than formula milk helps your baby’s digestive system to grow and develop helps protect against infection and reduces the risk of bowel infection Helps brain development. If your baby is born early or is sick he/she may not be given any milk for a few days but it is important that you start expressing your milk as soon as possible to establish a good milk supply. This can be frozen until your baby needs it. Even if your baby is not being fed milk you can clean his/her mouth with breast milk. This gets them used to the taste of the milk and also helps to mature their digestive system. Ask your nurse to show you how to do this. Sometimes if your milk supply is slow to establish or you are on certain drugs we may need to supplement your own breast milk with pasteurised donor expressed breast milk. We will talk to you about this if we feel your baby would benefit from this milk. 19 Helpful Information Shops Car Parking There is a W H Smiths in the main hospital up the corridor from pharmacy and main outpatients. The car park for the unit is pay and display. For parents a weekly ticket is available. You can buy ticket for 3 days for £5, when this runs out ask the nurse caring for your infant for an extended parking pass which will extend your ticket for a further 4 days meaning parking is £5 for 7 days. Chaplaincy A monthly Farmers market takes place within the hospital – ask staff for details. The WRVS regularly have stalls selling quality goods at reasonable prices often raising money for different areas of the hospital. The hospital is close to Altrincham Town centre – for directions ask a member of staff on the neonatal unit. There is a chapel in the main hospital – Contact Number: 0161 291 2297 Registering your baby The chaplaincy service is always available, if you would like support please ask the nurse caring for your baby to contact the chaplaincy service for you. Your baby’s birth must be registered before they are 6 weeks old. This can be done at the registry office in Manchester – ask staff for a leaflet with details. Eating There are vending machines with snacks, drinks and hot meals available at maternity reception. There is limited availability for this to be done within the hospital – contact number: 0161 291 5188. Fundraising The main restaurant in the hospital is the Southmoor restaurant, just down the corridor from the chapel. This restaurant serves hot and cold food. There is also a WRVS sandwich and coffee counter in the main outpatients department of the hospital. Opening Times: There is a Tesco supermarket on the corner of Southmoor Road and Altrincham Road with a restaurant and a MacDonald’s restaurant on Altrincham Road. We are very lucky to raise a number of funds through charitable donations. The Neonatal unit has an endowment fund for buying specialist equipment and a Daisy fund for staff education. If you would like to make a donation feel free to contact Jan Owen in Income generation on 0161 291 5961 or speak to a member of staff. 20 Planning for Home Your baby will be eligible for discharge home when feeding on demand and gaining weight satisfactorily. Occasionally babies will be sent home with extra support with feeding and home oxygen. This is explained in more detail in the Bliss booklet available in your admission pack. Your baby will be followed up by the neonatal team led by your named consultant. Prior to discharge the staff on the neonatal unit will ensure that you feel completely confident in all aspects of your babies care and support you with any worries or concerns you may have. You will have teaching on resuscitating a baby before going home. This is offered to all families that have had a baby on the neonatal unit. This gives you the skills you may need if you were ever around when any baby stopped breathing. Follow up appointments are in Paediatric outpatient clinic. Your first follow up appointment is usually 6 weeks after discharge and will be sent out in the post to your home address. Babies born weighing less than 1.5kg or at less than 32/40 will be followed up until around their 2nd birthday. 21 Community Special care Support When you go home depending on the area you live you will be supported by your health visitor or the community special care team who will support you with any questions you may have and will keep an eye on your baby’s progress. You will be given more information on this by the nursing staff helping you to prepare for discharge. Parent Support Group Wythenshawe neonatal unit offers a parent support group in the community. This is offered to all parents whose baby has spent time on our unit. So come along and join us, the last Wednesday of every month 12.30 – 2.30pm at: Surestart Children’s Centre, It gives support and offers advice allowing parents to share experiences. Friendships between parents are formed and staff are at hand to provide information on feeding, reaching milestones and weaning. These topics have been a great resource to parents. We are a small informal group and meetings are held once a month……. Baguley, Manchester, M23 1LB. Contact 0161 291 2932 or email [email protected] for more information. 22 Accessing further information There are numerous websites available for you to gain further information on having a baby on a neonatal unit; many of these can be found at the back of the Bliss booklet you received in your admission pack. www.bliss.org www.makingitbetter.nhs.uk www.nice.org.uk
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