Paediatric Intensive Care — PICU at The Children's Hospital Westmead

Contact details

Phone: (02) 9845 1995


Fax: (02) 9845 1993


Location: Intensive Care Unit, Ward Street, Level 3

Our vision is to provide the best care to children and their families.

The Paediatric Intensive Care Unit (PICU) is a 21-bed unit providing supportive care to 1400 infants, children and adolescents each year. Patients come to us with the entire spectrum of critical care problems. We manage all critical illnesses, including mechanical ventilation, mechanical support of the circulation, and support of organ systems.

Patients may be admitted following surgery including cardiac surgery, neurosurgery, liver or renal transplant or with a range of other conditions such as respiratory illness, trauma, burns or other severe medical conditions.  We provide an Outreach Service for review of ward-based patients following discharge from PICU, and any patient experiencing clinical deterioration where PICU assistance is requested or any patient that may require PICU admission.

We are a nationally funded centre for paediatric liver transplantation. We are one of two sites participating in the national funding centre program for Hypoplastic Left Heart. The Children’s Hospital at Westmead is also the state referral for burns. 

PICU provides intensive care facilities for all NSW children, and when required to interstate and overseas patients. PICU is open 24 hours a day 365 days a year.

Quality and safety

Our mission is to serve critically ill children with the highest level of expertise, dedication and compassion. For many years PICU has monitored quality and safety and incident management procedures have been in place since the mid-1980s. In 2014 PICU redesigned its Quality and Safety Committee to align with The National Safety and Quality Health Service Standards. The philosophy of the quality and safety committee is to promote a just culture, enhance incident reporting and encourage staff participation in quality initiatives. To enhance staff and consumer engagement, PICU provides:

  • A visible electronic safety and quality board in the ward
  • Quarterly Quality, Safety and Research newsletter (QuaSaR)
  • Regular auditing
  • Family advisory council within PICU

PICU meets monthly to review any incidents and quality improvement projects, with changes implemented by a team of senior staff. All staff involved in direct patient care are included in running clinical projects and are supported to implement changes to enhance Quality care in PICU. 

For parents

Being in the PICU is different than being in a regular hospital ward. The intensive care environment and the experiences of parenting a critically ill child can be challenging. Your child may look very different with all the monitoring and care equipment surrounding them. There may be swelling, skin tone differences and your child will likely not be wearing pyjamas. Your child may also act differently, depending on his or her age and how awake he or she is while in PICU. Your child may be very sleepy or unusually restless.

Your bedside nurse and the other members of the team are there to explain these changes and help you to anticipate what will happen next. We recognise that you are the expert about your child and need you to help determine your child’s needs with us. Together we can make sure your child is comfortable, rests well and is supported toward recovery.

It’s important to ask questions about things that you notice about your child and the PICU care.

Because your child requires specialised care, there will be a number of different health-care providers will be involved with your child’s care. The PICU team will coordinate and communicate with your child’s other doctors and team members during your time in PICU.

Who's who in PICU

An Intensivist is a doctor with expertise in caring for critically ill children. Fellows are doctors who have completed their core education and are now focusing on children with critical illness. Registrars are doctors who are undertaking further education in Paediatric Medicine, Surgery, Anaesthetics, Emergency Medicine and other disciplines.

Consulting Staff Specialists are doctors who are experts in a specific area of the care of children. The Staff Specialist will assist in the management of your child. You may have a team who cares for your child outside of PICU. The PICU team will work with that team. A consulting staff specialist will also have a team of fellows and residents.

The Nurse Manager and Clinical Support Nurses run the hour-to-hour activities in the PICU. These nurses will make shift-to-shift decisions and plans for nurse assignments, discharges and admission of patients, and assist with patient care.

Your child’s care

Every day a pod will be assigned to your child’s and they will work with your child’s nurse to answer all your questions. Let the bedside nurse know you have questions or issues to discuss and they will arrange for the right person to meet with you.

Each day one of our intensive care consultants will see your child to check on their progress. These visits are called rounds and occur at your child’s bedside, and are attended by the bedside registered nurse, PICU doctors (consultant, fellow and registrar), nurse team leader / access nurse and a nurse practitioner.

Morning rounds commence at 8am with afternoon round starting from 3pm. During rounds, your child’s condition will be discussed with plans made for the day. You are welcome to be present and are encouraged to ask questions at the end of the round.

Procedures

Sometimes medical procedures take place in PICU. Some of these procedures are planned and some are emergencies. If a procedure is happening to another child in your child’s room we will ask all family members of the other children to wait outside the room. If your child is having a procedure while in PICU, you can discuss with your nurse how we can help you to support your child during the procedure. Each situation is different and a plan for the procedure can be made ahead of time.

Keeping in touch

You can call day or night: When you are at home or outside PICU, phone the main desk on 02 9845 1171, alternatively you can contact your child’s bedside on 9845 15_ _ (bedside number i.e. bed 1, dial 01, bed 10 dial 10) and speak directly with your child’s nurse for progress reports.

Information is given to parents or legal guardians. If we cannot come to the phone, someone will explain why. We will call you back as soon as possible.

Visiting PICU

As a parent, you are encouraged to be with your child as often as you wish. Supervised visits by brothers and sisters a welcome, however, if your child is critically ill it might be better for siblings to wait until improvement has been made. There’s a supervised sibling care play area on Level 1 of the hospital and you may prefer to let siblings play there while you spend time with your child in PICU.

Relatives and friends are welcome to visit but a parent must be present when they visit and none can have access to your child without your permission and presence. A maximum of two visitors are able to be with you and your child at any one time.

Visiting hours for relatives and friends is 10-noon and 3-8pm. PICU rest time is from noon-3pm. Visiting hours are limited for children in PICU as they require time to rest and recover.

Access to PICU

The PICU doors are locked 24-hours a day and access is only available by using the intercom on the wall outside the department and speaking with a staff member who will be able to see you on camera and unlock the doors to let you in.

Please don’t let others follow you into the ward.

To exit PICU you must press the green button on the left-hand side of the wall near the exit door to unlock the doors.

Nurses

PICU nurses

The PICU team is made up of a Nurse Manager, three Nurse Unit Managers( NUM), a Nurse Educator (NE), five Clinical Nurse Educators(CNE), 20 Clinical Nurse Specialists (CNS) and approximately 135 Registered Nurses (RN). We are supported by a team of seven Nurse Practitioners (NP).

The nursing team is a dynamic, energetic and dedicated group, providing critical care to a complex and diverse patient population. Frontline clinicians are supported by a number of expert practitioners and hands-on clinical leadership team who provide in hour-to-hour bedside care delivery.

The Nurse Management Team manage the daily operations of the PICU with support from senior management. The team meets every month to discuss current practice issues, leadership development and continuing education. This group is integral to advancing practice and innovations in paediatric critical care nursing.

The Clinical Nurse Specialist Group are specialist intensive care nurses who are supported in the pursuit of advanced skills and education for paediatric critical care expertise including:

  • Dialysis, Peritoneal, Hemodialysis, CRRT
  • Renal and Liver Transplants
  • Chemotherapy certified RNs provide therapy to oncology and associated patients
  • Arrest Team
  • Outreach program 
  • HFOV and Difficult Ventilation
  • Nitric
  • Care of post-op cardiac patient including pacing
  • Burns
  • Trauma
  • Neurology
  • ECMO Specialist Training
  • Extra Corporeal Life Support 

Our frontline nurses contribute to organisation initiatives, quality improvement projects, local, national and international education and conferences. Having a clinically competent and confident nursing staff caring for critically ill children and their families is essential in the Paediatric Intensive Care Unit.

Nurse Practitioners

PICU has a team of Nurse Practitioners are experienced and knowledgeable paediatric intensive care nurses. They are expert responders to a deteriorating child and provide clinical support to both nursing and medical staff. PICU Nurse Practitioners hold a range of clinical skills including advanced assessment, diagnostic ordering and reasoning, decision-making, prescribing, intravenous access, airway management, and team-leading acute situations.

They are expert responders to a deteriorating child and provide clinical support to both nursing and medical staff. PICU Nurse Practitioners hold a range of clinical skills including advanced assessment, diagnostic ordering and reasoning, decision-making, prescribing, intravenous access, airway management, and team-leading acute situations.

The PICU Nurse Practitioner role focuses on improving the quality of acute patient care and patient experience. They share knowledge and skills to enhance the competence and confidence of clinical staff; to reduce adverse clinical events; and to improve the delivery of comprehensive care to sick children across organisational and professional boundaries.

PICU Nurse Practitioners are responsible for coordinating the Paediatric Intensive Care Outreach Service and providing a dedicated outreach service with care and management plans that incorporate patient need and trajectory of illness.
Led by the Nurse Practitioners, the Outreach Team has the unique ability to commence intensive care management outside of the PICU and care for patients on the ward while awaiting an intensive care bed. The Outreach Service also provides a follow-up service for those patients discharged from the PICU to the wards, aiming to optimise patient transition and overall satisfaction within the child and family’s hospital journey.

As well as leading the Outreach service, PICU Nurse Practitioners are involved in education and training, simulation, safety and quality projects, incident management, policy and procedure development, research and long-term patient case management.

Nurse education

Our mission is to provide safe and supportive inter-professional development: grounded by the principles of family-centred, evidence-based practice in content, method, design and in all learning relationships. To contribute to excellence in patient care and professional development utilising principles of student-focused learning. To contribute to scientific knowledge specifically related to professional staff development, educational strategies and knowledge transference. Paediatric care nursing and inter-professional education is a collaborative program founded on the philosophy of evidence-based, inter-professional family-centred care.

Goals

  • To provide a practice environment responsive to patient, family, professional team, community and organisational needs
  • To enhance the capacity for continuing education of the interdisciplinary team
  • To facilitate individual learners to achieve excellence in their professional practice and to meet their personal developmental objectives
  • To provide resources and support for the critical care of children outside of the critical care program and hospital
  • To maintain and enhance safe patient care

Initial and ongoing education is valued and supported in PICU. The nursing orientation program and ongoing training efforts are designed using adult learning principles and varied methods of teaching and learning. There is a wealth of knowledge shared and a collaborative approach to educational opportunities helps in achieving the goal of service excellence bringing us ever closer to the vision of healthier children.

Our quality educational program aims toward continuous quality improvement, optimising patient safety, facilitating skill growth and leadership development, enhancing communication effectiveness and accountability. The critical care education is aimed at developing and retaining highly skilled and engaged nurses.

PICU orientation is designed to gradually prepare the newly-hired nurse for this highly complex and technological environment. 

The goal is to prepare the new nurse for collaborative practice, partnering with other healthcare providers to deliver excellence in patient and family-centred care. The duration of orientation is dependent on the individual’s years of experience and considers their individual learning needs and styles.

Newly hired clinical nurses undergo extensive orientation and transition support. Multi-modal approaches including; didactic, workshop, simulation and clinical supervision is provided by our in-house education team and experts from the hospital. This preparation is individualised to the needs of each person, is provided over a period of months and includes a precentorship period.

Staff

  • Dr Nick Pigott, Medical Director, Co-Head
  • Brad Ceely , Acting Nurse Manager, Co-Head
  • Dr Jonathon Egan
  • Dr David Schell
  • Dr Stephen Jacobe
  • Dr Barry Wilkins
  • Dr Marino Festa
  • Dr Robin Choong
  • Dr Elena Cavazzoni
  • Dr Vishal Jatana
  • Dr Corinne Balit
  • Melanie Arino, Nurse Unit Manager
  • Jane Barrington, Nurse Unit Manager
  • David Harper, Nurse Unit Manager
  • Brad Ceely, Nurse Practitioner
  • Michael Haddad, Nurse Practitioner
  • Oliver Tegg, Nurse Practitioner
  • Lynette Kirby, Nurse Practitioner
  • Natalie Duns, Nurse Practitioner
  • Sarah Pearson, Advanced Practice Nurse
  • Kate Leutert, Nurse Educator
  • Amelia Griffiths, Clinical Nurse Educator, ECMO
  • Patrice Valdes, Clinical Nurse Educator
  • Kylie Olcayto, Clinical Nurse Educator
  • Jaisa Kuraikose, Clinical Nurse Educator
  • Jodi Pasfield, Organ and Tissue Donor Co-ordinator
  • Karyn Paull and Gail Harper, Quality and Data Managers

Milestones and heritage

In addition to the history of The Children's Hospital at Westmead, here's some of our highlights.

Date

Event

Intensive care unit named as Helen McMillan Paediatric Intensive Care Unit

1986

First liver transplant

1995

CCIS

199

Medication recorded by computer

2002

Living related liver transplant

2002

Split liver transplant

2011

Nurse-run ECMO program commenced

2014

Simulation centre opened

2016

Green ECMO nurses