Friday Fast Five - meet the Children’s Health Queensland Retrieval Service (CHQRS)

This month for Friday Fast Five we are shining a spotlight on the Children’s Health Queensland Retrieval Service (CHQRS) and their work in supporting the ‘brain on the go’ or neurodevelopmental care during retrieval.  Our training centre is delighted to work collaboratively with the Queensland Children’s Hospital and Mater Children’s Hospital over the past three years in the PICU and NICU setting supporting the application of developmental care through the delivery of FINE level One and FINE Level Two training.

This month we interview Anne-Maree Brady, she is the Clinical Nurse Consultant for CHQRS she has been in this role for 5 years she has an extensive neonatal & paediatric ICU background & qualifications. And has worked in the retrieval setting at both NETS & the Royal Children’s & Mater Children’s Hospital, Brisbane.

Tell us about Children’s Health Queensland Retrieval service:

CHQRS – CHQRS provides a specialist paediatric advice, coordination & transport service for infants, children and young people throughout Qld & NNSW. CHQRS is a hybrid retrieval service, it is neither entirely unit-based (PICU) nor standalone. We are functionally linked to PICU but are not part of PICU. This means that retrieval staff – medical & nursing work in PICU & rotate into CHQRS usually every 2nd month for a month’s duration. This enables staff to maintain their ICU skills but also to incorporate guidelines, procedures and language into the retrieval environment ensuring continuity for the families & patients. There are currently 22 CHQRS clinical nurses in the service. CHQRS retrieves between 750 – 850 retrievals a year & coordinates approximately 1800 cases a year. In 2019 60 neonates were transported by CHQRS with varying conditions – cardiac, respiratory, neurological conditions.

Why have you decided to incorporate neurodevelopmental care into neonatal retrieval?

PICU are incorporating neurodevelopmental principles into their care so it makes sense that CHQRS would start the patient journey adapting the principles to meet the retrieval environment. The carers will see & hear the same language/care by CHQRS & PICU. Retrieval can be a stressful & noisy environment for infants & by incorporating some simple practices into retrievals we can help alleviate some of these stressors.

What components are you undertaking to support the brain on the go (i.e. neurodevelopmental care in retrieval)?

  • Developmental hearts – these will be taken out by the CHQRS team & given to the carers, and placed with the infant providing maternal scent during transfer. My hope is to leave some at referring hospitals & for them to start making them perhaps in their communities

  • Nesting – Kelli Palmer one of the CHQRS nurses made a nest for our neonates that can be used in the neocots with the harness incorporated to secure the baby. We have found using this system the babies appear to be more settled and comfortable in the nest. It also provides support for their heads/necks where previously there has been none.
  • Noise/hearing protection – At a recent neonatal conference in the UK there was a presentation around noise in retrievals. I have contacted the service undertaking this research for further information. My intention is to monitor the noise in our retrieval environment & also source better hearing protection for our patients.
  • NETS trick – I learnt this when I worked at NETS – to show the CHQRS team how to move the infants in a blanket in the shape of a triangle to the neocot or onto the stretcher. This helps with a slower transition from the bed to the neocot & can be done with the baby keeping contact with the bed – leads to safe/appropriate vestibular experiences
  • Breast milk– if the mother can or can’t accompany the infant & is Breast fed we will carry EBM & dip the dummy into EBM rather than offer sucrose

Over what period will the project occur and are you planning on measuring the effectiveness?

The plan is to embed this as standard care. We will endeavour to gain parent/carer & team feedback on all retrievals where we have had a developmentally supportive (FINE based) retrieval. Any learning will be shared with the CHQRS team.

What would you like other retrieval teams caring for neonates to consider in relation to neurodevelopmental care in transport?

Whilst these are small changes in care the outcomes for infants and families can be significant. We need to share our approach and resources so that the retrieval journey for these infants starts in the best possible way.

 

Editor's note: The views of individuals do not represent the view of the Australasian NIDCAP Training Centre.