Hospitals collaborate for patient care

It all started when Jayln began complaining of a sore foot. After a couple of days, his foot started to swell and turn purple, his temperature spiked to 39 degrees and he developed an itchy rash all over his body.

Concerned mum, Rebecca, took Jayln to their closest hospital in Warren, in Central NSW. Jayln was then transferred to Dubbo Hospital. Dr Dominic Fitzgerald, Dubbo Paediatrician reviewed and then referred the family to the Rheumatology Department at The Children's Hospital at Westmead (CHW).

It was here that Dr Singh-Grewal, Paediatric Rheumatologist diagnosed Jayln with Systemic Juvenile Idiopathic Arthritis (SJIA). SJIA is one of the subtypes of arthritis in children and teenagers. “Systemic” means it affects not only the joints but causes fevers, rash and sometimes other parts of the body. In Jayln's case, it caused fever, rash and swelling in his ankles, knees, hands, and wrists.

On the bad days, Jayln’s condition stops him from getting out of bed. He has trouble walking and as a result, has to miss out on school.

“SIJA is caused by having too many cytokines in the bloodstream that leads to the inflammation of different joints in the body. Tocilizumab helps to block one of the cytokine pathways and in turn, reduces inflammation, lessons the symptoms and helps stop further joint damage,” explained Anne , Rheumatologist at The Children’s Hospital at Westmead. 

When Jayln was originally diagnosed, to support Jayln and the family to prevent them from making the massive 477km journey to CHW every fortnight, the Rheumatology team liaised with the Dubbo Paediatric Ward and pharmacist to allow Jayln to receive his two-hour Intravenous Tocilizumab.

Once it was established that Jayln tolerated the infusions, the three teams worked collaboratively to support Jayln to receive his treatments closer to home.

Thanks to the collaboration between the Rheumatology Department at Westmead and Jayln’s local hospital in Warren, Tina Robinson, Registered Nurse at Warren Hospital, put her hand up to learn how to mix and administer Jayln’s medication so the family didn’t have to travel so far.

“My colleague and I went to Dubbo Hospital to be taught by Pharmacist there about the specific mixing technique for Jayln’s medication. Over six months, we learnt how to use certain devices to mix the specific quantities needed. For each mix, we need to wear Personal Protective Equipment (PPE) to ensure the medication isn’t compromised during the mixing process,” said Tina.

With this new skill, Tina can administer Jayln’s medication through an IV drip every fortnight for the two-hour appointment. Being closer to home has helped ease some stress for the family and allows Jayln to reduce the days he misses school.

“The Rheumatology team have made a big difference to our family and Jayln. He has been treated so well by all of the team and they have gone above and beyond especially looping in with our local nurse Tina to help with his treatment. I thank them so much for what they have done and what they continue to do for us,” said Rebecca.