The Tanner Report
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42 recommendations
Skills, training &maintaining competence
Ambulance service
Resuscitation
Stabilisation
HDU Care
Planning
Governance
Surgery in children
Support for the family
The Tanner Report
Implementing the
recommendations in Scotland
(Are we ahead of the game?)
Neil S. Morton
RHSC Glasgow
(with thanks to Maria Rollin)
Recommendations
• Competencies not professional labels
• Team working
• Networks of care
• From initial presentation to PICU and
beyond!!
Generic skills
1. To recognise the
ill child
Spotting the Sick Child. Ffion
Davies
DH Sept 2004
http://www.ocbmedia.com
Skills, Training and Maintaining
Competence
1.
Generic skills
2.
To initiate appropriate immediate treatment
3.
To act within a team
4.
To maintain and enhance skills
5.
To be aware of issues of safeguarding children
6.
Effective communication with children and carers.
Skills, Training and Maintaining
Competence
•
Opportunities to maintain skills
•
In-service training and scenarios
•
Forward planning of resuscitation and
stabilisation teams
•
Intensivists with PICU experience
Skills, Training and Maintaining
Competence
Where an anaesthetist is, through unexpected
circumstances such as a very ill child
inappropriately presenting to a hospital
without paediatric expertise, required to act
beyond his or her practised competencies it is
his duty to make the care of the patient his
first concern and his employing trust’s duty to
support him’.
Recommendation 7 (iv).
Tanner report
Ambulance Service
•
•
•
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Transfer plans
Retrieval service
Drive-by policies?
Paediatric training and expertise?
Resuscitation
• Advanced paediatric life support skills
• Led by clinicians with appropriate skills and
knowledge to identify life-threatening illness
and start emergency treatment
• Suitable environment and resus facilities and
drugs
Stabilisation
• Team= paediatrician, anaesthetist or intensivist,
nurse +others as appropriate
• Lead senior clinician
• Location
• Routine (daily) check of drugs and equipment
• Develop common standards across the hospital
High Dependency Care
All hospitals providing in-patient care for
children should have arrangements for
High Dependency Care
Ref: High Dependency Care for Children-
report of an expert advisory group for
Dept of Health 2001
Planning
• Network DGHs + tertiary centre with PICU
• Good communication
• Guidelines on admission to adult ITU.
• Where A and E but no paediatrics,
consideration must be given to cover
Surgery in Children
• Networks
• Proper training and updating
• Emergency surgery only where there is
elective surgery and inpatient facilities
Surgery
Protocols for:
• Airway obstruction
• Shock
• Head injury : -requiring intubation
- not requiring surgery
- requiring surgery
- with other injuries
• VP shunt malfunction
• Acute scrotum
• Fractures
• Burns
Responsibilities
Individual
Keep up to date and practised
• courses
• continuing experience
• simulators (Sim-Baby)
• refresher training
• Hands-on weeks
• Accompanied lists in local centre
• “DGH lists” in paeds centres?
• telemedicine
Responsibilities
Team
Practise together
- real time, real environment
scenarios
Responsibilities
Organisation
• Equipment and facilities for resuscitation and
stabilisation
• Time and resources for training and
practice
Responsibilities
Consultant paediatrician
Must maintain personal involvement in
and responsibility for the care of the
child.
Tanner 2006
Responsibilities
PICU/ Tertiary Centre
• Timely advice: one call system, telephone
advice, telemedicine links
• Support
• Practical help in securing a bed
Everything OK then?