LAUSR

Background Children admitted for a long-term hospital stay are at risk of developmental delay due to limited access to developmentally appropriate stimulation. Children, in critical periods of their development, are often isolated due to infection and restrictions of treatment. They can be confined to one bedroom, tethered to equipment, have limited access to peers, play areas and family life. This project assessed the needs of children and families staying on the Great Ormond Street Hospital (GOSH) Transitional Care Unit and evaluated the value of potential solutions to these challenges. Method This was a mixed methods service evaluation utilising the ward multi-disciplinary team (MDT). Methods included semi-structured qualitative interviews, observations of the ward environment and culture, creating systems to monitor children’s access to developmental opportunities and monitoring children’s progress. Results Semi-structured interviews established that all staff felt that the current situation for these children was unacceptable. Key targets were embedded in the children’s routine care such as; trips off the ward, encouraging parent-led activities, improving staff awareness, developing the ward environment including improved parent and child spaces. Developmental ward rounds were created to support staff to target developmental milestones. Conclusion This study has shown that critical analysis of a complex situation requires creative thinking and MDT engagement. Small changes to ward routines and staff culture can potentially improve the developmental outcomes for children. All children who stay in hospital long-term should have their developmental needs considered to reduce the potential impact of a long hospital stay. The ethics of medically complex children, requiring lengthy hospital admissions, remains a complex issue that requires a team approach to service provision and evaluation. The MDT plans to continue to monitor the developmental outcomes for children on the ward to support future clinical planning.Abstract 010 Table 1 Comparison of ward changes Child’s experience in 2013 Problem Solution Child’s experience in 2018 Unable to leave bedroom of ward Limited staffing to leave the ward Increased staff and a culture of weekly trips out Frequent trips off the ward Inappropriate space to play Small bedrooms – children often left in bed with toys Building a developmentally stimulating play room and larger bedrooms Access to play room and larger bedrooms Limited access to developmental support Sporadic MDT involvement, nursing team report little time/experience in developmental support Joint MDT developmental, nursing staff ward rounds to set developmental goals, regular nursing and play input Regular access to developmental support Staff unable to recognise developmental delay Staff identified they did not know developmental milestones for children Regular MDT input to set developmental goals based on milestones Nursing staff participate in ward rounds help monitor children’s progress Parents unable to stay on ward No room for parents to stay, no space for parents to spend time other than their child’s small bedroom Large ensuite bedrooms and dedicated parents space provided for support and social interaction Parents on ward for longer, participating in wake-up and bedtime routines No developmental assessments Staff outsourcing developmental assessments to neurodisability team every 6 months MDT completing regular assessments and highlighting needs. Still a need for developmental paediatrician role on the ward Regular formal developmental assessments completed to track progress Ward care focussed on medical needs Little focus on developmental support for children Changes to nursing daily plans to monitor developmental care e.g. trips out, protected mealtimes etc Developmental care now monitored via paperwork completed daily by nursing team TV and dummies regularly used for comfort as children left along for long periods Children left to play alone with TV on and dummy in, some children presenting with challenging behaviour e.g. self-decannulation if left alone Staff made aware of impact of TV’s and dummies and reduced reliance on these Staff now using volunteers if children left alone for long periods of time