Homecare Team

The aim of the Children's Homecare team service is to provide high quality, holistic care in partnership with child and family, maximising the child's developmental potential.  To reduce the negative effects of hospitalisation on children and families by facilitating early discharge or preventing admission and to support parents in the care of their sick child at home, when this is in the best interests of the child.

Visiting times - 7 days per week, 9am - 5pm including Bank Holidays.

Referral Criteria

• Referral to the Children's Homecare Team will prevent admission, reduce length of stay, or prevent ward attendance.
• Children will be under the care of an Acute Trust Paediatrician
• Children are aged 0-16yrs.
• Parents and children agree to be visited by the team

The team will visit any child that attends Barnet and Chase Farm Hospitals and resides in Barnet, Enfield, Hertsmere and North and East Herts.

Range of Services

• Acute nursing care provided in the home
• Monitoring of children during acute phases of chronic conditions.
• Terminal care
• Neonatal care
• Nurse led constipation/encopresis clinic
• Liaison between acute, community and tertiary services
• Health Promotion
• Parental support and education

Provision of care

Referrals come to the service from the Children's Wards, A&E, Out Patient Departments, Paediatric Assessment Units and Tertiary Centres. The following describes the type of work undertaken by the team on a regular basis, this is not however, an exhaustive list.

Short term intervention to treat, support and monitor children

• Children with acute respiratory conditions such as asthma and bronchiolitis, enabling a reduction in hospital stay
• Wound Care - preventing hospital attendance
• Provision of intravenous antibiotic therapy to reduce length of stay
• Monitoring of hydration status for children with gastroenteritis
• Sleep Studies for apnoea
• Monitoring of conditions including Nephrotic Syndrome, Henoch Schonlein Purpura, thus avoiding or reducing length of admission
• Teaching drug administration to parents/carers

Oncology care

The oncology caseload forms a large part of the overall workload of the team and includes care of children with solid tumours, leukaemias and other haematological diseases.  The majority of patients require home visits at least 1-2 times weekly for blood sampling, clinical monitoring and central line care.  Results need to be closely monitored and acted upon promptly. This involves close communication with the family and staff from secondary and tertiary centres. The team provide a strong link between the family and Primary, Secondary and Tertiary services.

The Oncology Sister supports the team in the management of weekly oncology clinics, and chemotherapy administration.

The team provide terminal care and work closely with the Symptom Care Team at GOSH across all PCT's in order to provide a cohesive end of life service mainly, but not exclusively, for oncology children.

Enteral feeding support

Acute care includes teaching families and other formal and informal carers management of enteral feeding. This may also include teaching in placing Gastrostomy and Naso-Gastric tubes. Visits may be needed in order to pass NG tubes as either part of routine care or at short notice in cases of displacement.

Once families are able to self manage they are discharged from the caseload.

The Team also provide advice at home or within schools on the treatment and management of infections, granuloma and resizing of buttons.

Dermatology

The team provide support and advice on the management of Eczema for families and carers, including teaching on specific areas of treatment such as Wet Wraps and other bandaging techniques.

Orthopaedic conditions

The team provide support and monitoring at home for children in hip spicas and harnesses, they are also able to set up and support families caring for children at home in traction.

Acute episodes/on-going therapy in long term conditions

There are a number of children with relapsing conditions such as Nephrotic Syndrome and Chronic Renal Failure who need support and management during periods of relapse. The team also provide a service administering cytotoxic therapy such as methotrexate injections at home to children with Juvenile Rheumatoid Arthritis.

General teaching and support

The Team provide training to children, parents and carers in other areas such as:

• Anaphlaxis management and Adrenaline administration
• Other medication training e.g. inhalers, eye drops
• Medical and Nursing equipment, Nebulisers, Suction

Neonates

The aim of the community Neonatal nurse is to reduce the length of stay for premature babies on the neonatal unit by supporting parents in discharge planning followed by support and advice in the initial period at home. 

Whilst there is no set criteria for gestation and weight for a baby to be discharged home, the neonatal team is now able to confidently discharge babies as young as 34 weeks gestation as well as weights from 1600gms.  Parents are supported with feeding, medication, oxygen therapy and any ongoing medical needs. 

Infants who have received phototherapy treatment for jaundice on the unit can also be monitored at home, thus reducing the length of stay.

The majority of babies are discharged to the care of the Health Visitor when they reach term; babies with complex conditions who require continuing support are followed up past their term date. 

All parents have contact details for the children's homecare team staff during service hours.  If parents have any concerns out of hours they are encouraged to contact the children's ward directly for advice and support from the medical/nursing teams.