Improving patient safety along the paediatric gastrostomy pathway is a new programme for the Oxford PSC, and currently in the scoping phase. Gastrostomy insertion is usually indicated in patients that are failing to thrive or have an oral nutritional intake which is expected not to resolve in 1 to 3 months’ time and failing to meet metabolic needs. Like any interventional procedure, there is potential for complications [including chemical peritonitis, infection, bowel perforation, haemorrhage, and aspiration pneumonia] but prompt recognition of these complications with early action reduces the risk of serious harm or death. However, significant portions of the patient pathway involve care in the community where parents and carers of patients may be supported by a variety of professionals, some of whom can be relatively inexperienced with respect to the specialised needs of this patient cohort.
The programme aims to foster closer collaborations between different stakeholders in the region, from the initial referral to surgical management of the gastrostomy insertion and subsequent follow-up and long-term care in the community, including transitional care to adulthood Through feedback from key stakeholders including patients and their parents and carers, vulnerable points along the pathway have been identified and projects developed to improve the reliability of processes and outcomes, the care provided to patients and support for parents and carers.
The inaugural Steering Group meeting was held in mid-October 2016. The group currently comprises paediatric surgeons, paediatricians, specialist paediatric nurses and dieticians from the acute, community and palliative sectors, from across the whole AHSN patch. There are plans to further expand it with additional professionals and patient [parent] representatives.
The composition of a wider Stakeholder group is also well underway
Early indications are that initial workstreams will focus on the later portions of the pathway, supporting parents of patients caring for their children in the community, and helping to improve communications and build networks between the different professionals supporting them
Early detection of complications after gastrostomy, NHS Direct Alert, March 2010