"Lack of tracheostomy trained nurses on PICU"

About: Birmingham Children's Hospital / Paediatric cardiology

(as a parent/guardian),

My son was transferred back to BCH after spending four months in Freeman Hospital, where he was awaiting a heart transplant. His heart gained some function back, enough to come off the transplant list and so we were transferred back to BCH as it is our local heart unit.

Whilst in the Freeman he had a very rocky road to recovery and had to have a tracheostomy as he failed to wean from the ventilator. He came to BCH on a Nippy ventilator.

I was shocked and upset by the lack of tracheostomy trained nurses in PICU. I had assumed that this was a standard of nursing that was basic but apparently not. Then it appears to be standard practice to allocate my son non trachy trained nurses on a regular basis. To heighten this he was in a cubicle due to MRSA so we couldn't have the peace of mind that the nurse in the bed space next to him was trachy trained either.

As parents, we are not allowed to care for our own son until we are fully assessed as being trachy competent, yet a nurse on her own could care for him when they are not trachy competent.

I don't dispute that his care was excellent in all other areas but feel this was inappropriate.

One night his tracheostomy dislodged, the nurse apparently pulled the buzzer and tried to replace his trachy with his spare but couldn't get it in so used the downsized tracheostomy. This is standard of what to do in an emergency trcahy change. However the downsized trachy tube remained in place all night when in fact as soon as the situation had calmed down and was under control he should have had his original size back in.

This led to another emergency trachy change in the morning when his smaller sized tracheostomy blocked with secretions and I am told he had a 'blue' moment. I believe this could have been avoided by changing back to his original size asap. The original size was managed to be put back in by a consultant this time but was probably a little uncomfortable for my 6 month old son as the smaller tube had been left in situ for so long.

I believe this situation could have been better managed had the nurses been trachy trained and competent. It is not enough to rely on the fact they know life saving skills in the event of an emergency but that they know all tracheostomy care including emergency tube changes.

This whole situation has left me feeling uneasy as I cannot be with my son as much as I would like as he has five other siblings I have to care for.

I hope from this some training is put in place for the staff and that nurse allocation is much more carefully considered.

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Response from Deputy Head of Nursing, Patient Experience & Participation Lead, Birmingham Women's and Children's NHS Foundation Trust We are preparing to make a change

Dear Loishayley,

Thank you for taking the time to bring this to our attention. Whilst it is encouraging to know that the overall care of your son has been excellent we are extremely sorry that the care of his tracheotomy has been less than so and has left you feeling shocked and upset.

Thank you for meeting with the Clinical Lead Nurse for PICU to discuss this in person, I hope this was helpful and provided you both with assurance that we are taking your concerns very seriously and reassurance that there is always a senior member of the team available for you to raise any concerns over your son's care with.

A thorough investigation will be undertaken and Gill will keep you informed of the outcome. In the meantime please do not hesitate to contact her or any other member of the PICU team who will welcome any additional feedback.

I sincerely hope your son continues to make a good recovery and during this time you feel confident that he is receiving the best possible care, something we want every family to feel.

Best wishes,

Sarah Bundy

PICU Family Liaison Sister

Ext: 9686

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