Prevention Detection and Management of Hypothermia in the Newborn 1

Transcription

Prevention Detection and Management
of Hypothermia in the Newborn
Prevention Detection and Management of Hypothermia in the Newborn
J Bradshaw RM
July 2013 Version 6.0
1
Policy Title:
Executive Summary:
Supersedes:
Description of
Amendment(s):
Prevention Detection and Management of Hypothermia
in the Newborn
To provide information on the correct neutral thermal
environment in order to maintain a normal body temperature
and eliminate thermal stress
Previous Guideline Version 5.0 /2012
Equality Analysis Tool
Addition of Neonatal Early Warning Score Chart
Change to Business Unit
This policy will impact on: Maternity Services
Financial Implications: Non Known
Policy Area:
Maternity Services
Document
Reference:
Version Number:
Issued By:
6.0
Family and Wellbeing
Business Unit
J Bradshaw RM
Effective Date:
Review Date:
Author:
Consultation Phase:
Clinical Lead
Dr A Ho.............................
Prevention
Detection and
Management of
Hypothermia in the
Newborn
July 2013
July 2016
Impact
Assessment Date:
APPROVAL RECORD
Committees / Group
Labour Ward Forum,
Educational Link Tutor and
MSLC members. Midwives,
Obstetricians, Paediatricians
and Paediatric Practice
Development Nurse
Neonatal Nurses
Maternity and Women’s
Service Clinical Governance
Commitee
July 2013
Date
July 2013
July 2013
Date
Head of Midwifery
Mrs L Moorcroft
………………
Date
Received for information:
IT Dept & Legal Services
July 2013
J Bradshaw RM
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Content Page
1.0 Policy Statement
1.1 Background
1.2 Organisational Responsibilities
2.0 Planning and Implementation
2.1 Measuring Performance and Audit
2.2 Review
3.0 Rationale
3.1 Objectives
3.2 Summary of Evidence
3.3 Prevention Detection and Management of Hypothermia in the Term Infant
4.0 Prevention Detection and Management of Hypothermia in the Preterm
Newborn
5.0 Subsequent Care
Infants Nursed in Heated Cots
Kanmed Heated Cots
CosyTherm Heated Cots
5.1 Instructions for the Use of all heated Cots
6.0 Infants Nursed in a Non Heated Cot
6. 1nfants nursed in Incubators on the Neonatal Unit
6. 2 Humidity
7. 0 Servo Control
7. 1 Incubator -Ambient air mode
8. 0 Audit/Monitoring Standard
9.0 References
10.0 Appendix 1 – Neonatal Observation/Feed Chart
Appendix 2 - Equality and Human Rights Policy Screening Tool
J Bradshaw RM
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1.0 Policy Statement
Care should ensure the immediate care of the newborn is appropriate to prevent
avoidable harm. It is important the baby does not develop hypothermia
1.1 Background
This guideline includes guidance based on recommendations following the National
Institute for Health and Clinical Excellence (2007) Intrapartum Care: Care of healthy
women and their babies during childbirth and forms part of the current NHS National
Litigation Authority Clinical Negligence Scheme for Trusts Maternity Clinical Risk
Management Standards 2013/2014 Standard 5 Criterion 4 Immediate Care of the
Newborn.
1.2 Organisational Responsibilities
Chief Executive
Has ultimate responsibility for the implementation and monitoring of the policies in use
in the Trust. This responsibility may be delegated to an appropriate colleague.
Clinical Leads/Head of Midwifery
Where Clinical Leads/Head of Midwifery are asked to ratify this guideline they are
responsible for the review of the guideline and the final ratification prior to the guideline
actually being implemented. This ratification process will take place following the
consultation and approval process.
Trust Committees
As a group are responsible for the consultation and approval process required during
the development of guidelines for the Trust. The committees are responsible for the
review of guidelines submitted to them to ensure that guidelines are appropriate,
workable and follow the principles of best practice.
All Staff
It is incumbent on relevant staff, when asked, to provide comments and feedback on
the content and practicality of guidelines that are being developed and reviewed. It is
the duty of all staff when asked, to provide assistance during the development and
review stages of guideline formulation.
Stakeholders
Are those people with an interest in a guideline who contribute, comment and agree to
the content of the guideline. They include specific committees, groups or forums,
individual colleagues, whole departments, service users and their families.
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2.0 Planning and Implementation
The objectives of this guideline are aimed to ensure best practice in relation to the care
of the newborn to prevent hypothermia.
Newly ratified guidelines are included on the maternity newsletter. Relevant staff have
the responsibility to ensure awareness of the contents of the guideline and to inform
their Line Manager of any training needs which may affect their ability to follow this
guideline
Relevant staff have the responsibility to inform their Line Manager of any training
needs which may affect their ability to follow this guideline.
2.1 Measuring Performance and Audit
The Trust will measure performance of this guideline against the NHSLA criteria stated
under the heading Audit/Monitoring Compliance below.
2.2 Review
This guideline will be reviewed every three years or sooner following findings from
audit, changes to national guidance, or in response to clinical practice. The
responsibility for the review of guidelines lies with the Practice Development Midwives
who will report to the overarching maternity clinical governance committee.
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3.0 Rationale
To ensure that immediate care of the newborn is appropriate to prevent avoidable
harm. It is important to provide a correct thermo-neutral environment so that the
newborn can maintain a normal body temperature and eliminate thermal stress.
This guideline is only one aspect of the Immediate Care of the Newborn (NHS
Litigation Authority (2013/2014)
3.1 Objectives
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To maintain the infants temperature between 36.5°C and 37.3°C
To correct hypothermia safely
3.2 Summary of Evidence
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Thermoregulation is a physiological function closely related to the survival of the
sick or preterm infant.
Thermal stress is associated with increased mortality and morbidity.
Sub optimal temperatures decrease surfactant production and therefore increase
the risk of respiratory problems.
Hypoglycaemia will occur if the baby uses nutritional reserves to maintain normal
body temperature
Thermalneutrality is defined as the environment at which minimal rates of oxygen
consumption or energy expenditure occurs.
The ability to thermoregulate is dependent upon infant's condition and gestational
age. The use of humidity has been shown to reduce trans-epidermal water loss,
improve the maintenance of body temperature and assist in maintaining skin
integrity in the extremely low birth weight infants
Establishing and maintaining a stable and appropriate thermal environment is a
vital prerequisite to the well being of all infants.
There is a relatively narrow range of ambient temperature within which the preterm
infant can maintain a normal body temperature with the least thermogenic activity.
The range of temperature that constitutes a thermo-neutral environment is
narrowest at the lowest gestational age.
The optimum room temperature for delivery is 25° C (CESDI 2003) and should be
free from draughts.
3.3 Prevention Detection and Management of Hypothermia in the Term Infant
At Delivery
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The babies’ temperature should be taken post-delivery and documented on the
Euroking database.
If the temperature is not between 36.5º c – 37.3ºc document management plan in
the baby notes.
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If resuscitation is required the infant should be received onto a previously warmed
resuscitaire, dried thoroughly and wrapped in warm towels. The wet towel must be
removed.
Infants born by Caesarean section are more likely to encounter problems with
respiration and thermoregulation due to the fact that they have not undergone
stress at vaginal delivery.
Infants on the hypoglycaemia protocol must be nursed in a heated cot.
If the infant is not skin to skin it must be dressed in appropriate clothing to maintain
a temperature of 36.5 – 37.3°C.
If the temperature is <36.5°C add a hat and an extra layer of clothing or nurse skin
to skin with their mother. Ensure the infant is covered whilst receiving skin to skin,
and make sure the room is free from draughts. Recheck temperature in 1 hour.
If the temperature is below 36°C place the infant in a heated cot in the delivery
room. The infant should be nursed in the heated cot with one layer of clothing
together with a hat.
If the temperature is below 36°C the infant should be encouraged to feed
immediately
The infant’s temperature should be increased gradually by 0.5 - 1° C per hour.
If there is significant concern that the infant may have Hypoxic Ischemic
Encephalopathy and will be considered for total body cooling, do not actively heat,
use the resuscitaire without heat.
All observations must be documented on the Neonatal Early warning Score Chart
(NEWS) Appendix 1. On the neonatal unit (NNU) the appropriate observation chart
will be utilised dependent on the neonate’s condition.
4.0 Prevention Detection and Management of Hypothermia in the Preterm
Newborn
At Delivery
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The optimum room temperature for delivery is 25°C (CESDI 2003) and should be
free from draughts.
The infant should be received onto a previously warmed resuscitaire.
For resuscitation infants 30 weeks or less should be placed undried in a clear
plastic bag and on a prewarmed transwarmer. The bag should be sealed loosely
around the neck, leaving the head exposed. The head should be dried and a hat
immediately placed on the head.
The infant must be kept under the radiant warmer after inserting into the bag and
should not be covered with towels or blankets while the heater is on. During transit
to the NNU cover the infant as the radiant warmer will be switched off.
Preterm infants should be transferred from Maternity theatre in the transport
incubator or covered on the resuscitaire. (Refer to ECNHST Neonatal Transport
Guidelines)
Infants should have chest auscultation etc through the bag.
If vascular access is needed, a small hole should be made in the plastic bag, the
bag must not be removed.
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The infant should be weighed in the bag on arrival to the NNU and should then be
placed in a pre-warmed, humidified incubator before the bag is removed and the
infants’ temperature measured or they should remain in the bag and be placed on
the open giraffe bed.
The resuscitaire heater must be kept on during the resuscitation.
The infant’s temperature must be recorded within 1 hour of delivery and then 4
hourly as a minimum.
Infants requiring intensive care should have their temperature monitored
continuously.
Well infants >34 weeks can be cared for on the Maternity ward and must be
dressed appropriately to maintain a temperature of 36.5 – 37.3°C.
If temperature <36.5°C place in a heated cot.
Infants on the hypoglycaemia protocol must be nursed in a heated cot.
All observations must be documented on the Neonatal Early warning Score Chart
(NEWS) Appendix 1. On the neonatal unit (NNU) the appropriate observation chart
will be utilised dependent on the neonate’s condition.
5.0 Subsequent Care
Infants Nursed in Heated Cots
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Infants who are unable to maintain a normal temperature in a cot can be nursed in
a heated cot.
The heated cot consists of:
1. A standard baby cot
2. A control unit (which hangs over the end of the cot)
3. Heating pad and water mattress (Kanmed Baby Warmer) or heated mattress
(Inditherm CosyTherm).
Kanmed Heated Cots
 The water mattress should always be left plugged in and switched on as it can take
up to 4 hours for the water mattress to reach the required temperature of 37°C.
 Heated cots are available in each delivery room and in Maternity theatre to prevent
hypothermia in the neonate
 Infants must only be placed on the water mattress once the required temperature
has been reached, as the cold water would cool the infant.
CosyTherm Heated Cots
The heated mattress provides instant heat and does not need to be left plugged in
when not in use. These do not feel warm to light touch.
5.2 Instructions for the Use of all heated Cots
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Check the heated cot is set at the correct temperature of 37°C.
For the Kanmed the actual temperature of the water mattress and the selected
temperature are indicated by two different coloured lights. The selected
temperature, i.e. 37°C will stay lit constantly. The actual water mattress
temperature light will flash until the selected temperature is reached.
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The infant should be lightly dressed in one layer of clothing e.g. a babygro, and a
hat should be used. The infant should then be covered with a sheet and blankets. A
cot lid may be used if required.
The infant’s axilla temperature must be checked and recorded every 2 hours
initially; progressing to 4 hourly once the temperature has risen sufficiently to within
normal limits. The infant’s temperature should ideally rise by 0.5 - 1.0 °C per hour.
The parents should be advised to keep the baby in the heated cot.
If the infant’s temperature is stable and within normal limits then the temperature of
the heated cot can be reduced gradually, 0.5°C at a time, in accordance with the
infant’s axilla temperature.
Following use the heated mattresses and cots should be decontaminated in
accordance with the local Infection Control Policy.
6.0 Infants Nursed in a Non Heated Cot
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When an infant's temperature is stable and the medical condition allows they can
be transferred to a non heated cot.
Infants transferred to a non heated cot should be dressed with 2 layers of clothes
and a hat applied.
Use several layers of covers and remove as required to maintain a temperature of
36.5 – 37.3°C.
Infants who are small and < 34 weeks gestational age should be nursed using
developmental correct positioning and should only be nursed in a non heated cot
when they are no longer on the hypoglycaemia protocol.
Small infants nursed in cots should be positioned away from windows and
draughts.
Infants who are not connected to electronic monitoring should be nursed in the cot
using the Department of Health for Social Services and Public Safety Reduce the
Risk of Sudden Infant Death Syndrome
Small infants nursed in a non heated cot should continue to have regular
temperature monitoring 4-6hrly. It is vital that infants who display temperatures
below 36.5°C should have additional blankets in order to bring the temperature to
within the normal range. Infants who have a consistently sub-optimal temperature
should either be nursed in an incubator or in a heated cot.
Temperature monitoring can be reduced to daily as the infant’s temperature
stabilises in a cot and preparations for home are being made.
Infants receiving phototherapy should have their temperature checked regularly.
6. 1 Infants nursed in Incubators on the Neonatal Unit
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The infant's temperature must be taken and recorded on admission. The correct
thermo-neutral environment should be selected that meets the needs of the infant’s
gestational age and temperature recording.
6. 2 Humidity
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As soon as the infant is stabilised humidity should be commenced.
Humidity should be used for all infants < 32 weeks gestational age.
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Maximum humidity up to 90% should be commenced and maintained for the first 2
weeks of life.
Humidity can be weaned to 50% and discontinued towards the end of the second
week of life in the more mature infant when the infant is considered to be
physiologically stable.
Humidity should be continued for greater than 2 weeks in the extremely preterm
infant at a lower level 50-60% in order to maintain skin integrity. With the exception
of a ventilator hat and nappy, infants nursed in humidity must be naked.
If an infant is consistently exhibiting a skin temperature >37.2°C, wean the humidity
to 50% do not reduce the set temperature on the servo control below 36.9°C. If the
infant's temperature remains consistently >37.2°C then consider discontinuing the
humidity.
Infants nursed in humidity should have continuous temperature monitoring
7. 0 Servo Control
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If servo temperature control is used the probe is ideally located over the hepatic
region. The probe should be sited on the skin using a reflective tape.
The infant should not lie on the probe or have it covered by clothing or the nappy.
The set temperature should be between 36.9 °C - 37.0° C to maintain
thermoneutrality.
In the event of a sub optimal temperature when maximum humidity is already in
progress temperatures >37.0° C can be achieved by using the override device.
Once humidification has been discontinued and the ambient temperature has
remained stable servo control can be discontinued. The ambient temperature
should be set at the incubator temperature recorded for the past few days.
When servo monitoring has been discontinued the infant should be dressed
appropriately.
Regular axilla temperature monitoring should continue using the Welch Allyn
thermometer.
7. 1 Incubator -Ambient air mode
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The incubator set temperature will vary according to the infant’s gestational age
and condition.
The ambient air temperature can be altered in order to maintain the infant’s axilla
temperature between 36.5 - 37.3° C.
Wean incubator temperature, as infant becomes physiological stable.
Ensure any oxygen flow is not directed on to the infant and that nothing is blocking
the circulation of air around the incubator.
When the incubator temperature has been weaned to 29.0 °C - 30 °C and the
infant has maintained a stable normal axilla temperature (if the medical condition
allows) the infant can be transferred to a heated cot.
Term infants, appropriate weight for gestational age can be transferred from an
incubator directly into a non heated cot.
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NB
It should be recognised that infants who are unwell may have an inability to
maintain their body temperature Therefore infants whose temperature becomes
unstable and labile having previously demonstrated good temperature control
should be assessed by a Paediatrician or Advanced Neonatal Nurse Practitioner
for well being
This guideline has been assessed using the Equality and Human Rights Policy
Screening Tool
These guidelines cannot anticipate all possible circumstances and exist only to
provide general guidance on clinical management to clinicians.
8. 0 Audit/Monitoring Standard
This Guideline will be audited in line with the Key Performance Indicators identified in
the NHS Litigation Authority CNST Maternity Standards 2013/14 - Standard 5 Criterion
4. The remaining key performance indicators are included in the relevant guidelines
This guideline forms part of the Immediate Care of the Newborn Standard 5
Criterion 4
Minimum Requirements
Method of Assessment
CNST Standard
Prevention detection and
management of
hypothermia
A minimum of 1% or 10
sets, whichever is the
greater of newborns
health records.
5.4
Frequency
This Guideline will be audited each month in relation to the current CNST minimum
requirement for the applicable level of assessment. The annual amount of health
records audited will equate to a minimum of 1% or 10 sets whichever is the greater of
newborns health records. This audit will occur as per the Maternity Service Audit Plan
Following the collection period an annual audit report will be produced which will be
presented at the Maternity and Women’s Service Clinical Governance Committee.
Coordination of Audit
The audit co-ordination is the responsibility of the Practice Development Midwives in
accordance with the Maternity Service Audit Plan
Reporting Arrangements
The Practice Development Midwives will report the results of audit to the overarching
Maternity and Women’s Service Clinical Governance Committee on a monthly basis.
The results will be presented using the Maternity Service Monthly Monitoring Report.
J Bradshaw RM
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An action plan will be produced if 100% compliance with the CNST Standard is not met
as indicated on the Maternity and Women’s Service monthly monitoring tool. Any
action plans will be tabled at the overarching Maternity and Women’s Service Clinical
Governance Committee by the Practice Development Midwives
Acting on Recommendations
The audit recommendations and subsequent action plan will be discussed and agreed
by the overarching Maternity and Women’s Service Clinical Governance Committee.
The Maternity and Women’s Service Clinical Governance Committee will agree which
individual will be responsible for action(s) within a specified timeframe. This will be
documented on the action plan and within the minutes from the Maternity and
Women’s Service Clinical Governance Committee.
Changes in Practice and Lessons to be shared
Any required system or organisational change to practice will be discussed and agreed
by the overarching Maternity and Women’s Service Clinical Governance Committee.
Changes to practice will be identified and actioned within a specified time frame. A
lead member of the team will be identified to take each change forward. This will be
documented on the agreed action plan and monitored at the Maternity and Women’s
Service Clinical Governance Committee on a monthly basis until completion.
Lessons will be shared with the relevant stakeholders.
9.0 References
Blackburn, St. Loper, DL. (1992) Thermoregulation. In: Maternal, Foetal and
Neonatology Physiology: A clinical perspective WB Saunder 677-98.
Boxwell, G. (2000) Neonatal Intensive Care Nursing.
CESDI 2003 27-28 Week Project
Christenssen et al (1992) Temperature, metabolic adaptation and crying in health, full
term newborns cared for skin to skin or in acot. Acta paediatrcia 81:988-93
Cochrnae Database of Systematic reviews (2008). Early skin-to skin contact for
mothers and their healthy newborn infants
Department of Health (2004) Maternity Standards, National Service Framework for
Children, Young People and Maternity Services. London www.dh.gov.uk
J Bradshaw RM
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Department of Health for Social Services and Public Safety - Reduce the Risk of
Sudden Infant Death Syndrome 2012
East Cheshire NHS Trust Neonatal Jaundice Guideline
East Cheshire NHS Trust Newborn Life Support
East Cheshire NHS Trust Neonatal Transfer
Inditherm Medical Cosytherm Operating Instructions 2007.
KanMed Baby Warmer Users Manual. October 2003
NHS Litigation Authority Clinical Negligence Scheme for Trusts Maternity standards
Standard 5 Criterion 4 2013/2014
National Institute for Health and Clinical Excellence (2007) Intrapartum Care: Care of
healthy women and their babies during childbirth. London. NICE www.nice.org.uk
Resuscitation Council (UK). (2006). Newborn \life Support (2nd Edition) Resuscitation at
Birth. London.
Roberton, N. (1993) A Manual of Neonatal Intensive Care.
Royal College of Anaesthetists Royal College of Midwives, Royal College of
Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health.
(2007) Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care
in Labour. London RCOG Press www.rcog.org.uk
Thomas, K. (1994) Thermoregulation in neonates. Neonatal Network 13(2)15-22
Yeo, H. (1998) Nursing the Neonate.
This policy is adapted from Liverpool Women’s Hospital Thermoregulation for babies
admitted to NICU Policy, July 20th 2007 (version 2-NICU 109)
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10. Appendix 1
NEONATAL EARLY WARNING SCORE OBSERVATION CHART
See over for observations and frequency
REMEMBER TO USE CLINICAL JUDGEMENT IN EACH CASE IRRESPECTIVE OF SCORE
Name
Hosp No
SCORE
0
TONE
Normal
1
2
Stiff or Floppy
3
COLOUR
CONSCIOUS
LEVEL
Pink
Alert
Blue/Grey/White
Unrousable or
Unconscious
GRUNTING
Absent
Present
RECESSION
NASAL
FLARING
Absent
Present
Absent
Present
Date
Time
Tone Score
Colour Score
Conscious level
score
Grunting score
Recession score
TEMPERATURE
(degrees C)
Nasal flare score
39.5
3
39
3
3
2
1
0
0
1
2
3
38.5
38
37.5
37
36.5
36
35.5
35
Temp Score
3
3
3
3
3
3
2
1
0
0
0
2
3
3
(Beats per minute)
300
280
260
240
220
200
180
HEART REAT
160
140
120
100
80
60
40
Heart rate score
J Bradshaw RM
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3
3
2
1
1
0
0
0
3
3
100
RESPIRATORY RATE
(breaths per minute)
90
80
70
60
50
40
30
20
10
Resps rate score
Total NEWS
Signature
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NEWS Observation Frequency
Condition
Frequency of observations (approx)
Babies born to mothers with one or
more risk factors for bacterial
infection:
- Maternal GBS carriage on
HVS/infection during current
pregnancy (with or
without intrapartum antibiotic
prophylaxis)
- Previous affected child with GBS
sepsis
- Prelabour or Prolonged rupture of
membranes (>18 hours in preterm or
> 24hrs in term)
- Spontaneous preterm labour (<37
wks)
- Intrapartum fever (>38 C)
- Chorioamnionitis or parental
antibiotics for suspected/confirmed
sepsis in mother 24hrs before or after
birth.
Receiving Antibiotics for suspected or
proven infection
At risk of Hypoglycaemia
(<37wks, < 9th centile, Infant of
Diabetic mother >99.6th centile,
Maternal labetalol)
Meconium stained liquor
Within 1hr of birth
Within 2hrs of birth
Then 2hrly until 12hrs of age
(can be discontinued at 12 hrs if news 0 and
not on antibiotics)
Babies causing other concerns
Observations as above for first 12 hours, then
4 hourly whilst on treatment
Observations required before 3 hourly feeds
until glucose measurements are stable.
If there is thin Meconium, baby is to have
observations at 1 and 2 hours
If there is thick Meconium, observations should
be performed at 1 and 2 hours of age and then
2 hourly for a further 10 hours.
Use clinical judgement
THIS IS A MINIMUM REQUIREMENT FOR OBSERVATION FREQUENCY AND
STAFF SHOULD USE CLINICAL JUDGEMENT IN EACH CASE IRRESPECTIVE OF
SCORE
NEWS ACTIONS
Score 0 – Continue normal care; continue NEWS observations as determined by
relevant policy, no action required.
REMEMBER TO USE CLINICAL JUDGEMENT IN EACH CASE IRRESPECTIVE OF
SCORE
Score 1 – Adjust thermal environment as per Prevention, Detection and Management
of
Hypothermia in the Newborn guideline, if appropriate.
Repeat NEWS hourly until NEWS = 0.
If NEWS = 1 after 4 hours, call paediatric SHO (Bleep 5083) for review.
Score 2 or above – Call paediatric SHO (Bleep 5083) for review.
J Bradshaw RM
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Appendix 4.0
Equality Analysis (Impact Assessment)
What is being assessed? Name of the policy, procedure, proposal, strategy or
service:
Details of person responsible for completing the assessment:
 Name: J Bradshaw RM
 Job title: Midwife
 Team: Maternity
State main purpose or aim of the policy, procedure, proposal, strategy or
service:
(usually the first paragraph of what you are writing. Also include details of
legislation, guidance, regulations etc which have shaped or informed the
document)
To provide information on the correct neutral thermal environment in order to maintain a
normal body temperature and eliminate thermal stress
2. CONSIDERATION OF DATA AND RESEARCH
To carry out the equality analysis you will need to consider information about the
people who use the service and the staff that provide it.
2.1 Give details of RELEVANT information available that gives you an
understanding of who will be affected by this document
Race:
The 2005 mid year estimate (Cohesia Report 2008) show that the majority of the population in
Cheshire (94.6%) is White British, with 5.4% non White British. Issues for BME communities
include
lack of knowledge of services, access to services, access to translation/interpretation, cultural
differences, family values.
Gypsies and travellers – at the last count (July 2006) the highest number was recorded in the
Borough of Congleton (125). 42% of gypsies and travellers report limiting long term illness
compared to 18% of the settled population, with an average life expectancy 10-12 years less than
settled population. 18% of gypsy and traveller mothers have experienced the death of a child
compared to 1% in the settled population.
Disability:
There are over 10 million disabled people in Britain, of whom 5 million are over state pension age.
Nearly 1 in 5 people of working age (7 million, or 18.6%) in Great Britain have a disability.
Hearing loss: 1 in 4 has a hearing problem.
Sight problems: There are 2 million people with sight problems in the UK.
Learning disabilities: There is quite a high proportion of people with learning disabilities in the local
area
due to there being a number of residential homes/institutions in the area.
Problems encountered can be lack of staff awareness, communication issues and information
requirements.
Carers
Around 6 million people (11 per cent of the population aged 5+) provided unpaid care in the UK in
April 2001. While 45% of carers were aged between 45 and 64, a number of the very young and
very old also provided care. By 2037, it is anticipated that the number of carers will increase to 9
million.
Prevention Detection and Treatment of Hypothermia in the Newborn
K Agar RN, J Bradshaw RM and E Alston RM SoM
May 2011 Version 4
17
Gender
On average in Cheshire, 49% of the population are male and 51% are female
Transgender: No local data available, national trends show:
1/12,000 males, transgender from male to female
1/33,000 females, transgender from female to male
Specific issues around access to services, specific services for men or women, and ‘single sex’
facilities. In terms of the transgender population, GIRES (Gender Identity Research and Education
Society ) gives an estimate of 600 per 100,000. If these figures were applied to the Cheshire East
community based
on the 2005 mid year estimates, there may be around 2,100 trans people in the area.
Religion/Belief
In the Cheshire East area the 2001 census showed:
Christian
- 80%
Buddhists
- 0.16%
Hindu
- 0.15%
Jewish
- 0.12%
Muslim
- 0.36%
Sikh
- 0.05%
Other religion - 0.15%
No religion
- 11.84%
Not stated
- 6.67%
The Muslim population has the highest levels of ill health amongst faith groups – this includes
higher smoking rates amongst men and higher rates of coronary heart disease and diabetes.
Sexual Orientation
Lesbians, gay men and bi sexual people (LGB) make up to 5-7% of the UK population (Dept of
Trade and Industry, 2003). 13% of Gay men and 31% Lesbian women are parents (Morgan and
Bell, First Out:
Report of the findings of Beyond the Barriers national survey of LGB people)
The experience and health needs of gay men and women will differ. However, both groups are
likely to experience discrimination, higher levels of mental ill health and barriers to accessing
health care National Health Inequalities data shows that lesbian, gay, bisexual and transgender
(LGBT) people are significantly more likely to smoke, to have higher levels of alcohol use and to
have used a range of recreational drugs than heterosexual people. They are also at greater risk of
deliberate self-harm. Although most LGBT people do not experience poor mental health, research
suggests that some are at higher risk of mental health disorder, suicidal behaviour and substance
misuse.
2.2 Evidence of complaints on grounds of discrimination: (Are there any
complaints either from patients or staff (grievance) relating to the policy, procedure,
proposal, strategy or service or its effects on different groups?)
No
2.3 Does the information gathered from 2.1 – 2.3 indicate any negative impact
as a result of this document?
No
May 2011 Version 4
18
3. ASSESSMENT OF IMPACT
Now that you have looked at the
purpose, etc. of the policy,
procedure, proposal, strategy or service (part 1) and looked at the data and
research you have (part 2), this section asks you
to assess the impact of the policy, procedure, proposal, strategy or service on
each of the strands listed below.
RACE:
From the evidence available does the policy, procedure, proposal, strategy or service affect,
or have the potential to affect, racial groups differently?
Yes  No

Explain your response: No this guideline relates to the Prevention Detection and Management
of Hypothermia in the Newborn and is irrespective of race.
Staff are aware of the trust interpreter guidelines, how to access an interpreter and know that
family members should not be used to interpret. All staff need to be aware that the trust is now
using the Big word as the main supplier, with Intralinks as local around the Crewe area.
GENDER (INCLUDING TRANSGENDER):
or have the
potential to affect, different gender groups differently?
Yes
 No

of Hypothermia in the Newborn and is irrespective of gender
DISABILITY
or have the potential to affect, disabled people differently? Yes  No

No this guideline relates to the Prevention Detection and Management of Hypothermia in the
Newborn and is irrespective of disability
It may be appropriate to use BSL interpretation, information in another format suitable to meet
their individual needs enabling women to understand neonatal sepsis
AGE:
From the evidence available does the policy, procedure, proposal, strategy or service,
affect, or have the
potential to affect, age groups differently?
Yes  No  
Explain your response: No this guideline relates to the Prevention Detection and
Management of Hypothermia in the Newborn and is irrespective of age
LESBIAN, GAY, BISEXUAL:
or have the
potential to affect, lesbian, gay or bisexual groups differently?
Yes  No 
of Hypothermia in the Newborn and is irrespective of sexual preference
May 2011 Version 4
19
RELIGION/BELIEF:
or have the
potential to affect, religious belief groups differently?
Yes  No  
of Hypothermia in the Newborn and is irrespective of religion/beliefs however any drugs used
associated with the procedure would be checked to ensure they did not contain products e.g.
porcine, which would conflict with the family’s religious beliefs
Staff have access to information on a variety of different cultures and beliefs.
There is a privacy, dignity and cultural beliefs booklet. Staff can access training on equality and
diversity.
CARERS:
or have the potential to affect, carers differently?
Yes 
No  
of Hypothermia in the Newborn and is irrespective of caring responsibility However,
parents/carers will have open visiting to the NNU to enable mutually convenient times to visit
should the neonate be admitted to the NNU
4. Safeguarding Assessment - CHILDREN
a. Is there a direct or indirect impact upon children? Yes 
No  
b. If yes please describe the nature and level of the impact (consideration to be given to
all children; children in a specific group or area, or individual children. As well as
consideration of impact now or in the future; competing / conflicting impact between
different groups of children and young people:
c. If no please describe why there is considered to be no impact / significant impact on
children
Any safeguarding issues will be addressed in the antenatal and postnatal period to ensure safe
care of the neonate
5. Relevant consultation
Having identified key groups, how have you consulted with them to find out their
views and made sure that the policy, procedure, proposal, strategy or service will
affect them in the way that you intend? Have you spoken to staff groups, charities,
national organisations etc?
6. APPROVAL – At this point, you should forward the template to:
 The Trust’s Equality and Diversity Lead [email protected]
Equality and Diversity response:
Safeguarding Children response:
7. Any actions identified: Have you identified any work which you will need to do in
the future to ensure that the document has no adverse impact?
Action
Lead
Date to be Achieved
8. Review Date: Date completed: July 2013
May 2011 Version 4
20
The Trust’s Equality and Diversity
Lead:
May 2011 Version 4
21

Prevention Detection and Management of Hypothermia in the Newborn 1

Transcription

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