Intensive Care Unit

Our PICU is a 23 bedded unit and is a designated Lead Centre. We care for children (0 – 16 years of age) from all specialties including cardiac surgery, neurology and neurosurgery, burns, trauma infections, shock and oncology. The unit accepts over 1000 admissions per year and is one of the largest PICUs in Europe. Our unit is modern and provides all forms of therapy including haemofiltration, Nitric Oxide, High Frequency Oscillation and cardiac ECMO providing care for level 4 intensive care children. The unit is bright and child friendly and predominantly open plan with 8 cubicles for isolation. Since November 2010 the North West & North Wales Paediatric Transport Service (NWTS) undertakes the stabilisation & transfer of almost all critically ill and injured children to our PICU from district general hospitals. Many of our nurses and doctors on PICU are part of NWTS.

There are over 160 nurses on the PICU including a nurse manager, a nurse consultant, three advanced nurse practitioners, a senior nursing research fellow, a clinical educator, an audit nurse and a lecturer-practitioner who runs the specialist PICU course.
Other members of the team include 10 consultant intensivists, 2 specialist physiotherapists, a specialist dietician, a PICU pharmacist, a play therapist, social workers, chaplains, clerical and domestic staff and a team of rotational training doctors in PICU and anaesthesia.
We also provide placements for nursing students, medical students and other health care students.

Nursing on PICU

The nurse to patient ratio on PICU is mainly 1:1, but can be 2:1 in very ill children.
Our nursing philosophy in PICU is one strongly centred on providing family-centred care at all times, and delivering the highest possible level of care to our patients and their families. We believe that an environment which is supportive and encourages education and research is essential in order to support professional and personal growth and provide these children with best care underpinned by evidence. We recognise that the speed of a child’s recovery is dependant on the presence of his/her family and so we welcome family and friends to visit and participate in the child’s care. We also strive to keep parents continually informed about their child’s condition, so building a supportive relationship of trust, honesty and respect, while maintaining confidentiality and dignity.

We also value each other and encourage nurses to speak freely, acting as the child’s advocate when his or her parents are not able to do so, so promoting and safeguarding the well being of our patients.

Shift patterns and annual leave

The PICU offers long days (0700 – 2030) x 3 week, short shifts (0700 – 1430) or (1230 – 2030) x 5 week. There is internal rotation onto nights (2015 -0715) but flexible working contracts are available to suit all staff. Nurses get 7 weeks annual leave a year. Rotational programs between the PICU and the designated 15 bed PHDU or within other CBU areas (Cardiology and Burns) are strongly encouraged.

Mentorship

A formal 3-month orientation program (the Foundation to PICU Nursing course) is compulsory for all nurses new to PICU. Other nurses who commence with a PICU background will have an orientation program specifically developed to suit their needs. There is a structured program for all based on a critical care competency book and formal assessments as part of it, and nurses must pass this course to work in the PICU. All new staff are also allocated a Band 7 nurse team leader who will facilitate regular appraisals.

Access to education

We encourage staff development and there is access to many educational programs including:

The specialist PICU Nursing CPD course (7 months) through LJMU
Mentorship in practice
Paediatric High Dependency course (through LJMU)
The Renal course (through LJMU)
The ECMO course @ Glenfield Hospital
Paediatric Life Support (PLS) and APLS courses
Degree programs
Paediatric clinical examination module (LJMU)
The one-day PICU nurse-led ventilation weaning course run in house

In addition to this, there are various in-house study days on both clinical topics (eg cardiac intensive care, pain, IV Study days) and others including clinical leadership, counselling skills, research and bereavement.

Nursing Developments and Activities in PICU

There are many special interest groups and teams within the PICU which the nurses can join, including the patient safety team, the Translating research into practice (TRiP) group and other specialist nursing teams (ECMO, haemofiltration).There are also many link nurses, who involved with other departments within the trust and also link nationally. Senior band 5 nurses can also apply to rotate into developmental educator jobs (6 months) or research nurse jobs in PICU when vacancies arise.
Many of the nurses are members of the Paediatric Intensive Care Society (PICS) and the European Society of Paediatric and neonatal Intensive care (ESPNIC) and attend their annual meetings.
Current developments in PICU include:

The development of nurse-led weaning and extubation
The development of a team of ECMO nurse specialists
A team of advanced nurse practitioners to optimise the care of children on PICU
A number of nursing research projects within PICU led by the Nursing Research Fellow
The implementation of evidence-based clinical guidelines for procedures and practices
The implementation of new patient safety strategy and new initiatives

For more information please fell free to contact either:

Sharon Gough (Clinical nurse educator) on 0151 228 4588
Email: Sharon.gough@alderhey.nhs.uk

Alison Fellowes (PICU ward manager) on 0151 252 4612
Email: Alison.fellowes@alderhey.nhs.uk

PICU Medical Information

The unit has 10 (7 Whole Time Equivalent) consultants in paediatric intensive care medicine, providing cover 24 hours a day, 7 days a week. Non-consultant cover for the unit is provided by 1 Associate Specialist, 3 Advanced Nurse Practitioners and 15 trainees from anaesthetic and paediatric specialties. Alder Hey is one of the recognised centres for providing training in intensive care medicine in the UK and at any given time 2 to 4 trainees are undertaking specialist training to pursue a career in paediatric intensive care. Our unit has also been popular among overseas trainees seeking experience in paediatric intensive care and a number of our posts (currently 4) are available as Clinical Fellow posts for those interested for a period ranging from 6 to 24 months.

Provision of Continuity of ICU Patients’ Care

Duties will be based at Alder Hey as a member of the intensive care team and (if applicant has suitable knowledge and skills and wants to gain experience in transport medicine) may rotate to the North West and North Wales Paediatric Transport Service (NWTS).

The ICU trainee will be supervised by a consultant at all times and will work a full shift system of 48 hours per week on average, with number of trainees on shift adjusted to meet PICU activity. The rolling rota includes allotted time for anaesthetic experience or audit and experience (if appropriate) as ‘chief’ which entails taking an overall management role for the unit during the day.

Teaching

The post offers comprehensive training in paediatric intensive care, including resuscitation and advanced paediatric life support and stabilisation & transport of the critically ill child. You will be expected to participate in a programme of lectures and tutorials on all aspects of paediatric intensive care, as well as supporting and supervising less experienced colleagues. Practical skills related to the management of critically ill children are taught.

In addition there is scenario training using high-fidelity mannequins at our local simulation centre which all trainees are encouraged to participate in.

All PICU Consultants play an active role in the teaching program. There are excellent postgraduate facilities at Alder Hey.

Each trainee will be assigned an Educational Supervisor during their rotation who, will ensure that the training they receive wherever possible will cater to their individual requirements. At the completion of the service term, the fellow will receive a formal appraisal from a supervisor.

There are excellent postgraduate facilities at Alder Hey which provides access to additional in house educational and life skill courses. Study / exam leave with financial support for courses may be provided.

PICU Weekly Timetable

MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SAT./ SUN.
0830: Wd.Rnd	0830: Wd.Rnd	0830: Wd.Rnd	0830: Wd.Rnd	0830: Wd.Rnd	0900: Wd.Rnd
			0830:Cardiac meeting	0900:Grand Round
1300: MDT Radiology	1030-1330: PICU Teaching	12⁰⁰-14⁰⁰: Weekly Meeting includes monthly Mortality & Critical Incident meetings	1100: MDT Radiology
1730: WR	1400: MDT Nutrition WR 1530: Microbiology 1730: WR	1730: WR	1730: WR	1530: Microbiology 1730: WR
2030: H’over	2030: H’over	2030: H’over	2030: H’over	2030: H’over	2100: H’over

There are daily business ward rounds on the ICU, and a specimen timetable is outlined above. Tuesday morning is mandatory protected ICU teaching. In addition there is a PICU Journal club 1^st Tuesday each month (08⁰⁰-08³⁰) and the Joint Cardiac (including surgery), Anaesthetic, PICU teaching 2^nd Tuesday each month (09⁰⁰-10⁰⁰). There is joint videoconference teaching every 2-3 months with Great Ormond Street and Birmingham Children’s PIC teams.

Attendance at and presentations of research projects to local and national meetings on paediatric intensive care and transport medicine will be actively encouraged.

Audit and Research

The appointee will be expected to participate in medical audit. During the appointment, the post holder will be encouraged to participate in clinical studies and research projects with the Consultants in Intensive Care.

The ICU is an active participant in the National Paediatric Intensive Care Network Audit (PICANET).

If you would like more information on the research undertaken on PICU please view our Research Profile.

If you would like to discuss more about training opportunities on PICU at Alder Hey please call or email:

- Dr Stephen Kerr (Clinical Director) [Stephen.Kerr@alderhey.nhs.uk]

- Dr Dorothea Sidaras [sidaras@doctors.org.uk] on 0151 252 5555.

Research and Dvelopment at Alder Hey Children's Hospital link