AimsTo describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices.MethodsWe analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales’ National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.ResultsThe most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer.ConclusionsThere are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.
We describe two cases of a non-epileptic florid movement disorder presenting as status epilepticus. Both patients presented with florid jerking of the limbs and eyes. Convulsive status epilepticus related to presumed meningitis or encephalitis was suspected in both cases. The patients received treatment for seizures, without resolution of the abnormal movements, resulting ultimately in anaesthetic, intubation and ventilation. EEGs showed no epileptic discharges. The diagnosis was opsoclonus myoclonus syndrome in both. One patient was treated with adrenocorticotropic hormone (40 IU/day), the other with prednisolone (4 mg/kg/day) with rapid resolution of symptoms. Neither patient had an underlying neoplasm or infectious agent identified. To date, neither patient has suffered a relapse of symptoms nor does either show any sign of developmental delay. These cases show that the movements in opsoclonus myoclonus syndrome can be sufficiently florid to mimic convulsive status epilepticus. Video footage of both patients at the time of diagnosis is presented online.
IntroductionThe RCPCH General and Community Child Health (CCH) curricula list nearly 50 competencies related to child mental health. It has long been recognised that these competencies are difficult to achieve without dedicated CAMHS training. As CAMHS is not an Allied Specialty according to the RCPCH, an Out of Programme Experience or Training (OOPE/T) must be undertaken.AimsTo explore the process and benefits of a CAMHS training post for CCH trainees.MethodsA focus-group discussion at a regional training meeting, followed by collaboration with a colleague undertaking a survey of CCH trainees nationally, explored the attainment of mental health competencies. The steps followed to undertake formal CAMHS training were: identification of a suitable OOPT post, approval from the local department, the NHS trust, the Deanery, the RCPCH and the GMC.ResultsLocal and national surveys highlighted the difficulties in achieving mental health competencies within standard CCH training as well as lack of provision of CAMHS training. The process of applying for an OOPT took 12 months and was fundamentally facilitated by supportive, professional links between the local CCH and CAMHS Consultants. The CCH CSAC was supportive, and recognised the opportunity for competencies to be met.ConclusionsBenefits for the trainee, the CAMHS team, the CCH team and patient care were identified. Weekly consultant supervision and regular joint assessments provided ample opportunity to complete workplace-based assessments. There were opportunities to work within all CAMHS subspecialties. Attendance at CAMHS regional weekly registrar training meetings provided further learning and networking opportunities.A formal training post in CAMHS led to valuable clinical experience for a future consultant career in CCH, but would also be valuable for trainees in General Paediatrics or other sub-specialties. The post in itself naturally led to a liaison role, facilitating communication between CCH and CAMHS teams and benefiting patient care.Future work to streamline the process of accessing this type of post by the RCPCH and RCPsych will be of great benefit for the specialities as a whole, to the local departments and ultimately for the patients being treated in those settings.
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