Aim To ensure the nursing team at a children’s hospice have a robust system in place to recognise and manage children who become acutely unwell whilst cared for at the hospice preventing admission to hospital.

Background Children cared for at the hospice, have complex medical conditions. They are susceptible to becoming acutely unwell. The on call rota available for medical advice within the hospice was reduced significantly so an additional source of advice was required.

Method Discussion took place between hospice and local hospital enhancing collaborative working in caring for the unwell child. The paediatrician on call rota and children’s assessment unit at the hospital were made available for advice in addition to the medical team at the hospice. A policy and procedure was written for use at both locations so all were clear on roles and responsibilities. Education sessions were provided on the use of the Situation Background Assessment Recommendation (SBAR) tool to ensure a concise and familiar communication system between the two services. Paediatric Early Warning Score (PEWS) tool adapted for use within the hospice.

Findings The PEWS assisted nurses to recognise and determine the level of response to an unwell child. The SBAR tool focussed communication when seeking advice. Advice available to the nursing team has been strengthened and diversified. Enhanced communication and collaborative working between the paediatric unit and children’s hospice on a daily basis, not just when a child is acutely unwell.

Conclusion The nursing team at the hospice have a comprehensive system in place enabling them:

• To quickly recognise when a child is becoming acutely unwell

• To seek advice from a robust arrangement of senior nursing or medical colleagues, 24/7, within the hospice or hospital

• Ensure a coordinated and timely response is in place to effectively manage children who become acutely unwell.