6794 Creating and implementing an LTV clinical guideline across four paediatric clinical networks

Objectives The number of Children and Young People (CYP) who are receiving Long Term Ventilation (LTV) is increasing, and the provision of this care is complex. The NCEPOD national report¹ recommended a structured training programme with associated resources to be available to non-specialist clinicians for hospital admissions and to ensure that all people on LTV have access to age appropriate emergency care. The LTV Clinical Guideline would be a resource to support clinical colleagues looking after CYP on LTV. Methods Creation of a working group consisting of network lead nurses and LTV clinical leads, stakeholders from DGH paediatric services and LTV skills educators from across the four networks. Combined expertise from this group enabled the formation of an agreed comprehensive guideline to be developed. The guideline was then reviewed and approved by clinical teams which included consultants, clinical specialists and physiotherapists. Results A guideline which provides clinical guidance and a standardised approach of looking after CYP who receive Tracheostomy Long Term Ventilation (TrLTV) and Non-Invasive Ventilation (NIV). The guideline working group was a collaborative complex piece of work across four clinical networks, in which there are nine centre's providing tertiary LTV services to CYP. The document provides guidance on safety, assessment, troubleshooting and escalation for both tertiary specialist centre & district general hospital staff involved in the care of CYP who receive LTV. Discussion highlighted area's in which there were differences in practices, an example being the emergency tracheostomy box. A focus group of tracheostomy clinical nurse specialists explored current practice across multiple areas and an agreed minimal emergency box content was achieved for use in this guideline. Acknowledging differences in practice that may exist and guidance on these additional items included within this guideline. Conclusion Following the development of the guideline, it has been implemented across the four clinical networks and provides clinical guidance and a standardised approach to looking after CYP receiving LTV when they are admitted into hospital. Feedback has been positive, with trusts implementing the guideline locally, some trusts replacing current guidance and plans to place the standardised guideline on local intranets. LTV education is being delivered across the four clinical networks, and the guideline has been incorporated into these LTV education programmes. Feedback from these programmes has included the ability to use the guideline to provide support when troubleshooting LTV, awareness of the document and where to access it. Reference Long Term Ventilation: Balancing the Pressures, NCEPOD, February 2020.