Prevention Detection and Management of Hypothermia in the Newborn 1
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 Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 2 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 Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 3 Prevention Detection and Management of Hypothermia in the Newborn 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 4 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 5 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 To maintain the infants temperature between 36.5°C and 37.3°C To correct hypothermia safely 3.2 Summary of Evidence 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 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 6 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 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 7 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 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 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 8 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 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 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 As soon as the infant is stabilised humidity should be commenced. Humidity should be used for all infants < 32 weeks gestational age. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 9 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 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 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 10 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 11 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 Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 12 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) Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 13 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 Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 14 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 Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 15 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. Prevention Detection and Management of Hypothermia in the Newborn J Bradshaw RM July 2013 Version 6.0 16 Appendix 4.0 Equality Analysis (Impact Assessment) What is being assessed? Name of the policy, procedure, proposal, strategy or service: Prevention Detection and Management of Hypothermia in the Newborn 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 Prevention Detection and Treatment of Hypothermia in the Newborn K Agar RN, J Bradshaw RM and E Alston RM SoM 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): From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender 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 gender DISABILITY From the evidence available does the policy, procedure, proposal, strategy or service affect, 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: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual 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 sexual preference Prevention Detection and Treatment of Hypothermia in the Newborn K Agar RN, J Bradshaw RM and E Alston RM SoM May 2011 Version 4 19 RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief 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 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: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers 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 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 lynbailey@nhs.net 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 Prevention Detection and Treatment of Hypothermia in the Newborn K Agar RN, J Bradshaw RM and E Alston RM SoM May 2011 Version 4 20 The Trust’s Equality and Diversity Lead: Prevention Detection and Treatment of Hypothermia in the Newborn K Agar RN, J Bradshaw RM and E Alston RM SoM May 2011 Version 4 21
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