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HOSPITAL INFORMATION |
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A child’s diagnosis of cancer is naturally a difficult and uncertain time for all parents.
Throughout treatment you will meet many different healthcare specialists in several hospitals. Their various roles and how they will help
you may often seem confusing. We hope the following explanation will
show you what to expect from the Paediatric Oncology Shared Care team
at Kingston Hospital.
What is shared care?
Children with cancer need to have their care planned and co-ordinated by
a paediatric cancer centre (sometimes called a POC
or "paediatric oncology unit") such as Royal Marsden Hospital, Great Ormond Street Hospital, University College London Hospitals or Barts & the Royal London Hospital.
Here your child’s consultant oncologist will discuss
- your child’s diagnosis
- your child’s treatment plan
- your child’s future outcome
- possible side effects and complications of the treatment
- important national or international clinical trials that they might ask
to enrol your child into
(These trials are crucial so that important questions regarding the best type
of treatment may be answered - your agreement or otherwise will not affect your child’s care.)
However not all of your child’s care needs to be undertaken at the POC.
Some care can be provided at your local hospital (also termed POSCU "paediatric oncology shared care unit"), and some care can
be provided
at your home. Your child’s treatment plan will be divided into time when
care needs to be at the POC, and when it can be at home or at the POSCU.
You will receive our help at whichever stage of treatment your child is at. We will ensure that all these groups of professionals keep in regular contact with you and each other, so that your child receives the best possible care.
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What role does Kingston Hospital POSCU have?
The children’s wards at Kingston Hospital have extensive experience in
sharing the care of children with cancer with the various POCs.
There are two wards for children:
- Sunshine Ward for children requiring a hospital stay of a few days
- Dolphin Ward (the ambulatory care unit) where children visit for
short procedures such as administration of chemotherapy
Children usually attend Kingston Hospital for one or more of the following reasons:
- Febrile neutropenic episodes: this is when your child has a
fever due to an infection. This occurs because their blood white
cell count is low as a result of the effects of chemotherapy.
Children require admission and stay in an isolation cubicle for an average of 4-5 days on Sunshine Ward while they receive antibiotics. Sometimes children continue to have antibiotics given at home.
These are given by either the Kingston Paediatric Outreach Nursing Team (PONT) or the Richmond Children’s’ Community Nursing Team, depending upon where you live.
- Administration of chemotherapy: certain chemotherapy drugs
may be given at the request of the POC in order to reduce the
number of visits that you need to make to that hospital.
This helps to reduce the degree of disruption to family life by
providing care closer to home.
- Administration of blood products (blood transfusion and platelet transfusion): a fall in the blood count often occurs after chemotherapy. Transfusion to improve the blood count can be performed at Kingston Hospital.
Whilst you are at home, you may have other concerns that require a doctor’s opinion. To help, you will receive a direct access letter from Kingston Hospital. This includes instructions and a telephone number to ring to access medical advice.
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Whom will I see at Kingston Hospital?
The team comprises several different members:
- There is a part time clinical nurse specialist and teams of hospital nurses led by a matron and ward sisters who will care for you and
your child as well as perform tasks such as administering antibiotics.
- The medical staff comprises senior house officers and specialist registrars who will advise on treatment as well as examine your
child regularly to monitor their progress. They are under the supervision of the consultants.
- Dr Winrow, one of the consultants, has responsibility for all children with cancer and he will usually meet with you during your child's stay to update you on your child’s progress whenever possible.
- physiotherapists, dieticians, pharmacist, social worker, psychologist
and play specialists, all of whom are part of this multidisciplinary team.
- paediatric community nurses or paediatric outreach nurses (PONT)
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Who are the PONT / paediatric community nurses?
These nurses provide care and support for you and your child at home.
They take blood samples as well as administer intravenous antibiotics. Members of these teams will visit you shortly after discharge home from hospital, often together with the corresponding team from the oncology
unit.
In addition to practical activities, the nurses are often very useful in
providing answers to queries about your child’s health.
They liaise closely
with Dr Winrow on a weekly basis. A contact telephone number will be given
to you on that first meeting.
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What will happen if my child needs admission to Kingston Hospital?
If the admission is planned, and only for the day, your child will probably be admitted to a cubicle on Dolphin Ward, while the medication or transfusion is administered.
If your child is unwell, particularly if they have a febrile neutropenic episode, they will be admitted to an isolation cubicle for treatment. These cubicles
have separate toilet facilities. Admission to an isolation cubicle is necessary
to prevent your child from acquiring an infection from another child on the ward. Because of this, it is very important that your child stays in the room and does not go to the playroom.
It is crucial that all the staff and visitors wash their hands to reduce the risk of bringing in an infection from the other children.
Space in these areas is tight, and the facilities basic, but a fold up bed is available to put up next to your child so that you can always remain close.
The nurses will explain the catering arrangements and the arrangements for the car parking fees.
Although every effort is made to view your child as the top priority and to provide treatment as quickly as possible, there are times when all the staff
are busy looking after a critically ill child who requires life saving care.
Whilst the team always treats your child’s care with great importance, in
that situation, we ask you to be patient as we will always need to tend to
the sickest patient, first regardless of their diagnosis.
Ward Routine:
- A morning ward round is carried out every day to review your child’s care.
- Blood tests are usually taken first thing in the morning by the nursing staff.
- Informal visits occur on most evenings, when that day’s investigation results are shared with you.
Dr Winrow and his team will not alter the overall plan of your child’s care,
as this needs to conform with the oncology centre’s protocol. However other decisions, for instance, about antibiotics or blood transfusions, will be taken here.
Regular telephone discussions with the POC will always occur, and on discharge home, a proforma letter will be faxed to the POC so that the team
is aware of all the treatment given at Kingston Hospital.
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What follow up can I expect for my child?
Much of your child’s follow up will occur at the POC. Once the majority of treatment has finished, some of the outpatient visits will take place at Kingston Hospital. Dr Winrow runs an oncology clinic on a Thursday morning (day may change)
and appointments will be arranged with you as necessary. However if you wish
to meet with Dr Winrow at any stage in clinic, please contact his secretary
on 020 8546 7711 ext. 2410 to arrange this. You do not need a letter from your GP to do so.
Once a year, the Kingston team undertakes an anonymous postal survey looking at the standard of care that the team provides. I hope that you will
feel able to participate in this feedback survey.
Seeking Advice or Admission
Kingston Hospital
Paediatric Oncology Shared Care Unit
And finally……
If you are ever concerned or worried, please share those worries with
the nursing and medical staff – they will always take your concerns seriously.
A.P.Winrow
Consultant Paediatrician
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