Escalation to HFNC for deteriorating patient
Referral and Consultation

Level ≥4 CSCF facility consultation MUST be sought within 2 hours of HFNC therapy treatment commencing.
The level ≥4 CSCF facility to your HHS facility consultation should occur at the Senior Medical Officer (SMO) level from both facilities

Referring clinicians to contact their relevant level ≥4 CSCF facility for consultation – this should be Senior Medical Officer (SMO) level referral at both facilities.

If retrieval is required in the first instance contact RSQ (1 300 799 127) to link all relevant parties together including:

  • referring SMO from a remote hospital
  • local level ≥4 CSCF facility
  • relevant local Intensive Care Specialist – dependent on the patient’s condition

A patient must be accepted at an SMO level at the receiving facility.

If it is assessed at 2hrs post commencement of HFNC therapy that the patient does not require transfer to a level ≥4 CSCF facility, consultation with the level ≥4 CSCF facility is still mandated to ensure the level ≥4 CSCF facility is aware of the patient and their condition.

 

Diagram of Remote HFNC patient

Patients who remain in Remote Facility on HFNC

Patients who remain in a remote HHS facility on HFNC therapy will have the following ongoing consultations as a minimum:

Daily consultation with the level ≥4 CSCF team until discharged from the remote HHS facility

Twice daily consultation by the local remote hospital treating team team (including SMO,) until discharge

 

Other considerations to include for a child on HFNC in a remote HHS facility include:

  •  Local nursing clinical leadership (Director of Nursing/ Nurse Unit Manager/ Clinical Nurse Coordinator/ Shift Team Leader) should be notified of the patient (as per normal patient status communication processes,) as soon as is practical.
  • Ideally the consultation between the level ≥4 CSCF facility and remote HHS facility will involve an inter-professional approach with nursing and patient/family input where possible and appropriate.
  • Consultation will be conducted via the telephone at the clinician’s discretion to use videoconferencing when resources are accessible and appropriate.
  • Communication throughout the tertiary consultations will use the ISBAR technique that is standardised within Queensland Health. This will be used in conjunction with the Clinical Handover Inter-facility transfer checklist, which outlines observations and prompts information that is required to be readily available throughout the consultation process.
  • For all children with an acute illness, clear and unbiased communication with a full set of observed physiological parameters is essential and will be expected by the level ≥4 CSCF facility consulting SMO.

 

At a minimum this includes:
Weigh
Blood glucose level
Respiratory rate
Degree of respiratory distress/ work of breathing
Oxygen saturations
Prescribed oxygen and mode

 

Temperature
Heart rate
Blood pressure
Capillary refill time
Level of consciousness/ AVPU
Child Early Warning Tool (CEWT) score

Communication and Documentation

Communication throughout the consultations with the level ≥4 CSCF facility team will include the use of the ISBAR technique that is standardised within Queensland Health. This will be used in conjunction with the relevant prompt/advice/transfer checklist used locally in your hospital. Document all advice provided on patient management in your patient medical record.

Additional local documentation tools may be used such as the CHHHS Advice/Retrieval record form. View form below

View Form

Staffing requirements

Children on HFNC outside of PICU, require a minimum of two (2) paediatric HFNC competent clinicians to be present on any given shift. This may be a combination of Registered Nurse’s (RN) or RN and Enrolled Nurse (EN). At a minimum, one of these staff must be a RN. If staffing is reduced, follow local practices to ensure patient safety.

When a patient is commenced on HFNC therapy, a SMO is required to remain within the facility, until the initial 2hr trial of therapy has been completed. After this time, if the team has established that the patient has stabilised, the on-call SMO is required to arrive at the patient’s bedside within the local facilities specified guidelines regarding on-call times.

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