Hong Kong

Paediatric Nurses

Association

In this issue :

ISSUE

www.hkpna.com.hk

Feature Story

April

2018

50

Gastrostomy Tube Insertion – A Systematic Approach

Experience Sharing

Ms Kwee Yung, Nurse Specialist, Paediatrics, Tuen Mun Hospital

Experience Sharing: • Gastrostomy Tube

Insertion – A Systematic

Approach

• Symposium on “Towards

Better Health for Children

2018”

Nurse’s Story: • Take the Ride

• The Journey Starts at

the Paediatric & Adolescent

Medicine

HKPNA Activities: Spring Dinner 2018

Professional Development

Activities

Renewal & Application of

Membership

Member’s Communication

Channel

A nasal gastric tube (NGT) or oral gastric tube (OGT) is a most often readily

available means to provide enteral feeding for sick children at bedside. However,

some potential risks reported with prolonged NGT or OGT include oral

aversions, pharyngeal discomfort, sinusitis, gastritis, psychological trauma,

misplacement etc. So, when children with expected prolonged need of enteral

feeding and a reasonable prospect of patient survival, gastrostomy tube (G-tube)

placement should be considered. In the past, parents and caregivers often had a

wrong concept of replacing an NGT/OGT with a G-tube as a big surgery that

may limit the daily activities of their child. Clinically, there is a lack of

standardized guidelines to provide a systematic approach for gastrostomy tube

placement.

The guidelines include four domains:

1. Decision for Gastrostomy Placement

When a decision to proceed a gastrostomy insertion is made by clinical

management team, doctor and specialist nurse will discuss with the child &

his/her parents to clarify any query. Appropriate information will be provided by

the ways of demonstration, dialogue conversation and written information. All

cases will also be referred to aero-digestive team for comprehensive assessment

and Paediatric Surgeon will be consulted too.

In early 2016, a comprehensive approach for gastrostomy tube placement was

developed in Tuen Mun Hospital. The approach includes care pathway,

guidelines, discharge and follow up process to guide and provide a holistic

approach for the whole journey.

2. Perioperative Management

Systematic workflow checklist is developed for standardized perioperative

management includes pre-operative preparation and post-operative immediate and

subsequent care.

3. Caregivers Empowerment Training

Before patient discharge, gastrostomy care training will be provided with

demonstration and return demonstration to ensure care-takers are competent in

managing routine care and emergencies at home.

4. Multidisciplinary Follow Up After Discharge

Upon discharge, patient will be referred to multidisciplinary team: paediatric Continue on next page

Forthcoming Events &

International Conference

Submission to HKPNA

Newsletter & Young

Nurses’ Sharing

HKPNA

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Conclusion

A comprehensive standardized guidelines and care pathway clarify pre-operative misunderstanding,

provide comprehensive logistics and strengthen the care-takers’ competence in taking care of patients

with gastrostomy tube insertion.

2

5 10

In-patients

Transfer to other hospitals

Home after operation

Result

There were total seventeen children underwent gastrostomy tube insertion from early 2016 till end of

2017. Ten of the children were out-patients and were discharged on Day 9 – Day 36 post-operatively;

five were transferred out to other hospitals for continuous care. For those out-patient cases, phone

follow up was provided. All of the children did not encounter significant problems after discharge and the

care-takers were confident in handling the gastrostomy tube at home.

surgeon, dietitian, Community Nursing Service etc. for follow up to ensure patient will receive holistic

care even after discharge.

HKPNA

Symposium on “Towards Better Health for Children 2018”

Ms Tang Sze Kit, Ward Manager, Prince of Wales Hospital

As one of the country members of the Asia Pacific Paediatric Nurses Association (APPNA), the Hong

Kong Paediatric Nurses Association (HKPNA) was glad to host a symposium, themed “Towards Better

Health for Children 2018” on 13 Jan 2018 in Hong Kong. More than one hundred participants joined the

symposium. After a simple but solemn opening ceremony, Associate Prof. Rashanee Seeda, President of

APPNA and Ms Susanna Lee, founding President of APPNA gave the opening and welcome addresses to

all participants. It was honored that APPNA had invited well-known paediatric experts to be the

speakers at the symposium.

After the symposium, a gala dinner was arranged to thank all the speakers and organizing committee

for their unfailing support to APPNA and the symposium.

Speakers included Professor Kate Chan (Assistant Professor of the Department of Paediatrics, Faculty

of Medicine, the Chinese University of Hong Kong); Professor Simon Lam (Associate Professor of the

Department of Paediatrics, the Chinese University of Hong Kong); Dr. Daniel Chiu (Specialist in

Paediatrics); Ms Chan Yim Fan (International Board-certified Lactation Consultant); Ms Chan Kam

Ming, Maria (Nurse Consultant - Neonatal Care, Department of Paediatrics and Adolescent Medicine,

United Christian Hospital) and Dr. Dorothy Tam (Specialist in Paediatrics). Wide ranges of paediatric

health care topics were shared in the symposium. All the participants enjoyed an updated information

on respiratory syncytial virus disease in infants, micronutrients and child health, updated on

vaccination for children, breastfeeding in infants and myths of feeding from neonate to toddler.

HKPNA

The Journey Starts at the Paediatric & Adolescent Medicine Department Ms Tang Chung Yan, Sandy, Registered Nurse, Alice Ho Miu Ling Nethersole Hospital

Nurse’s Story

Take the Ride?

Mr Wong Chi Fung, Registered Nurse ,Tuen Mun Hospital

Babies are no different from adults; they may encounter brain, eye, heart, lung, gut problems as you could

ever think of, especially for premature babies. Babies are admitted in the neonatal intensive care unit

(NICU) for treatment and life support. The ward that I work in is not a surgical center; so babies who

require surgery are needed to be transferred out to other hospitals.

Transporting a sick baby is never easy and always an emergency. An incubator, a portable ventilator, a

cardiac monitor, two cylinders of oxygen tanks and a medium-sized shoulder bag are all you have to carry

on board the ambulance with your little baby and the escorting doctor. The journey usually takes at least

30 minutes to another hospital. Should anything happen during the journey you need to manage by your

own. Therefore, I found transporting a sick baby is a super challenging and exciting task.

To do so, firstly, you need to equip your brain. I feel grateful that my supervisor has given me chances to

attend valuable courses like the S.T.A.B.L.E. Program especially for sick infants, Inter-Facility and Critical

Transport Medicine Course (ICCTM) and safe procedural sedation program. Besides knowledge that I have

acquired from these programs, I have also learnt about one word - ‘Preparation’ : always prepare

yourself, your equipment and your mind. Finally yet importantly, bringing money with you to take the ride

as you need to take a taxi for the return journey.

Secondly, you need to know your equipment. ‘Learn more, know better and equip yourself’- one of my

mentors always told me. I am glad that I have joined the ‘Equipment Competency Enhancement Program’.

In the program, members made quick references and did demonstrations repeatedly so I could refresh

myself and through practices to familiarize with the equipment operations.

In these two years, I have been many NICU babies’ papa. If you ask me now, ‘Are you still afraid

of transporting a sick baby?’ I will answer ‘YES’. Nevertheless, if you ask me ‘Can you take this

baby for the ride’? I will give you the definite answer ‘YES’ because a father will do everything for

his babies.

From University to Hospital

As a freshman in society, I was excited but yet nervous towards my first job in nursing. I was grateful

that the Hospital Authority has implemented mentorship program for new graduates to help newbies to

adapt to the new environment. Moreover, the inclusiveness and affinity of other team members have

made me get involved very quickly into the department. I was pleased that my journey started with this

great team.

Establishing Trust with Patients and Their Relatives

The therapeutic communication technique I learned in school has been used most frequently. Kids,

young adolescents as well as parents need more communication and interactions to build up trustful

relationships. Therapeutic communication helps me prioritize the physical, mental and emotional well-

being of patients while maintaining professionalism.

Continue on next page

HKPNA

Spring Dinner 2018

Ms Connie Tse, Editorial Committee, HKPNA

HKPNA Activities

Chinese New Year is a time of good fortune and happiness, celebrating the custom of reunion and blessing.

The Year of the Dog has come swiftly and the celebration of it seems to have come to a halt.

To let the festive continue, the HKPNA has held a spring dinner on 9 Mar 2018, to give members a chance

to chat and greet. The dinner started after President Ms Iris Yeung gave her blessing and led a toast to the

floor. Eight tables were filled with cheerful faces. The joyous atmosphere was pushed high by interesting

games arranged by the organizing committee. Members exhibited their talents and teamwork to grab as

many gifts as they can.

A Big Group of the

HKPNA Members

Members with Guest

Professor Lau Yu Lung

Fishing for Luck

Members Awarded

with Their Presents

Personal Development

To enhance professionalism, we need to receive various trainings to equip ourselves for challenges. Regular

drills enrich my experience to cope with different cases and emergencies. My problem-solving skills have

been cultivated throughout these trainings. In addition, lectures held by doctors and experienced nurses

help consolidate my clinical skills and knowledge. On-line resource is another platform providing the most

up-to-date and evidence-based information to nurses without boundaries.

With the solid foundation that I have built, I am confident that I am well equipped and ready to continue my

nursing career journey.

Evolving from Manual to System

The rapid development of science and technology enhances and optimizes different industries. Our team

has undergone a transition in the drug administration process. The new system – ‘In-patient Medication

Order Entry’ (IPMOE), has been introduced in the beginning of 2017 in our department. It redesigns the

workflow for doctors, pharmacists and nurses to replace the traditional manual prescription. Besides,

Electronic Patient Assessment Form-Paediatrics (ePAF) was implemented for better access and

documentation of initial nursing assessment. With the new systems, we have enhanced work efficiency and

accuracy.

Continue from last page

HKPNA

Professional CME Meeting on Child Health 2018 - Gut

Microbiome and Use Of Probiotics, Prebiotics and Synbiotics

in Children, co-organized with the Hong Kong Paediatric Foundation

was held on 6 Feb 2018.

Hong Kong Society of Paediatric Surgery Dinner Symposium

on The Management of Intestinal Failure in Children", co-

organized with the Hong Kong Society of Paediatric Surgery was held

on 7 Feb 2018.

Hong Kong Paediatric and Adolescent Dermatology Society -

2018 HKPADS Paediatric Dermatology Symposium, co-

organized with the Hong Kong Paediatric and Adolescent Dermatology

Society was held on 3 Mar 2018.

Professional CME Meeting on Child Health 2018 - Human Milk

Oligosaccharides and Neonatal Immunity, co-organized with the

Hong Kong Paediatric Foundation was held on 13 Mar 2018.

Hong Kong Society of Paediatric Surgery Annual General

Meeting & Annual Scientific Meeting - Paediatric Solid

Tumors, Surgical Management of Paediatric Solid Tumors,

Building Blocks of Psychosocial Care & Child Life Services for

Child Cancer Patients and Their Families, Nursing

Management of Paediatric Patient with Solid Tumors, co-

organized with the Hong Kong Society of Paediatric Surgery, was held

on 17 Mar 2018.

Hong Kong Society of Paediatric Respirology and Allergy -

What's New? Gut Microbiota & Food Allergies Management,

co-organized with the Hong Kong Society of Paediatric Respirology and

Allergy, was held on 20 Mar 2018.

The 14th Congress of the Asian Society for Pediatric Research

Emergent and Relevant Issues in Child Health Hosted by the

Philippine Pediatric Society, Inc. will be held on 2-4 Oct, 2018 in

Philippines. Please visit http://aspr2018.com/ for details.

rofessional Development Activities P

orthcoming Events F

enewal & Application of Membership R Registered and Enrolled nurses who have experience in paediatric care are

welcome as members. Any nursing undergraduate and pupil nurse, of the

universities and nursing schools, who has interest in paediatric nursing are also

welcome.

Please complete the Membership Application/Renewal Form and return

it to Ms Caroline Lee, Hon. Dep. Secretary, S404, QEH together with a cheque

made payable to “Hong Kong Paediatric Nurses Association Ltd”. Application

forms can be obtained from HKPNA Hospital Coordinators or downloaded

from web site http://www.hkpna.com.hk . Kindly fill in your email address

when returning the completed form, so that we can keep you informed of the

activity / course information updates.

Life Members are also welcome to update any personal particulars annually

and furnish your email address using the same form.

ember’s Communication Channel M HKPNA treasures every idea and comment from members. Please forward

your suggestions or input in writing to either the President, Ms Iris Yeung at

DOM (PAED) Office, 9/F, Block F, QEH. Besides, you can contact us via

email address: hkpna@ymail.com

The HKPNA Newsletter is published three times annually. Articles such as

case studies, research findings, work reports, member’s views and ideas are

welcome. Each article is preferably no more than 250 words. Submit either

the hard or electronic copy of full text and photographs with subtitles.

Author name(s) and contact details should be included. It is the author’s

responsibility to comply with patient privacy and data protection. Where

necessary, informed consent should have been obtained before submission.

The Editorial Committee reserves the right to select or reject the submitted

article. Send submission to: Ms Lee Wan Ming, at NC (PAE/Neonatal) Office,

K-1007, Block K, QMH OR e-mail: leewm1@ha.org.hk

ubmission to HKPNA Newsletter S

Views expressed in this publication are

not necessarily those of the Editorial

Committee, nor of the HKPNA. The

publishers accept no liability for the

contents in this publication. Articles

may be reproduced only with the prior

consent of the Editorial Committee.

Editorial Committee 2016 - 2018

Chair: Lee Wan Ming, QMH

Members: Tse Connie, CMC (Chief Editor)

Chan Eugenie, QMH

Cheng Sau Wai, QEH

Law Shing Ping, PWH

Lo Carol, CMC

Ma Ella, HKCH Commissioning

Invitation of Articles Submission Paediatric Young Nurses’ Sharing To facilitate young nurses working in paediatrics to speak

up / out for professional growth and development that

knows no boundaries, and share in the HKPNA

Newsletter column

Please send submission to:

Ms Lee Wan Ming at

NC (PAE/Neonatal) Office, K-1007, Block K,

QMH or Email: leewm1@ha.org.hk

with template download from HKPNA website

The 7th ICCN International Conference on Clinical Neonatology Symposium organized by HK Neonatal Society will be held on 23-26 May 2018 in Turin, Italy. Please visit www.iccn2018.eu for details.

Evening seminar - Anxiety problems in students across the spectrum from the mild to the severe end, co-organized by the Hong Kong Society of Adolescent Health, will be held on 11 May 2018

nternational Conference

The 6th Asia Pacific Congress of Pediatric Nursing (APCPN)

Pediatric Nurses - A unified Voice towards Achieving SDGs

and Reducing Inequalities Organized by the APPNA will be held

on 27-29 Aug 2018 in Bali Nusa Dua Convention Center (BNDCC)

Nusa Dua - Bali, Indonesia. Please visit www.apcp-pitika2018.org for

details.

The HKPNA offers sponsorship for members to attend the APCPN,

interested members please contact hospital coordinator for details.

I