This form was completed: Month 05 Year 2002
(please change the date when you update information)
Hospital Name: Kitimat General Hospital
Address: 899 Lahakas Boulevard
Person to contact for transfer arrangements: Kathi Nelson RN
A. The Unit/Hospital has:
A ward exclusively for children: Yes _____ No
The ward is called ________________________________. It is on the ______ floor.
Children up to age _______ are cared for on this ward.
The steps we can take when a child’s condition gets worse:
a.) continue to care for the child on the ward with support from Terrace
b.) transfer the child to ____________________________________ in our hospital,
b.) transfer the child from our facility to Mills Memorial hospital.
The ward has ______ beds for children. Most rooms have _______(#) patients.
A parent can be with his/her child 24 hours a day? Yes No _______
Or during these times: this is provided most of the time unless a private room is not
A Special Care Nursery for newborns: Yes _______ No
Physicians who care for children in your unit/hospital:
NAME OF PHYSICIAN SPECIALISATION
If parents are unhappy about the medical care they should follow this process:
Parent can contact: _____________________________ Tel. _______________________
What is the average ratio of nurses to children?
The Nurses who work with children are:
a.) a core group of pediatric nurses,
b.) nurses from adult wards who also routinely
work with children,
c.) both of the above.
Do you have a lactation specialist/consultant
a) Hours available?
b) Lactation specialist is familiar with premature
c) Electric breast pumps available?
Do any nurses have a speciality relevant to children? (Please indicate the area of specialisation).
What do you do to maintain consistency in care? eg. care plans, shift change nursing rounds,
primary nursing. taped reports, care plans if complicated
If parents are unhappy about the nursing care they should follow this process:
speak with nurse in charge
Parent can contact: ___________________________________ Tel. _______________________
Which health professionals would perform the following procedures?
On average how often in a 3 month period would s/he perform this task on a child?
Who on the Frequency Who in the Frequency
Drawing Blood Lab staff
Starting IVs RN’s/DR’s 6/year
IV antibiotic delivery
Inserting Chest Tubes
Intubating and Hand Ventilating DR’s 6/year
Types of Ventilator care provided 0
# ventilators available
Heart and Lung Monitoring
Oxygen saturation monitoring
(# of monitors available) 2
NG Tube Feeds RN’s 2/year
G or J Tube Feeding 0
Tracheostomy Care 0
TPN Care 0
Central Line Care 0
Glucose Monitoring RN’s
Support for infants/children with Physio/OT
difficulty feeding by mouth
Please add any comments: ________________________________________________________
Please indicate any special equipment that you do not stock e.g. neonatal size supplies
C. Support Services
Types of medical imaging available: Hours:
X-ray M-F, 8-4 p.m., on-call
Ultrasound “ “
Lab Services: Hours: M-F, 8-4 p.m., on-call
Laboratory can work with very small blood samples: Yes No _______
Can families request a topical anesthetic cream before a poke? Yes _______ No _______
Types of rehabilitation services available: Hours:
Physiotherapy/ OT M-F, 8-4 p.m.
Social Worker available: Yes _______ No
Nutritionist available: Yes No _______
D. Family Centred Care: (Please indicate if things are different in the Nursery)
1. What resources do you have to provide for the play and learning needs of the children?
When caring for a young baby are you able to reduce stress by controlling noise and
light? Minimally – due to integration with all of acute care/adults/obst.
What facilities do you have for parents?
Beds Showers Food Laundry
3. Can children wear their own clothes? Yes No _______
4. Can a parent be with the child during procedures like IV start? Yes No ______
5. What processes, tools, procedures are in place to ensure that families are kept up to date
on their child’s condition? Eg.
Daily contact with nurses
Daily contact with physicians
Team meetings with families
Family access to charts __________________________________________
6. How are parents made to feel part of the team?
7. Can siblings visit: Yes No _______
Is any type of childcare available for siblings Yes _______ No _______
8. Is parking convenient & readily available? Yes No _______
What are the parking charges? None
9. Cafeteria hours: M-F, 9-4 p.m.
10. If a parent wants to talk with someone at the facility before the transfer, or arrange a
tour, whom does s/he call?
11. Do you have a booklet/brochure about the hospital? Yes No _______
Please send one to: Family Resource Library
Children’s Hospital of British Columbia
4480 Oak Street