ZB- ZB has a diagnosis of symptoms like cerebral palsy and epilepsy, and right sided colitis, and she is non-speaking.

ZB IS NIL-BY-MOUTH, and all her medications and feed are administered via her PEG tube. ZB seizures are well managed by her medication, if ZB was to have a seizure staff are to call an ambulance 3 minutes after the start of her seizure.

IF ZB REQUIRES ANTIBIOTICS THIS HAS TO BE LIQUID FORM. ZB is a wheelchair user and is supported to transfer via her sling and ceiling track hoist. ZB is allowed up to 4 hours at a time in her chair and then is required to have at the very least 45 minutes but preferably 1 hour bed rest. She is then allowed a further 2 hours in her chair later in the day.

The colours for her sling are red top and green bottom. Staff are to closely monitor for any pressure areas and breakdown of skin and report these immediately.

ZB is supported to set up her feed in the morning (this can only be completed by staff who are PEG trained) ZB medication times are 05:30, 11:30, 17:30, 19:00 and 23:30 again only staff who are PEG trained are able to support with medication. ZB has a suction machine and is supported with suctioning when she is over producing saliva or she has a chest infection and is struggling to bring this up herself. ZB is supported with chest physio to help her clear her chest.

Only staff who have been suction trained are able to support Zoe with suctioning. If no staff on shift are suction trained staff are to call an ambulance. ZB is supported with her personal care regularly throughout the day and is supported with a pad change every 4 hours.

ZB has bed sides on her bed and when she is on bed rest these are to be pulled up to prevent her from turning in her bed and falling out. When she is on bed rest the head end of her bed should be raised to the black line that is on her head board, and raise the lower part of her bed to prevent her sliding down in her bed, she also has a t-roller (blue cushion) that is used to prevent her sliding down the bed. Paperwork is in folder for this with pictures. Staff are to ensure that cushions are placed down the side of the bed closest to her tv to prevent ZB from getting her foot stuck down the side of the bed. ZB is not to have any duvet or blanket on her bed as she could suffocate. If her room was to appear cold she should be supported with turning on the heating and putting more clothes on her.

ZB SHOULD NOT BE LAID FLAT AT ANYTIME as there is high risk of aspiration. ZB is to be regularly checked to ensure that she has not pulled on her PEG tube or got her hands/ feet legs stuck somewhere on her bed, staff are to ensure that when she is on bed rest they are completing regular welfare checks also. ZB has PRN pain relief.

ZB is supported with her observations every evening these are completed to help spot the early signs of infection to catch it early so she does not have to go into hospital. Her oxygen should be above 90, if it is below 90 staff are to call an ambulance immediately no questions asked. If they are above 90 and below 96 staff should contact out of hours doctor or 111 or GP if open and seek advise regarding possible infection. ZB temperature should be around 36-37.5 as normal if above 38 staff are to administer pain relief. If staff have concerns around ZB blood pressure they are to refer to the guidelines around blood pressure that were provided by the LD nurse.