Policy No:
OP13
Version:
4.0
Name of Policy:
Hospital Transfer and Discharge Policy
Effective From:
23/05/2011
Date Ratified
Ratified
Review Date
Sponsor
Expiry Date
Withdrawn Date
21/02/2011
SafeCare Committee
01/12/2013
Director of Nursing & Midwifery
20/02/2014
This policy supersedes all previous issues.
1
Version Control
Version
Release
Author/Reviewer
Ratified
By/Authorised
By
Date
1.0
August
2004
N S Russell
TPF
Trust Board
July 2004
August 2004
2.0
February
2006
N S Russell
TPF
Trust Board
3.0
March 2009
Practice
Development
Team
SafeCare
Council
January
2006
January
2006
March 2009
3.1
February
2010
N S Russell
N/A
N/A
4.0
May 2011
N S Russell
SafeCare
Council
December
2010
2
Changes
(please
identify
page no.)
CONTENTS
Page
number
1
Introduction
6
2
Policy Scope
6
3
Aim of the policy
6
4
Roles and Responsibilities
7
4.1
The Chief Executive
7
4.2
The role of the General Practitioner and Primary Care Team
7
4.3
The Hospital Consultant and Medical Team
7
4.4
Ward Manager / Designated Deputy
8
4.5
Ward Clerk
8
4.6
Patients
8
4.7
Carers
9
4.8
Pharmacy
9
4.9
Nutrition and Dietetic Service
9
4.10
Physiotherapists
9
4.11
Occupational Therapists
9
4.12a Community Based Services
10
4.12b Safeguarding Children
10
4.12c Concern is Raised when a Child is Admitted to Hospital and
Discharged
4.13a Care Packages
10
4.13b Assessment / re assessment of needs
11
4.14
The Integrated Hospital Discharge Team
11
4.15
The Ambulance Service
11
4.16
Community Nursing Team
11
4.17
Community Care Nurse Assessors
11
4.18
Intermediate Care Services
11
4.19
Specialist Patient Services
12
4.20
Health Records
12
5
Definitions of Terms
12
6
Key Principles of Discharge Planning
13
6.1
Pre assessment
13
6.2
Process for transfer out of hours
13
6.3
Process for transfer from one clinical area to another
14
6.4
Process fro transfer to a Residential / Nursing home
14
3
10
6.5
Direction on Choice
14
6.6
Process for transfer to another hospital
15
6.7
Process for discharge out of hours
15
6.8
Pharmacy out of hours
15
6.9
Guidelines relating to patients leave from hospital for a significant
family event
15
6.10
Patients or carers disagreeing with the discharge plan
15
6.11
Patients wishing to take their own discharge
15
6.12
Discharging patients who are homeless
16
7
Training
16
8
Equality and Diversity
16
9
Monitoring Compliance and effectiveness of the Policy
16
10
Consultation and Review
17
11
Implementation of the Policy
17
12
References
17
13
Associated Documentation
17
Appendices
1
Discharge Process
18
2
Patients taking their own discharge
19
3
Care Standard 20: Discharge Planning
21
4
Discharge Summary
22
5
Discharge Pathway for patients wishing to go home to die
23
6
Primary Care nursing referral form
24
7
Acutely Ill patient referral form
25
8
Inpatient Transfer Form
26
9
A tool to aid decision making when boarding
27
10
Boarders Transfer Form
28
11
Critical Care Transfer Form
28
12
Residential / Nursing Home Transfer Form
31
13a
Direction on Choice
32
13b
Home of Choice letter
33
14 a
Children’s Services: Discharge Arrangements
34
14b
Children’s Unit Discharge Checklist
35
14c
Paediatric Collaborative Transfer Document
36
15a
Post Natal Transfer Home
40
15b
Antenatal Handover of Patient Care
42
15c
Delivery Suite or Postnatal Ward to SCBU
43
15d
Delivery Suite to Postnatal Handover of Patient Care
44
4
16
Patients’ taking leave for significant family events
45
17
Homeless Pathway
46
5
GATESHEAD HEALTH NHS FOUNDATION TRUST
HOSPITAL TRANSFER AND DISCHARGE POLICY
1. Introduction:
Many people admitted to hospital fear the experience of hospitalisation and of losing their
autonomy: they want to return to living their previous lives as soon as possible and every
effort should be made for this to become a reality. (DH,2003). Acute hospitals should only
be used for the delivery of services that cannot be provided as effectively elsewhere in the
health service, social care or housing system (DH, 2003).
Discharge is not an isolated event which occurs at the end of a patient’s stay but is a
process (DH, 2003) which for the majority of patients is often referred to a ‘simple’
occurring in approximately 80% of cases whereby the patient has no identified needs or
their needs do not require complex planning and delivery. For the remaining 20% their
needs will be more complex requiring effective management by members of the multi
disciplinary team (DH, 2004).
2. Policy Scope:
This policy underwrites good practice guidelines for all patient groups which are patient,
carer and family focused and endorses partnership and collaborative working among the
various professions, disciplines and agencies involved. This unified approach will promote
choice and independence (Putting People First, DH, 2007).
The Transfer and Discharge Process requires each individual patient to be formally
assessed and any identified needs clearly documented, acted upon and completed within
an agreed timeframe (Appendix 1). An inadequate plan for discharge is unacceptable and
so it is vital to identify any complexities early in the patient journey to ensure that any
complications are foreseen and overcome. During this process both the patient / carer will
play an integral role and will be kept fully informed of any developments regarding their
planned programme of care. The provision of personalised care is required to be tailor
made to the needs of patients and agreed with them and their carers (Lord Darzi, 2008).
3. Aims of the policy:
This policy provides a systematic approach to the safe transfer and discharge
arrangements of all patients across the Trust irrespective of speciality. However, it is
recognised that a number of particular vulnerable groups when arranging either their
transfer or discharge.
These groups may include:•
•
•
•
•
•
Terminally ill patients and those patients wishing to go home to die
Patients with long term conditions and continuing disability including Learning
Disabilities, Physical Disabilities and Sensory Impairment
Patients who have mental health problems
Patients who are homeless
Patients requiring 24 hour care in the community either in the form of residential,
nursing or living in their own home
Children and Young people
6
In particular when planning a child’s discharge the following groups of children should be
considered carefully
•
•
•
•
•
Children who are subject to a Child Protection Plan
Children in need including all children who have complex health needs or disability
Children who are looked after by the local authority and those in foster care
Children with a life limiting condition
Children who have been admitted to an adult ward or medical assessment unit ( over
the age of 15)
4. Duties (Roles and Responsibilities)
4.1 The Chief Executive:
The Chief Executive has ultimate responsibility for the safe, effective and timely transfer
and discharge for all patients’ across the organisation. However this responsibility will be
designated to the Director of Nursing and Midwifery
4.2 The General Practitioner (GP):
If a patient is admitted to hospital via their GP they are required to provide the hospital with
a detailed history of events leading up to the patient’s admission. Information should also
be provided regarding any circumstances, which may impact on patient’s care and
subsequent discharge plan.
4.3 The Hospital Consultant and Medical Team:
Each Consultant is responsible for the overall care of a patient while in hospital. They will
at the earliest appropriate opportunity, identify with the patient and carer the outcome of
their assessment and provide them with an anticipated date of discharge. In most cases
this will be identified at the first ward round following admission and will be documented
within patients’ medical records. The estimated date of discharge will be used as a
reference point to inform timescales associated with MDT assessment and planning in
preparation for the patient’s discharge. Any tests or investigations that are not urgent are
required to be identified and undertaken as an out patient. It is the responsibility of the
consultant to determine when a patient is medically stable for discharge either by direct
contact with the patient or documenting clear and concise parameters in the medical
records to support nurse led discharge.
A discharge flimsy must be completed prior to or on the date of discharge for all in-patients
within the Trust by a member of the medical team. The ward clerk should fax the master
copy to the GP on the date of discharge, however if the ward clerk is absent, the
discharging nurse is required to undertake this role. If medication changes have been
made to the patients’ treatment, this needs to be highlighted and explained on the
discharge flimsy. A formal discharge letter will be sent to the patient’s GP within 14 days of
the patients’ discharge.
In relation to a patient taking their own discharge the medical team must inform the
patient’s GP that the patient has taken their own discharge against medical advice. Please
refer to Appendix 2 concerning the appropriate action that must be taken in this situation.
7
If a patient is being transferred to another hospital or organization the medical team are
responsible for providing written documentation regarding the patients medical
management plan.
4.4 Ward Manager or Designated Deputy:
The Ward Manager has responsibility for ensuring that effective transfer and discharge
planning processes and practices operate within the ward. This responsibility however will
designated through individual qualified members of the nursing team leading and
managing that individual patient’s care, utilising a multi disciplinary team approach.
Patients on admission to the Trust will have a holistic assessment of needs completed
including a social history, irrespective of their speciality. The Ward Manager will ensure
that each patient has a personal, documented discharge care plan (Care standard 20) on
which ongoing care arrangements will be recorded (Appendix 3).This will be monitored
and evaluated throughout the patients stay in hospital.
If a child is admitted to hospital and the staff has either child care or child protection
concerns it is the nurses’ responsibility to contact Children, Families, Young Offenders,
Learning and Children within 1 day of admission to agree a formal written plan before the
individual child can be discharged from hospital. It is essential that any concerns raised
are addressed and the home environment is assessed as being safe. Where it is believed
that a child will remain in hospital longer than 3 months who are currently under the care of
the local authority, the same department must be contacted to undertake an assessment
concerning their legal responsibilities concerning the Children’s Act 1989.
The discharging nurse is the person responsible for co-ordinating the patient’s discharge
which includes the giving of any advice and information. At the point of discharge each
individual patient will be given written instructions regarding any aftercare which is required
and any advice given in the form of a Discharge Summary (Appendix 4)
The discharging nurse will also provide / arrange:
•
7 days supply of medication which has been checked by 2 qualified nurses against the
discharge flimsy and the drug kardex
•
7 days supply of dressings if required (this is related only to the timing of the dressing
changes e.g. 3 dressings will be provided if the wound requires to be redressed twice a
week)
•
Any equipment required e.g. hospital bed, pressure relieving mattress, cushion,
oxygen, mobility aids etc.
In relation to the transfer of patients the nurse is responsible for co coordinating the
transfer, communicating verbally with the receiving ward, giving an overview of the
patient’s previous care and completing the necessary SBAR transfer document.
4.5 Ward Clerk:
Following completion of the discharge flimsy by a member of the medical team the master
copy is required to be faxed to the GP on the day of discharge by the ward clerk, however
if the ward clerk is absent the discharging nurse is required to undertake this role.
4.6 Patients:
8
Each patient should be fully aware of the circumstances relating to their stay in hospital
and be able to give informed consent regarding any treatment and aftercare. Where
patients cannot represent themselves, the next of kin, carer, relative or an independent
mental capacity advocate (IMCA) must be involved. Their role is to represent the patient’s
interest and to challenge any decision that does not appear to be in the best interests of
the patient (Ministry of Justice, 2005). Wherever possible, the views of children will be
taken into account and respected.
4.7. Carers:
With the patient’s agreement, relatives and carers will be fully involved in the transfer and
discharge process. The role of the carer will be acknowledged and recorded regarding
their contribution to the discharge plan. Don’t assume that a person’s carer will necessary
be able to or want to continue with their caring role. Patients and their carers may have
different needs and aspirations. Carers have a right to their own assessment and to any
services they may need to support them in their caring role which may be conducted post
discharge. It is also important to remember that young people may also be providing a
major part of a patients care (DH, 2010).
Many patients and carers are becoming expert in managing long term chronic conditions
and often providing care that is equivalent to that provided by a registered nurse. In such
circumstances home care arrangements can be set up quickly once the patient is clinically
stable and safe for transfer
( DH,2010)
4.8. Pharmacy:
Following the completion of a discharge prescription by the medical team, ward staff
should contact their ward pharmacist, using the internal pager system. On arrival to the
ward the pharmacist will check the discharge prescription against the current drug kardex /
patient notes and organise the dispensing of 7 days’ supply of medication by the
Pharmacy Department.
4.9. Nutrition and Dietetic Service:
When it has been established that a patient requires to be fed enterally at home the
Nutrition and Dietetic Service require two days notice prior to the actual date of discharge
to ensure the appropriate equipment can be put in place. If the patient is to be discharged
on supplements these also need to be prescribed and dispensed at the point of discharge.
4.10 Physiotherapists:
Physiotherapists provide members of the multi disciplinary team with invaluable
information regarding patients’ progress and level of support a patient will require on
discharge to function at home. They may order appropriate aids and equipment to support
discharge if indicated and may perform home assessment visits with other agencies prior
to a patients’ discharge to ensure risk is minimised. Physiotherapists also provide an
educational role as well as providing specialist advice not only to the patient, family /
carers but to all members of the MDT.
4.11 Occupational Therapy:
Occupational Therapy intervention is a process of collaboration and negotiation between
the therapist and patient in which the patient is assisted to identify problems and goals and
9
to find effective ways of dealing with them. Occupational Therapists work with individual
patients to undertake assessment and treatment designed to facilitate safety and
independence within the areas of self maintenance, productivity and leisure. For example
this may include being able to wash and dress independently or prepare a meal, undertake
housework or use public transport.
Referrals to the service may be made by completing an OT referral form and sending it
either electronically to [email protected] or via the internal post to the OT Dept,
Bensham Hospital or faxing it to 0191 4455181. Referrals are accepted where they are
deemed to be appropriate and patients will usually be seen on the ward for initial
assessment. For further advice and urgent requests please contact the department on
0191 4455226.
Further assessment and treatment will then discussed with the patient and an individual
action plan agreed. A number of patients will require assessment at home; this may be
undertaken with or without the patient being present whilst they are still an in patient or
some patients will be followed up at home on discharge. Decisions around the need for,
and type of home visit undertaken will be identified by the Occupational Therapist who will
base this decision on the needs of the individual patient and on the associated risk
assessment of the situation.
4.12a Community Based Services:
The NHS and Community Care Act places a duty on Community Based Services (CBS) to
assess all people who require publicly funded community care. Referrals should be made
to CBS when a patient requires ‘social care’ in order to be discharged safely. This may be
provided in the person’s own home or in arranging 24 hour care in either a residential or
nursing home care setting. Assessments should not be undertaken in a hospital
environment but in a designated transitional bed where the patient may be transferred
following resolution of a period of acute illness.
Community Based Services operate an Emergency Duty System which operates after 5
pm. Telephone Number – 4770844. This is only to be used in the case of emergencies.
4.12 b Safeguarding Children:
Children who are in hospital should have their overall welfare safeguarded and promoted
in the same manner as all other children. Hospitals should take all reasonable steps to
ensure that children are cared for in secure children’s wards and are provided with suitable
adult supervision and care. Wherever possible, children should be consulted about where
they would prefer to stay in hospital and their views should be taken into account and
respected.
4.12 c Concern is Raised when a Child is Admitted to Hospital and Discharged:
If a child is admitted to hospital and the staff have either child care or child protection
concerns, Children’s Services should be immediately notified as per Trust’s Safeguarding
Policy. Liaison must take place between Paediatric staff and Children’s Services, within
one day to agree what action, if any, is required. The child should not be discharged from
hospital without a written plan being agreed which highlights how these concerns will be
addressed. ( Refer to Trust Safeguarding Children and Young People in Gateshead Policy
– RM68 and section 5.10.3 LSCB Inter-agency Procedures )
10
4.13a Care Packages (Basic restart):
If a patient is admitted to the Medical Assessment Unit, CBS will suspend care packages
for up to 48 hours rather than cancel the packages of care. However, if a patient is
admitted for a more prolonged length of stay, CBS will require a period of 48 hours to
restart a care package which can be initiated by contacting the relevant Care provider.
Advice can be sought from the Integrated Hospital Discharge Team via switchboard.
4.13b Assessment / re assessment of needs:
Where assessment or reassessment is required to be facilitate good practice would
indicate an early referral to CBS. No patient will be discharged home prior to the reinstatement of an established or planned new care package without the awareness and
agreement of patient. This must be clearly recorded in the Patient’s Discharge Summary.
Particular care should be taken to ensure adequate support is in place for patients’
discharged at weekends.
4.14 The Integrated Hospital Discharge Team:
The Integrated Hospital Discharge Team operate a 7 day a week service; in order to assist
all members of the multi disciplinary team to facilitate a safe, effective and timely discharge
for patients across the organisation who have both simple and complex discharge needs.
The Team also specialises in coordinating palliative discharges for patients who have a
limited life expectancy and have expressed a wish to go home. For further information
please refer to Appendix 5.
4.15 The Ambulance Service:
The North East Ambulance Service (NEAS) is responsible for providing transport for
patients who are unable to travel by any other means due to clinical need; the booking of
an ambulance for a patient to be discharged should be requested through the e-booking
system. This must be made at least on the morning prior to the day of discharge although
it is better to book transport in advance as far as is practically possible. Discharges are
not normally given a specific time and it is essential that the patients and their relatives are
informed of this. If a patients’ discharge is cancelled, it is essential that the Ambulance
Liaison Officer is informed.
Patient Transport Service: Telephone number - 2648870
4.16 Community Nursing Team:
The District Nursing Services provides a high quality service for those patients who have
identified nursing need who are housebound, palliative or who reside in residential care. If
a patient has an identified nursing need post discharge requiring intervention please
complete the necessary referral form and fax to the relevant District Office (Appendix 6). It
is good practice that this is followed up by telephoning (4787665) the Community Nursing
Service to confirm receipt of the referral. If the discharge is classified as being complex
then a case conference should be arranged and an agreed action plan formulated, for
example, especially when extensive pressure damage has been identified, or when enteral
feeding is required.
11
4.17 Community Care Nurse Assessors:
The majority of patients leaving hospital will not have needs that suggest eligibility for NHS
continuing healthcare. However patients who do have complex healthcare needs are
eligible to have their needs considered against the criteria. In relation to hospital
discharge, the NHS is required to assess a person’s eligibility for NHS continuing
healthcare before social services are notified of the case gaining the patients consent.
4.18 Intermediate Care Services:
A range of services have been developed to assist the facilitation of both prevention of
admission and the safe, effective and timely discharge from hospital for those patients who
have rehabilitation needs for time limited period of up to 6 weeks. For further information
and advice please contact the Integrated Hospital Discharge Team via switchboard.
4.19 Specialised Patient Services:
In addition to the range of staff and services indicated above significant patient groups
such as children, adult and elderly mental health and maternity, all have specific staff
undertaking similar but distinctive services and tasks which can be used as a specialist
resource in relation to discharge planning.
4.20 Health Records:
The timely completion of Health Records and communications between professionals are
essential for good practice and are crucial to this process. Filing systems and retrieval
should be uncomplicated and accessible, reflecting good practice guidelines. Case notes
should be legible, informative and up to date.
5. Definitions:
A medical / surgical / orthopaedic boarder:
A patient residing on a ward outside their admitting speciality
Estimated date of discharge:
Based on the expected time required for tests and interventions to be completed and the
time it is likely to take the patient to be clinically stable and ready for discharge (DH, 2010)
Homeless person:
A person is homeless if there is no accommodation that they entitled to occupy or they
have accommodation but it is not reasonable of them to continue to occupy this
accommodation (Housing Act 1996)
NHS Continuing Healthcare:
A package of care arranged and funded solely by the health service for a person aged 18
and over to meet physical or mental health needs which have arisen as a result of illness
(Delayed Discharges (Continuing Care) Directions 2009).
12
Residential Care:
24 hour care which is provided in a care facility for those patients who are no longer able
to cope at home with their day to day activities.
SBAR: (Situation, Background, Assessment, Recommendations)
An acronym which is used as a standardised framework to communicate vital information
in a clear and concise manner from one healthcare professional to another.
Nursing Care:
24 hour care which is provided in a care facility for those patients who require nursing care
on a daily basis due to illness or disability
6. Key Principles of Discharge Planning:
•
Discharge planning should commence prior to or on admission following a holistic
assessment of needs and an individualised discharge care plan formulated (Care
Standard 20)
•
Every patient will have a clear documented clinical management plan within 24 hours
of admission which will be reviewed daily
•
Ongoing discharge needs will be clearly identified as either simple or complex and the
appropriate action taken
•
An expected date of discharge will be identified within 24 hours of admission for simple
discharges and 48 hours for complex discharges and reviewed on a daily basis.
•
Ownership at ward level for individual patient transfer and discharge arrangements
•
All patients and carers will be at the centre of the discharge process
•
Discharge planning will occur seven days a week and morning discharges promoted on
a daily basis
•
Primary Care professionals will be invited to attend a case conferences prior to
discharge for those patients who have complex needs
•
Identified equipment will be provided prior to discharge
•
Ensure further relevant discharge information is processed as soon as possible to
ensure it reaches GP within 14 days.
6.1 Pre Assessment:
Prior to patients’ being admitted to hospital for elective surgery a comprehensive pre
assessment will be undertaken in order to identify any potential discharge needs post
discharge and any appropriate referrals initiated at this time. This pro active approach to
discharge planning will ensure each individual patient will be provided with an anticipated
discharge date and the necessary equipment and / or services provided on discharge.
13
6.2 Process for transfer in or out of hours;
Patients’ should only be transferred between 09.00 hrs – 22.00 hrs with the exception of
those patients being transferred based on clinical need or from assessment units such as
Coronary Care, Critical Care or Accident and Emergency to a base ward. It is only in
exceptional circumstances that the transfer of patients will occur outside of these times
including protected meal times (Appendix 10)
6.3 Process for transfer from one clinical area to another:
When a patient is being transferred from one clinical area to another within the
organisation, it is vital that the patient is placed according to clinical need, paying particular
attention to the issues related to infection control and privacy and dignity
The boarding of patients should be avoided as far as possible; however there are times
when such activity becomes a necessary part of managing emergency admissions and
maintaining a supply of appropriate beds. The decision to board will be coordinated by the
Bed Manager and discussed at the Bed Meetings held daily.
Prior to a patient being transferred across wards in times of variation in demand and
capacity, the transfer must be discussed and explained to the patient, relatives and carers.
Patients should only be subjected to one move during their hospital episode which this is
not directly related to their clinical management plan.
Patients who are suitable to board are those who are medically stable and are ready for
discharge. Patients who are confused or are suffering from dementia are not suitable to be
boarded (Appendix 9).It is acknowledged that they may be times when no patients meet
this criterion, under these circumstances the clinical team will be expected to make the
decision based on their professional judgement to identify patients to transfer.
If a patient is transferred to a ward which is not related to their clinical management plan,
then a boarder’s checklist must be completed (Appendix 10) by the base ward and a
verbal handover conducted by a qualified nurse using the SBAR format must take place
prior to transfer.
When a patient is being transferred from the Critical Care Department to a base ward then
a Critical Care Transfer sheet must be completed by Critical Care staff (Appendix 11)
It is the responsibility of the nurse in charge / deputy to establish if an escort is required
based on the patients clinical and nursing needs.
6.4 Process for transfer to a Residential / Nursing Home:
When a patient is being transferred to a residential or nursing home the discharging
nursing is required to complete a transfer letter, a standardised copy of which can be
found on each ward (Appendix 12). This is supplementary to the standard discharge flimsy
completed by medical staff and must accompany the patient on transfer. Any follow up
appointments or arrangements must be made and sent with the patient. A comprehensive
verbal handover must take place prior to transfer using the SBAR format. In relation to the
provision of equipment it is the responsibility of the NHS to provide the necessary
equipment required for patients residing in residential care but for nursing care it is the
responsibility of the individual home.
6.5 Direction on Choice:
14
Discharge or transfer from hospital is frequently delayed when a patient’s preferred
accommodation is not available. Although it is reasonable for a person to exercise their
choice, at a time in their lives when they are vulnerable; the patient cannot expect to
remain in hospital until their home of choice becomes available. It is expectable for a
person to move from an acute hospital bed into an interim placement or home with a
comprehensive package of care to support them at home as long as the proposed interim
arrangements meets the identified needs of the patient ( Appendix 13 a).
It is extremely important that consistent messages and information are given to both
patient and carers by all members of the multi disciplinary team about the expected length
of stay in hospital and the need to move into more appropriate care when they are ready to
do so. In the event of the ‘Home of choice’ not being available, a case conference will be
held and chaired by the ward Consultant / deputy and clearly inform the patient / carer that
NHS hospital care is no longer required and to sensitively advise the patient that it is no
longer appropriate to stay in hospital until a place in the home of choice becomes
available. The patient will be given a written letter explaining the situation and at this stage
CBS will then seek to offer an alternative until a place becomes available in the patient’s
‘Home of Choice’ ( Appendix 13 b).
6.6 Process for transfer to another hospital:
When a patient is being transferred to another hospital for further clinical management, the
transferring nurse is required to send with the ambulance crew the patients medical and
nursing notes. A full verbal handover will be given via the nursing staff using the SBAR
format prior to this and recorded in the patients nursing notes. The patients own drug
supply will be sent together with their drug kardex.
Separate arrangements exist for Children services (please refer to Appendix 14 a, b, c).
It is essential that a Paediatric Collaborative Transfer Document is completed when a child
is being transferred to another hospital using the SBAR format, in particular safeguarding
issues must be considered and concerns communicated to the relevant professionals.
Separate arrangements exist for Maternity (please refer to Appendix 15a, b, c, d,)
6.7 Process for discharge out of hours:
Pro active discharge planning is promoted across the trust and morning discharges are
encouraged. However if a discharge has been arranged for after 5 pm it is the discharging
nurses responsibility to contact the appropriate personnel according to identified need,
prior to 5 pm.
6.8 Pharmacy Out of Hours:
It is envisaged that pro active discharge planning takes places across the organisation
however there are instances when patients for what ever reason are discharged out of
hours. In this instance please refer to Drug Policy DP02 or seek further information from
the on call pharmacist via switchboard however pharmacists do not routinely attend site to
dispense prescriptions out of hours.
6.9 Guidelines relating to patients leave from hospital for significant family events:
15
In exceptional circumstances it may be necessary to arrange a period of temporary leave
from hospital for an in patient to attend a significant family event for example a funeral of a
close relative or a wedding. This would occur if a patient was unable to be discharged due
to the nature of their condition and needed to remain in hospital for continuing treatment.
In this situation it is necessary to complete the checklist (Appendix 16) to ensure that in
such circumstances arrangements are in place to support the patient and their carers
whilst on temporary leave.
6.10 Patient or carer disagreeing with the discharge plan:
When disagreements occur in relation to the patients discharge plan, it is essential that
concerns are raised at ward level with the ward manager. Additional support can be
sought for obtained from the Patients’ Advisory Liaison Service (PALS) situated at the
main entrance as well as every ward and department having copies of the Trust’s
Complaints leaflets clearly highlighting how to raise concerns.
6.11 Patients wishing to take their own discharge:
Sometimes patients for a variety of reasons wish to exercise their right to take their own
discharge against the advice and expressed opinion of the medical team. If this situation
occurs in clinical practice please refer to Appendix 2 for further information.
6.12 Discharging patients who are homeless:
Most homeless people especially rough sleepers or those with a chaotic lifestyle have
poorer health than the rest of the community. People living in temporary or insecure
accommodation may have difficulty accessing primary care. Once admitted they present a
complex medical and social history (DCLG, 2006).For many people who are homeless,
living in temporary accommodation or asylum seekers, admission to hospital may present
itself as an opportunity to deal with any underlying medical, social, mental health problems
and to address accommodation needs. Please follow the Homeless pathway (Appendix
17) in order to facilitate the patient’s discharge.
7. Training:
The Integrated Hospital team will be responsible for the delivery of training across the
organisation on a formal basis;
•
Trust Induction
•
Preceptorship Programme
•
Away Days for Ward managers and their deputies
•
SafeCare Events
However this is in addition to informal discussions at ward level between the ward
manager and member of the nursing team
8. Equality and Diversity:
The Trust is committed to ensuring that, as far as is reasonably practicable, the way we
provide services to the public and the way we treat our staff reflects their individual needs
16
and does not discriminate against individuals or groups on any grounds. This policy has
been appropriately assessed.
9. Monitoring compliance and effectiveness of the policy:
Annual monitoring of the effectiveness and implementation of transfer and discharge
procedures including documentation requirements across the organisation will be the
responsibility of the Integrated Hospital Discharge Team which will be coordinated by the
Clinical Practice Matron and reported to the Safe Care Council.
This will be complimented by quarterly audits:
Triangulation report concerning complaints, comments and issues raised via the PALS
service.
Health Records Audit which is undertaken in partnership with the SafeCare department.
However other audits will be undertaken according to changes in service provision and in
light of national guidance.
Weekly monitoring and reporting of both delayed transfers of care and individual patients
lengths of stay greater than 28 days will also be undertaken across all specialities and
formally discussed and at the weekly SITREP meeting by individual members of the multi
disciplinary team.
Information regarding boarded patients into different specialities will be reported on a daily
basis through SITREP in accordance with the Department of Health guidance. This
information will be shared with Divisional managers at the weekly ‘Achieving the Targets
Meeting’
10. Consultation and review:
This policy has been devised by adopting a collaborative approach using a multi
professional and multi agency focus regarding the transfer and discharge arrangements
for all patients across the organisation. The views and opinions of these professionals
have been sought and this policy has been devised based on their expert knowledge,
experience, and the relevant legislation and supporting guidance documents.
11. Implementation of the Policy (including raising awareness)
This policy will be embedded across the organisation following its ratification at a
Trustwide SafeCare event and its awareness raised by the Integrated Hospital Discharge
Team together with the Practice Development Team in conjunction with their day to day
clinical practices.
12. References
Achieving timely simple discharges from hospital (DH, 2004)
Children’s Act (1989)
Children’s Act (2004)
Community Care (Delayed Discharges) Act 2003
17
Delayed Discharges (Continuing Care) Directions 2009
Delayed Discharges (Continuing Care) Directions 2007
Discharge from Hospital: Pathways, Policy and Practice ( DH 2003)
Discharge from NHS in-patient care of people with continuing health care needs
Hospital Discharge Work Book (1994)
Mental Capacity Act (2005)
NHS and Community Care Act (1990)
Patients Charter Standards (DH 1995)
Ready to go – No delays ( DH, 2010)
www.gateshead.gov.uk /lscb
http://www.gateshead cyptrust.co.uk/partnership/iscb/procedures.htm
13. Associated documentation:
OP Pre Assessment
OP 21 Point of Discharge
OP 33 Bed Management and Escalation Policy
OP 39 Health Records
Appendix 1
DISCHARGE PROCESS
Clear medical management plan identified
by medical staff
Holistic assessment of needs completed
on admission by qualified nurse
Estimated discharge date
identified and reviewed daily by
medical staff
Appropriate referrals completed
by multi disciplinary team
according to identified need
Simple Discharge
Complex Discharge
No ongoing needs identified
Continuing Health Care
OR
Low level intervention required
Rehabilitation
Meals on Wheels
24 hour care in the community
18
Home of Choice
Large packages of care ( 3 / 4 visits
Appendix 2
PATIENTS TAKING OWN DISCHARGE
AGAINST MEDICAL ADVICE
When a patient determined to discharge his or herself against medical advice, the nurse must
inform the a member of the Medical Team and try to dissuade the patient.
If the patient insists on discharging self, this procedure should be followed.
Patient should be asked to sign the Self Discharge Book (2 copies in total)
•
•
1 copy to remain in the book
1 copy to be filed in the patients Medical Records
If the patient refuses to sign the form, this should be documented by the Nurse in the book and
the above procedure followed
The following action should be taken by nursing staff:•
inform the patient’s next of kin where appropriate
•
inform the 1200 Bleep holder
•
inform Community Based Services if involved
•
Inform relevant members of the multi disciplinary
•
Inform patient’s GP as soon as possible.
The following action should be taken by medical staff:-
19
•
It is the responsibility of medical staff to document the decision-making process and further
actions related to patient taking own discharge in the patients’ medical records. Any further
follow up plans should be recorded with clear timeframes identified
DISCHARGE AGAINST MEDICAL ADVICE
I,…………………………………………………………………………………..
Hereby take the entire responsibility attached to the taking of my Discharge
(or the removal of…………………………………………………………………………)
From the…………………………………………………………………………..Hospital
Against the advice and expressed opinion of the Medical Officer to the contrary.
Witness ……………………………………………………………………………………..
Designation…………………………………………………………………………………
(medical or nursing staff)
20
Name of medical on-call notified…………………………………………………………..
Bleep number…………………………………..Time notified………………………
Appendix 3
Care Standard 20
DISCHARGE PLANNING
21
1. Ensure proactive discharge planning commences on admission / pre assessment via an
individual holistic assessment of needs incorporating a social history and establishing current
level of support.
2. Identify the severity of discharge needs ( Simple or Complex)
3. Establish with members of the multi disciplinary team an estimated date for discharge within 24
hours of admission and review on a daily basis.
4. Ensure effective communication strategies are adopted at both ward level and with the patient /
family / carer regarding the discharge plan whilst maintaining the patient’s privacy and dignity.
5. Complete appropriate referrals to other members of the multi disciplinary team according to
identified needs (e.g. Physio / OT).
6. Complete appropriate referrals if required for post discharge intervention
a. Short term intervention ( Intermediate Care)
b. Long term intervention (Community Based Services)
If a patient is likely to require 24 hour care please complete a Continuing Health Care
Screening Tool
c. Nursing intervention (Community Nursing Service)
(Advice and support available from the Integrated Discharge Team – please contact
switchboard)
7. Ensure any identified equipment has been delivered and installed prior to discharge.
8. Establish mode of transport required for discharge and book ambulance if indicated.
9. Ensure discharge letter / script has been fully completed and available at time of discharge.
10. Discuss with the patient / family / carer their discharge medication and check their level of
understanding in order to promote self awareness of their condition.
11. Explain to patient / family / carer regarding any advice or instructions required post discharge
and any follow up appointments (Please record content of conversation and any leaflets given).
12. Patient / family / carer to be advised to contact Ward if they have any concerns post discharge.
13. Please completed ‘Patient Discharge Summary’ on discharge and provide the patient with a
copy.
REFERENCES:
Department of Health. (2010) ‘Ready to go? London: DH.
Department of Health. (2004) ‘Achieving ‘simple’ discharge from hospital, a tool kit for the multi
disciplinary team’. London: DH.
Department of Health. (2003) ‘Discharge from hospital, pathway, process and practice’. Health and
Social Care Joint Unit and Change Agent Team. London: DH.
Department of Health (2003b).’The Community Care (delayed discharges) acts LAC/2003 guidance
for implementation’ London: The Stationary Office
GHNHSFT (2009) Hospital Discharge Policy.
Lees, L.(2004) ‘ Improving the quality of patient discharge from the emergency setting’ British
Journal of Nursing: 13, ( 7) pp. 414-421
Appendix 4
DISCHARGE SUMMARY
To be completed by Nursing Staff on discharge of all patients
Name:
Reason for admission:
Address:
Consultant:
G.P:
22
Telephone No.
Date of birth:
Ward / Dept:
Age:
Date / time of discharge:
Nurse led Discharge : Yes □
NHS Number:
ACTION
Discharge destination:
(please state)
Clothing for journey:
□ Yes
□ No
Next of kin informed:
□ Yes
□ No
Mode of Transport:
□ Own □ Ambulance
GP Letter provided
Medication provided on
discharge:
□ Yes
□ No
□ Own
No □
INFORMATION
Identified key holder:
Comments:
Name of person:
Time of booking:
Time of arrival:
Notification:
Post □
Fax □
By patient □
Information regarding medication to be provided:
Discussed □ Yes
Written: □ Yes
Follow up appointment
required:
□ Yes
□ No
Date (if known)
With whom:
Given on Discharge □ Yes
Notification by post □ Yes
Referral to Primary Care:
District Nurse □
Community Matron □
Practice Nurse □
Other (please specify)
Reason:
Contact No:
Letter given □ Yes
Telephone No:
□ No
□ No
Instructions given:
Supply of dressing/ pads (Please State):
□ No
Referrals:
Community Based Services □
Intermediate Care □
Red Cross □
Other
Any other written / verbal
information given:
Nurse Signature and Band:
Print Name :
Reason:
Arrangements made:
Contact Name / Number:
VTE Information leaflet given: □ Yes
□ No
Patient / Carer Signature:
Appendix 5
Discharge Pathway for Patients Wishing to go Home to Die
23
Patient has a limited life expectancy of less than 4
weeks documented by consultant in medical notes.
Refer to Integrated
Hospital Discharge
Team
No
Referral appropriate
Other options will be
discuss with family
and plan identified
Yes
Holistic assessment of
needs incorporating risk
assessment of home
circumstances
Co ordination of discharge
Completion of Liverpool pathway
Identification / delivery of equipment
prior to discharge.
Partnership working with
the District Nurse / Rapid
Response Intermediate
Care Team
Handover to District Nurse
Reassessment of needs 2/52 post
discharge
Appendix 6
24
PRIMARY CARE NURSING SERVICE REFERRAL FORM Patients Name: Date of Birth: Hospital No/NHS No: Consultant: Date of Discharge: Home Address & Tel No: G.P. Name & Tel No: Discharge Address & Tel No: (if different from Lives Alone: (please tick) Yes No above) Name / Contact number for next of kin: Any special instructions i.e. keypad Reason for Referral: P.C.T. Contact Staff Details Name : Care Pathway for the Dying Patient : Position: Tel No: Yes No First Visit Date: Supplies (please tick) Devices (please tick) Medication Appliances Dressings Self Retaining Catheter Date inserted: Oxygen Continence Aids Type: Size: Drug Therapy Record Reason for insertion: Other(please state) Intra Venous Devices Type : Ensure 7 Days Supply is Provided of the Above Syringe Driver: Items Syringe Driver/Drug Prescription Chart Faxed Clip Removers Suture Remover Pack Pressure Damage: Specialist Mattress/Cushion Other Wounds: requested from Gateshead Equipment Service? Location: Yes No N/A Description: Wound Management: Pressure Ulcer Risk Score Location & Grade: Date of Last Dressing Change: Description: Date of Last Dressing Change: Wound Management: Nutritional Status : (please tick) Enteral Feeding: Diabetic Supplements Nutritional Risk Score Comments: Infection Control Status: (please tick) MRSA Positive Decolonised MRSA Result Pending Clostridium. Difficile Status: Comments: Other Agencies Involved: Name of Referrer: Grade: Hospital: Tel No: Ward/Unit: Fax No: Signature: Date: Time: Appendix 7 Gateshead Health NHS Foundation Trust
Name:
D.O.B:
Unit Number:
NHS Number
Affix
Addressograph
Here
Acutely Ill Patient Referral
25
This form is to support electronic and telephone referrals of
acutely ill patients
Effective Communication Saves Lives
SBAR referral
Referral Date:
Time:
Person contacted:
Response Time:
Situation and
Background…
State clearly and
concisely what has
previously happened
and exactly what is
happening now
• I am calling about:
Is a DNR order in place: Yes ( ) No ( )
• The patient’s diagnosis is:
Consultant (if identified):
EWS score:
• The patients EWS score is:
• I am concerned the person is going to arrest: (
time scored:
) please state if applicable
• I have just done the patients observations and they are:
Blood Pressure:
/
Pulse:
Respirations:
Temperature:
• The patient is ( ) is not ( ) passing urine and does ( ) does not ( ) have catheter
• The patient is:
Alert ( )
V responses to voice ( )
P responds to pain ( )
Unresponsive ( )
• The skin is: Warm ( ) Pale ( ) Mottled ( ) Perspiring ( ) Cold ( )
• The patient is ( ) is not ( ) on oxygen, the oximeter reading is:
• The patient has a IV Cannula: Yes ( ) No ( ) and is presently having Intravenous
Therapy: Yes ( ) No ( ) please state -
Assessment
• I think the problem is:
State clearly what you
think is happening at
this point in time
Remember effective care in the first hour is essential in severe sepsis
Recommendations
( ) I need you to come and assess the patient immediately
• It may be
Cardiac ( )
Respiratory ( )
Dehydration ( )
• I am not sure what the problem is but the patient is deteriorating (
Infection (sepsis) ( )
)
( ) I would like you to come and assess the patient within 30 minutes
( ) I would like you to come and assess the patient within 1 hour
What do you want done
now…
• Advice
• Urgent review
• Timely review
• For information only
Remember timescale
now or next week!
( ) I would like you to approve my course of action, which is:
( ) I would like you to arrange a Consultant to see the patient now
( ) I would like you to come and talk to the patient and / or the patient’s family
• If treatment is requested as a result of this referral ask:
When / frequency / what change do you expect to see? / at what point do you wish to be called again? Actions
required …...........................................................................…..
( ) Observations – Frequency:
( ) CXR
( ) ABG
( ) ECG
( ) Bloods: state which:
Persons referring the patient:
Print:
Sign:
Grade:
Person responding:
Print:
Bleep:
Grade:
To be filed in Section 3 of Health Record
26
Appendix 8 Gateshead Health NHS Foundation Trust
Name:
Affix
D.O.B:
Addressograph
Unit Number:
Here
SBAR referral
Situation and
Background…
The following items must
accompanying the patient on
transfer:
• Patient notes
• Medication
• Drug kardex
• Property
• Walking aid
Inpatient Transfer Form
This form must be used to support
all verbal handovers
Transfer Date:
Time:
From:
Reason for Admission:
To:
Is a DNR order in place:
Yes ( ) No ( )
Consultant (if identified):
Brief past medical history:
Existing medication:
Current Allergy Status:
Social issues identified: Yes ( ) No ( )
All allergies must be transferred to the inside cover
of Health Records and on Kardex
Lives alone Yes ( ) No ( )
Assessment
What is happening
clinically
Your findings …
Cannula: Yes ( ) No ( )
What has been done …
Catheter: Yes ( ) No ( )
Airway adjuncts: Yes ( ) No ( ) Oxygen: Yes ( ) No ( )
Intravenous Therapy: Yes ( ) No ( ) please state-
Bloods Taken: Yes ( ) No ( ) please stateElectrocardiography taken Yes ( ) No ( )
X ray taken: Yes ( ) No ( ) please state site Antibiotics administered: please state Analgesia administered: please state Pressure Ulceration Risk Assessment Score:
Grade:
Venous Thromboembolism Risk Assessment Complete:
Location:
Yes ( ) No ( )
Transfer Early Warning Score
=
Clinical Impression:
Time taken
Recommendations
What do you want done
now…
• Review
• Treatment
• Tests
• Observe
• Care
Neurological Observations: Yes ( ) No ( )
Oxygen:
Yes ( ) No ( )
Delivery -
Oral Intake:
Nil by mouth ( )
Clear Fluids ( )
Percentage:
Free Fluids ( ) Eat & Drink ( )
Altered texture ( )
Intravenous Therapy - Yes ( ) No ( ) please state type and rate Any further investigations or reviews. Please give details:
Remember timescale now or
next week!
Current status of investigation
c Requested c Confirmed : Date: Time: Prep:
Persons referring the patient:
Print:
Sign:
Grade:
Person responding:
Print:
Bleep:
Grade:
To be filed in Section 3 of Health Record
Are the patient’s next of kin aware of the transfer? Yes ( ) No ( )
Person informed:
:
Contact Number:
Time:
27
Appendix 9
Division of Medical Services
A tool to aid decision making when boarding
Patients suitable for boarding include:
Green
Amber
¾ Medically stable i.e. awaiting social services
¾ Cellulitis patients with a EWS score of 0
Patients not clearly fitting into red or green category
¾ Patients must not be boarded unless the nurse in charge has reviewed
the EWS and medical notes and ensured that the patient does not
have any red criteria
¾ Nurse transferring must document date and time of transfer and
Consultants name and destination ward in medical notes
¾ Receiving ward to document date and time received
These patients must not be boarded from the ward unless:
¾ Discussed with the patient’s Consultant on weekdays 9am – 5pm
¾ Discussed with the Consultant On Call at evenings and weekends if the
Consultant is on site or the On Call Registrar
Do not board if:
Red
¾ EWS score > 5 in any category or physiological triggers or diagnostic
triggers present
¾ Terminally ill, those with a new diagnosis of malignancy or those with
undergoing investigations likely to lead to a diagnosis of malignancy
¾ Cardiac patients requiring telemetry, those with established cardiac
failure during which diuretic does are being established, and those who
are within 72hrs of acute infarction
¾ Neurological Glasgow coma scale < 15 and patients with acute delirium
¾ Rheumatological – patients admitted with acute vasculitis or multi
system diseases
¾ Infections – any patient with an infectious disease, MRSA positive
patients and those with diarrhoea awaiting results of stool C+S
¾ Confused wandering patients at high risk of falls
28
Appendix 10
Gateshead Health NHS Foundation Trust
Name:
Affix
D.O.B:
Addressograph
Unit Number:
Here
Boarders Transfer Form
This form must be used to support
all verbal handovers
NHS Number
SBAR referral
Situation and
Background…
The following items must
accompanying the patient on
transfer:
Medical / Nursing notes
Medication / Drug kardex
Property / valuables
Walking aid
Transfer Date:
Time:
From:
Reason for Admission and Clinical Impression:
To:
Consultant:
Senior House Officer Bleep:
Current capabilities
Washing / Dressing:
Self caring ( )
Assistance of one ( )
All care ( )
Mobility:
Unaided ( )
Stick ( ) Zimmer ( )
Hoist ( )
Eating / Drinking:
Normal diet / fluids ( ) Altered texture ( )
Peg ( )
Falls ( )
Nutrition ( )
Elimination:
Identified risks:
Pressure Damage ( )
Deep Vein Thrombosis ( ) Moving / Handling ( )
Infection Status:
Current Allergy Status:
Instructions for Medication - E.g. Insulin / Warfarin / Parkinsonium Drugs
All allergies must be transferred to the inside cover of Health Records and on Kardex
Assessment
What is happening
clinically / in preparation
for discharge
Social issues identified: Yes ( ) No ( ) Lives alone Yes ( ) No ( )
Referrals completed
Community Based Services ( ) District Nurse ( ) Occupational Therapy ( )
Recommendations
What do you want done
now…
Review?
Treatment?
Tests?
Observe?
Care?
Remember timescale now or next
week!
Physiotherapy ( )
Transfer Early Warning Score =
Other:
Time taken
:
Any further investigations or reviews indicated e.g. other specialities:
Estimated Date for Discharge:
Is the patient suitable for Nurse Led Discharge:
Yes ( )
No ( )
Discharge script competed:
Yes ( )
No ( )
Transport arranged:
Ambulance ( )
Own ( )
Discharge Destination: Patient’s Home ( ) Residential Home ( ) Nursing Home ( )
Contact: Name & establishment:
Telephone number:
Package of Care: ( )
Start date:
Frequency:
Persons referring the patient:
Print:
Sign:
Grade:
Person responding:
Print:
Bleep:
Grade:
To be filed in Section 3 of Health Record
Are the patient’s next of kin aware of the transfer? Yes ( ) No ( )
Person informed:
Contact Number:
Time:
29
Appendix 11
Critical Care Department – Care
Standard J
Critical Care Discharge to ward
summary
Date of admission
to Critical Care: _______________
ADDRESSOGRAPH
Name:
Date of Birth:
Date of discharge: _______________
Time:
Address:
______________
Unit Number:
Discharged to:________________
Reason for admission: ______________________________________________________________
______________________________________________________________
______________________________________________________________
Airway / Breathing: (please tick box)
Oxygen requirements: _____________________ Via: Face mask
Trachy mask
Nasal Cannula
†
†
†
Other: _______________________
Tracheostomy in situ
damage
† Date inserted: __________________
Mini Track
† Date inserted: __________________
Nasopharyngeal Airway
†
Pressure
† Site: _________________________ Grade: __________ Wounds
† Site: _________________________
Drains
†
Site: _________________________
Catheter in situ †
Bowels †
Stoma †
Active? Yes / No
Nutrition / Fluids: (please tick box)
IVT
† Solution: ______________________________ Infusion rate: ______________
Diet
† Fluids † Special requirements: ______________________________________
Parental Nutrition † Enteral Nutrition
†
30
† NG tube
PEG
†
Other: __________________________________________________________________
IV Access: (please tick box)
Peripheral access
† Sites: ________________________ Date inserted:_____________
Central Line
† Site: _________________________ Date inserted: _____________
Other information: (please tick box)
Epidural † PCA † Other: _______________________ Pain Score on discharge: _______
Additional information:
_________________________________________________________________________
_________________________________________________________________________
___________________________________________________________________________________
_______________________________________________________________
Relatives informed of transfer
†
Parent team informed of transfer
†
Transferred on to EWS Chart and observations documented †
EWS Score on discharge: _________________
Known infections on discharge:____________________________________________________
MRSA discharge swabs completed †
Items to accompany patients: (please tick box) Notes † Property / Valuables †DNR in situ
Treatment limitations in place? Yes / No
†
Details:
For readmission into Critical Care? Yes / No
Signature: _________________________
Print name:_________________________________
Grade: ____________________________
Name:
D.O.B.:
Unit number:
NHS Number:
Date: _______________________
Affix
Addressograph
Here
31
Gateshead Health NHS Foundation Trust
Inpatient Transfer Form
This form must used to support all verbal handovers
Appendix 12
Residential / Nursing Home Transfer Form
This form must not replace the Discharge Summary but will support the verbal handover
SBAR report
Transfer Date:
Situation and
Background
Reason for Admission:
Assessment
Residential Home ( ) Nursing Home ( )
Current capabilities:
Infection status:
Identified risks: Falls ( ) Pressure Damage (
Nutrition ( )
Moving / Handling ( )
MRSA:
Clostridium difficle:
Time:
From:
To:
)
Washing / Dressing: Assistance of one ( ) All care ( )
Mobility: Stick ( ) Zimmer ( ) Other (
Assistance of 1 ( ) Assistance of 2 ( )
Hoist ( ) Type:
)
Eating / Drinking: Normal diet / fluids ( ) Assistance required yes ( ) No ( )
Thickened Fluids ( ) Altered texture ( ) Peg ( )
Elimination:
Urinary Catheter Yes ( ) No ( )
Bowel pattern:
Type:
Size:
Stoma: Yes ( )
Last changed:
No ( )
Skin integrity: (Please state) Intact Yes ( ) No ( )
Location of damage:
Grade:
Additional information:
Recommendations
Future care
management:
Wound Management Plan ( if required):
Dressing type:
Frequency of change:
Persons providing transfer information:
Person receiving verbal handover:
Designation:
Designation:
Are the patient’s next of Kin aware of the transfer? Yes ( ) No ( )
Person informed:
Appendix
13 a
Contact Number:
Direction on Choice Time:
32
The Trust’s Hospital Discharge and Transfer Policy takes into account the requirement for
NHS responsibilities for meeting Health Care need and the precondition of Gateshead
Council CBS to undertake assessment for community care.
When a patient has been assessed and it is agreed that the patient has a need to move
into a care home, the patient has the right to decide which care home is their first choice
providing the following conditions are met and that Community Based Services (CBS)
agrees.
•
The home of choice is suitable to meet the assessed care needs of the patient
•
That a contract of care can be established between CBS and homeowner
•
That care costs of the home are within CBS payment range or can be ‘topped up’ by a
third party.
•
That a place is available in the home of choice.
If a place is not available in the first home of choice, the patient cannot expect to remain in
hospital if NHS care is no longer required.
Options to this position would allow CBS to arrange a placement elsewhere until a place at
the home of choice becomes available or a complex care package may be arranged to
support the patient at home until such time as a place becomes available.
Appendix 13b
Home of Choice Letter
33
Dear
I understand that you are ready for discharge from the Queen Elizabeth Hospital.
After assessment by the multi disciplinary team on your ward it has been agreed with you
that your needs would best be met out of hospital in a care establishment.
It may be that the care establishment you wish to go to does not have a vacancy at the
time that the doctors consider you are well enough to leave hospital. If this happens to
you, it will not be possible for you to stay in hospital as we have patients who are in need
of hospital services.
If there is no available place in your preferred care home you will need to choose a place
in an establishment with a vacancy, as a temporary measure. This will not affect your
place on the waiting list of your first preferred option of care home and you will be
transferred there as soon as a place becomes available. However, it will not be possible
for you to stay in hospital to wait for your preferred option to become available.
If you or your family / friends are concerned about this and would like to talk to someone
about it, please do not hesitate to speak to the ward staff.
Yours sincerely
Ian Renwick
Chief Executive
Gateshead health NHS Foundation Trust
Appendix 14 a
34
CHILDRENS SERVICES
DISCHARGE PROCEDURE
Named nurse admits child and completes holistic assessment on admission. Parental /
carer involvement initiated at time of admission
Routine admission
(Simple pathway of care)
Child with multiple needs
(Complex pathway of care)
Liaise with relevant members of
Community team (CCN, HV, SHA, SW)
Consult with medical team, AHP’s
parent / carer / patient
Set provisional discharge date
Refer to appropriate team– AHP’s
Community children nursing service,
Special Needs team
Child Protection Team / HV / SS
(Attempted suicide / self Harm –
assessment by CAMHS required)
Identify potential discharge problems
Check if follow up required and
arrange if necessary
Arrange care plan / discharge
planning meeting with Consultant,
AHP’s, CCN, parent/carer
Set provisional discharge date
(Plan to be shared with GP)
Plan transport
Contact loan equipment
Contact loan equipment
Pharmacy
Plan transport
Complete discharge checklist
Pharmacy
Complete Health Visitor / School
Complete discharge checklist
Nurse form
Complete Health Visitor / School
Nurse form
Discharge letter direct to G.P.
Discharge letter direct to G.P.
Give appointment if
follow up required
Ensure follow up date
Appendix 14 b
Gateshead Health NHS Foundation Trust
35
Children’s Unit Discharge Checklist
Name:
Hospital/Site:
D.O.B.
Age:
Ward:
Address:
Date of Admission:
Date of Discharge:
Consultant:
Post Code:
Tel
No:
Named Nurse:
G.P.:
H.V.:
Contact Nurse:
S.W.
Tel No.: 445 2020 / 445 2019
Discharge Address(if different from above)
Diagnosis:
Post Code:
Tel
No.:
School/Nursery:
Summary of care given during stay:
Signature
Date
Name of Parent/Carer involved in discharge
Name of Person taking child home:
Transportation arranged: own/ambulance/hospital taxi yes/no
Medication Ordered
Time:
Medication to be collected by:
yes/no
Time:
Approximate date for return to School/Nursery:
Equipment/Dressings given
Specify:
Information Leaflets/Instruction/Verbal Advice given:
yes/no
Specify:
Follow-up Appointment given
With whom:
Place:
Open Access Given: Yes/no
yes/no
Date:
Time
Ward: 19 / 20 Time Limit:
Care agencies contacted prior to discharge:
yes/no
HV / SW / MW / Physio / SchN / CCN / DNS / Dietician / Others
Specify Others:
Any other comments
Signature
Discharge Nurse Signature:
Position:
Parent/Carer Signature:
36
Print Name:
Signature
Appendix 13 c Paediatric Collaborative Transfer Document
Patient Name:
Date of Admission:
Date of Birth:
……………………….
Unit Number:
Date of Transfer:
Gender:
……………………….
GP:
School / HV / MW:
Diagnosis/Reason for Transfer (Situation)
37
Consultant::
……………………….
Transfer Nurse:
……………………….
Diagnosis/Reason for Transfer Cont:
Past medical history (Background)
38
Social History : Details of NOK, Who has parental responsibility (inc Any Legal Order), Safeguarding
issues, Emergency Contact.
Social Worker
Contact Details
Regular Medicines
Allergies
Investigations (Assessment):
Blood results:
Blood Gas:
Imaging: Other:
39
Stabilisation for Transfer:
IV Fluids Y/N
Type:
Rate/Volume Given:
Fluid Bolus:
Medication:
Dose:
Route:
Time Last Given: Comments:
Cannulae Type / Size:
Frequency:
Site:
Date of Insertion:
Receiving Named Nurse (Child Protection)
Observations Prior to Transfer: Time:
T
HR
RR
SaO2
BP
Weight:
O2 requirement
Fluid Balance (for last 24 hours)
Oral Intake:
Last PU:
Last BO:
Advance Decisions:
Vol:
………………………………………………….
Ready to Go Tick List (Recommendation)
Please circle appropriately
Time
Hospital transfer accepted? Y
N
Retrieval Team to collect?
Y
N
Retrieval Team en-route?
Y
N
If no-Ambulance/
Transport en-route
Y
N
Escort staff needed?
Y
N
Nurse
Doctor
Anaesthetist
Escort staff prepared?
Y
N
Transfer box/ equip. ready? Y
N
Documentation photocopied? Y
N
Transferred to ……………………………..
Speciality……………………………………
Signature :
Appendix 15 a
Print:
POSTNATAL TRANSFER HOME
40
All women who have normal postnatal progress, this could include women who have had
operative deliveries, can be transferred home by a Midwife.
Women requiring examination by SHO, Registrar or Consultant before transfer home
include the following:
Acute retention of Urine
Hypertension
Postpartum Pyrexia
Wound Infection
Emergency C/S to discuss the events
Medical Problems
Suspected Depression
This is not an exhaustive list. If the Midwife has concerns about the woman, then the
Obstetric team responsible for her care should be contacted.
Once postnatal examination is completed, the Midwife will enter the details into the
computer.
All discharge documents are computer generated.
The Midwife checks the documents for accuracy and signs them.
The following documents are produced:
3 Discharge letters 3 Discharge letters Korner details
mother
baby
The Discharge letters are distributed thus:
1 set with mother and baby
1 set to General practitioner
Mother discharge - mothers notes. Baby discharge - baby notes.
Korner data filed in mothers notes
The discharging midwife must ensure that all relevant information (postnatal pack) and
discussions with the mother are documented prior to discharge. This will be audited by the
postnatal ward manager on an annual basis.
All transfers home are notified to the Community Liaison Clerk at 1300 hours on weekdays
Any transfers outside Gateshead district e.g. Washington, are notified by the Midwife
responsible for transfer to the appropriate hospital - see Information in Postnatal area.
At weekends and after 5.00 pm, inform the Community Midwife responsible for transfers or
Community Midwife On Call respectively.
Any transfers with special circumstances will require direct contact with Midwife
responsible for care in the Community.
41
The Midwife giving discharge details to Clerk or Community Midwife signs in the notes that
she has done so.
DISTRIBUTION OF NOTES
Mother and baby notes transferred to Coding Clerk for coding.
DOH form in Community Clerk's tray.
Nb:
If notes require dictated discharge letter, then they must be forwarded to the
appropriate Consultant's secretary.
6-WEEK POSTNATAL EXAMINATION
This will usually be arranged by the woman at the GP’ surgery.
1.
Women requiring hospital follow-up should be identified by the Registrar or
Consultant, eg stillbirth, complicated delivery, sevee pre eclampsia, medical
complications.
2.
The appointment is arranged before transfer home. An appointment card is issued
to the mother and the date and time recorded in the Obstetric notes.
3.
Ensure postnatal booklet will be available at the review appointment.
DOH form in Community Clerk's tray.
Nb: If notes require dictated discharge letter, then they must be forwarded to the
appropriate Consultant's secretary.
6-WEEK POSTNATAL EXAMINATION
This will usually be arranged by the woman at the GP’ surgery.
1. Women requiring hospital follow-up should be identified by the Registrar or
Consultant, eg stillbirth, complicated delivery, severe pre eclampsia, medical
complications.
2. The appointment is arranged before transfer home. An appointment card is issued
to the mother and the date and time recorded in the Obstetric notes.
3. Ensure postnatal booklet will be available at the review appointment. Reviewed Feb
2008
Next review February
2011
Appendix 15b
Gateshead Health NHS Foundation Trust
Antenatal Handover of Patient Care (SBAR)
To be completed by member of staff handing over care.
42
SBAR report
Situation
Please tick appropriate boxes (√) or circle correct answer
Antenatal Handover
Date and time of admission:
Background
Date and time of transfer:
Reason for admission:
Gravida:
Para:
Gestation:
weeks
Significant medical history: Yes (
) No (
Significant Obstetric history: Yes (
Blood group:
Midwifery led ( ) Consultant led ( )
) please state:
) No (
) please state:
Antibodies:
Rubella Immune Yes ( ) No ( )
Risk Assessment: Obstetric: High ( ) Low ( ) Thromboembolism: High ( ) Low ( )
Personal issues identified: Yes ( ) No ( )
Assessment
BP:
)
Pulse:
bpm
Temp:
AN2 Yes ( ) No ( )
°C
Resps:
Palpation:
Fetal heart:
rpm
Previous MEOWS trigger (
Uterine Activity:
bpm
Urine: volume:
CTG interpretation:
Urinalysis:
Vaginal Loss: discharge / amniotic fluid
MSU taken: Yes ( )
Colour:
Pv Bleeding: ( ) If yes – state approx amount
mls
Bloods: taken and / or results:
Anti D required: Yes ( ) No ( )
No ( )
Scan performed: ( )
If yes
Anti D given: Yes ( ) No ( )
Swabs Taken: Yes ( ) No ( ) If yes please state:
VE: ( ) If yes please state findings:
If applicable: Bishop Score:
Speculum: ( ) If yes please state findings:
No. of Prostins given:
Time of last prostin:
Any medication given:
Recommendations
Antenatal care plan (including observations and fetal monitoring):
Further tests / treatments required:
Identified indications for medical review:
Signature of person completing document:
Print name:
Date and time:
Signature of person receiving patient:
Print name:
Date and time:
Please file in the clinical notes section 2 of the hospital notes
Version 3 May 2010 / Review May 2013
Review by Practice Development Midwife.
Appendix 15c
Gateshead Health NHS Foundation Trust
Delivery Suite or Postnatal Ward to SCBU - Handover of Neonatal Care (SBAR)
Datix submitted ( )
To be completed by member of staff handing over care.
43
Please tick appropriate boxes (√) or circle correct answer
Neonatal Handover
Date of delivery:
Time of delivery
:
Time of transfer
SBAR report
Situation
:
Reason for neonatal transfer:
Delivery:
Normal ( ) Ventouse ( ) Forceps ( ) Breech ( )
Elective CS ( ) reason-
Emergency CS ( ) reason-
FBS prior to delivery if taken:
Cord gases: Arterial pH:
Venous pH:
Apgar :
@1min
Para:
Background
@5min
Gestation:
) No (
Significant Obstetric history: Yes (
Blood group:
@10min
weeks
Significant medical history: Yes (
(Maternal)
) please state:
) No (
) please state:
Antibodies:
Rubella Immune Yes ( ) No ( )
Risk factors for infection: PROM > 24 hrs: ( )
MRSA screen: ( )
GRB during pregnancy: ( )
Health Care Worker: ( )
Other (please state): ( )
Personal Issues identified: Yes ( ) No ( )
Assessment
No ( )
HR:
Oxygen stats:
Temp:
Baby: Colour:
(Baby)
AN2 Yes ( ) No ( )
Parents informed of reason for transfer: Yes ( )
bpm
°C Resps:
Skin:
pm
Eyes:
Passed meconium: Yes ( ) No ( )
Skin to skin ( )
Mouth:
Id bracelets x2 present and correct: ( ) ( )
FBC ( )
%
Cord:
Passed Urine: Yes ( ) No ( )
Breast fed ( ) Formula feed (
Bloods: Group + Coombs ( )
Base:
Base:
)
mls
Time:
Type:
Temperature on transfer:
SBR ( )
Glucose: ( )
Vitamin K given: Yes ( ) No ( ) If yes – route administered: Oral ( ) I/M ( )
Recommendations
Summary of plan of care:
Further tests / treatments required:
Signature of person completing document:
Signature of person receiving patient:
Please file in the clinical notes section 2 of the hospital notes
Review by Practice Development Midwife.
Print name:
Date and time:
Print name:
Date and time:
Version 3 May 2010 / Review May 2013
Appendix 15d
Gateshead Health NHS Foundation Trust
Delivery Suite to Postnatal Handover of Patient Care (SBAR)
SBAR report
To be completed by member of staff handing over care.
Please tick appropriate boxes (√) or circle correct answer
Postnatal Handover
44
Situation
Date of delivery:
Time of delivery:
:
Delivery: Normal ( ) Ventouse ( ) Forceps ( )
Elective CS ( ) reason:
Spontaneous ( )
Time of transfer:
Breech ( )
Emergency CS ( ) reason:
Induced ( )
Analgesia: if appropriate:
Perineum: intact ( ) 1st ( ) 2nd ( ) 3rd ( ) 4th ( ) Epis. ( )
SRC: ( )
Drains: ( )
Estimated blood loss:
Background
Para:
IVT: ( )
mls
Gestation:
weeks
MRP: ( )
Baby: Postnatal ( )
) No (
Significant Obstetric history: Yes (
SCBU ( )
) please state:
) No (
) please state:
Antibodies:
Rubella Immune Yes ( ) No ( )
Risk Assessment: Obstetric: High ( ) Low ( )
Thrombo-embolism: High ( ) Low ( )
Personal Issues identified: Yes ( ) No ( )
AN2 Yes ( ) No ( )
Social Services informed of Delivery: Yes ( )
Assessment
Sutured: Yes ( ) No ( )
If Consultant led – Name:
Significant medical history: Yes (
Blood group:
:
BP:
Pulse:
bpm Temp:
No ( )
°C Resps:
Fundus – contracted: ( )
rpm Previous MEOWS trigger ( )
Wound Site: dry / oozing
Passed Urine: Yes ( ) No ( ) If yes - volume:
Bloods: kleihauer ( )
Baby: Colour:
Lochia: Heavy / normal / light
Other - please state:
Skin:
Eyes:
Passed meconium: Yes ( ) No ( )
Skin to skin ( )
N/A ( )
Mouth:
Passed Urine: Yes ( ) No ( )
Breast fed ( ) Formula feed (
Id bracelets x2 present and correct: ( ) ( )
Baby Bloods: Group + Coombs ( )
Cord:
)
mls
Type:
Temperature on transfer:
FBC ( )
SBR ( )
Vitamin K given: Yes ( ) No ( ) If yes – route administered: Oral ( ) I/M ( )
Recommendations
Routine postnatal care: Yes ( )
No ( )
Further tests / treatments required:
Identified indications for medical review:
Signature of person completing document:
Signature of person receiving patient:
Please file in the clinical notes section 2 of the hospital notes
Review by Practice Development Midwife.
45
Print name:
Date and time:
Print name:
Date and time:
Version 3 May 2010 / Review May 2013
Appendix 16
IN CASE OF EMERGENCY CONTACT US ON
0191 482 0000 – EXT: _____________
GATESHEAD HEALTH NHS FOUNDATION TRUST
GUIDELINES RELATING TO PATIENTS LEAVE FROM HOSPITAL FOR
SIGNIFICANT FAMILY EVENTS
In exceptional circumstances it may be necessary to arrange a period of temporary leave from
hospital for an in patient to attend a significant family event. This would occur if a patient was
unable to be discharged due to the nature of their condition and needed to remain in hospital for
continuing treatment. Examples of significant family events may be a funeral of a close relative or
wedding etc.
This checklist aims to ensure that in such circumstances arrangements are in place to support the
patient and their carers whilst on temporary leave.
Patient Details
Outline of Reason for Leave
Explanation of risk to Patient / Carer
Comments
Discussion with
Consultant
Discussion with Senior
Nurse and Carer
Identify Key Carer
Name
Contact Number
Agreement over Length
of Time
From and To
Transport to Event
?Escort
Medication Required
O2
Dressings
Equipment –
Wheel Chair
Walking Aid
Commode/Urinal
Pressure Aids
Emergency Contact
Number for patient
?Liaise Primary Care
GP - D/N
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Signature
Date
HOMELESS PATHWAY
Appendix17
Wants to remain homeless
Accommodation
Requested
Psychiatrist Assessment to be
undertaken
In Working Hours
Out of Working hours
Has capacity
No capacity
Contact the Homeless Unit at Gateshead Civic
Centre to make an appointment for the patient to
attend
Access on Internet.
Discharge
May require Sectioning under
Mental Health Act:
•
•
•
Recommendation of 2
Registered Practitioners
Approved Social Worker
Next of Kin
www.spdirectory.org.uk
www.sheleter.org.uk
www.crisis.org.uk
Or
Contact:
The Integrated Hospital
Discharge team
(Up until 8 PM)
The following criteria will be applied:
Local Connection:• Can prove lived in borough 6 months out of 12
months.
• Close blood relative has lived in borough for 3
years out of 5 years
Priority Needs:• Couple with children
• People who are vulnerable as a result of Old
age, Physical or Mental Disability.
• Pregnant women
• Over 60 years
• Unintentionally Homeless
Non-Priority Needs:• Mortgage or Rent Arrears
• Single Person
• Aged 18-60 years and in good health
• Intentional Homeless
People in above category are classed as nonpriority and are only entitled to advice and
assistance to find accommodation.
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