Admission Transfer and Discharge Protocol Community Hospitals. 1 Patient Categories and Clinical Criteria for Patient Admission

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1 Admission Transfer and Discharge Protocol Community Hospitals Purpose Scope To ensure that patients are correctly assessed and managed during admission or transfer to, and transfer or discharge from Rural Health Services Community Hospitals and that patients are captured on the PMS system. All Community Hospitals in the CDHB Ashburton & Rural Health Services Associated documents Infection Control Manual Protocols for transfer to Rural hospitals- memo to CDHB Social Work Department related procedure documents, if any relevant external documents 1 Patient Categories and Clinical Criteria for Patient Admission o Patients who may be considered for care in the Community Hospitals include : Acute Medical patients from the local Medical / Health Centres. Patients are assessed by a General Practitioner as being either able to be medically managed at the Community Hospital e.g acute exacerbation of an existing respiratory condition, or, patients that are not sick enough to be admitted to a base hospital but do require observation and ongoing assessment by a Registered Nurse. Patients who are assessed as being able to be managed in a low technology environment without medical personnel being on site 24 hours a day. Akaroa, Darfield, Ellesmere and Waikari Hospital Patients who can be cared for during the night by a sole Registered Nurse. Oxford and Kaikoura Hospital / Rest Home Patients who can be cared for during the night by a Registered Nurse and Health Care Assistant. Long term care patients may be admitted to Darfield, Ellesmere, Oxford, Waikari Hospitals and Kaikoura if they have been formally assessed as requiring Hospital Care. Page 1 of 6 Be reviewed by: November 2019

2 Kaikoura and Oxford Hospital can take Rest home level care Carer Support and Respite Care patients if funding for the care has been organised at the appropriate care level. 2 Patients excluded from Admission to Community Hospitals All patients requiring a secure facility or who pose a risk to his/her self or staff e.g dementia, suicidal ideation. All patients who cannot be cared for by a sole Registered Nurse on night duty at Akaroa, Darfield, Ellesmere and Waikari Hospitals. Paediatric patients are not admitted to Community Hospitals except in an emergency situation when the child is assessed by the Medical Officer and it is recommended by him/her the child be admitted for observation or stabilisation of their condition. Any patient who cannot be cared for appropriately within the limited resources available at a Community Hospital. NB: Currently there is no formal assessment of dependency and acuity needs of patients at Community Hospitals, but, if the Nurse Manager or Senior Staff Nurse feels the admission of a patient will compromise safety, or standard of care, the patient will be refused admission. 3 Transportation Responsibility Responsibility for the transport of a patient to a Community Hospital for admission and discharge lies with the patient and family/whanau, except for patients who require ambulance transportation in which case the transferring hospital is responsible for the cost. Any consultations or appointments made during the patient's planned admission period at a Community Hospital must include transportation arrangements by the family/whanau. An ambulance is not available for this service. 4 Multi Drug Resistant Organisms (MDRO) Assess for MDRO history or risks. Refer to Flow Chart. 5 Prior to Admission from another Hospital 5.1 Social Worker will contact Community Hospital to arrange appropriate bed. He /she will ensure current admission protocol is followed by transferring ward. Page 2 of 6 Be reviewed by: November 2019

3 5.2 Registered Nurse to fill out and sign an ISBAR Checklist Notification of any patient safety incidents/accidents to be advised to Community Hospital Nurse Manager when admission request is made. 5.4 All patients will bring their existing clinical notes, leave in dividers, if transferring from another CDHB Hospital. If transferring from private hospital or GP admit they require a full list of current medication and other relevant information. A three week supply of medications is required. Copies of recent INR tests and prescription for at least 24 hours for warfarin therapy. 5.5 Any specialist wound dressings must accompany the patient and must be for one week minimum. On Admission Contact Medical Officer to advise of admission and condition of patient. 6 Medications All medications must be dispensed and sent with the patient. Controlled drugs entered in Register and locked in safe. These will be dispensed by Registered Nurse but, in some cases patients may self medicate their other drugs. It is NECESSARY for any prescription to note whether the patient has a Community Service Card, High User, or a Prescription Subsidy Card. 7 Documentation 7.1 Admission form to be completed and faxed to Ashburton Medical Records within the day of admission. Fax No Admission to be recorded in shift report and admission/discharge register book. 7.2 Update fire register/admission board. 7.3 History and care plan completed after consultation with patient and/or family/whanau within 24 hours of admission. 7.4 Complete dietary and laundry information. 7.5 If CDHB facility transfer to another CDHB facility and current medications are unchanged current QMR0004 can be Page 3 of 6 Be reviewed by: November 2019

4 continued with. A new QMR0004 will be required if patient is a GP/or private hospital admission. 7.6 Printed ID labels are attached to all patient records as soon as possible. 8 Transfer of Patient from Community Hospital to another Hospital 8.1 If a patient s condition deteriorates or staff feel they cannot be managed at a Community Hospital, the patient is assessed by the Medical Officer, or his locum, and transferred to another hospital as required. 8.2 Discuss with patient reasons for transfer if not already done by doctor. 8.3 Notify next of kin of impending transfer. 8.4 Notify hospital / department to which patient transferring. 8.5 Arrange transport by Ambulance or Private car. If Ambulance required to transport patient, complete and fax Ambulance transfer form. Provide a nursing handover to ambulance staff. 8.6 Complete QMR0243 Transfer notice of Nursing Care. 8.7 Ensure the doctor has entered in clinical file or a letter is written to accompany patient. Complete patients clinical notes for transfer. 8.8 When possible and if desirable, a relative may accompany patient, if transfer is to be by Ambulance. 9 Discharge of Patient from Community Hospital 9.1 Patients are discharged when assessed as well enough and able to cope independently or with assistance from community agencies and services e.g District Nursing services, Home Help, Personal Care and Meals on Wheels. 9.2 Ensure clinical notes are completed and filed correctly. 9.3 Fax completed discharge form to medical records within 24 hours of discharge. Fax Send medical notes to Christchurch Hospital Clinical Records department on discharge. Page 4 of 6 Be reviewed by: November 2019

5 Protocol for an Admission to Rural Hospitals Hospitals Available: Akaroa (03) Darfield (03) Ellesmere (03) Oxford (03) Rangiora (03) Waikari (03) Kaikoura (03) APPENDIX 1 Convalescence in rural Hospitals is offered to patients who need more time to recover before safe to go home with support services in place, they are often elderly or live alone. Acuity/dependency needs to be discussed with Nurse Manager as all rural hospitals except Kaikoura, Oxford and Rangiora only have one nurse available on night duty. 1. Social worker calls hospital to establish if there is a vacancy. 2. Patients need to take 3 weeks supply of medication with them. Treating doctor to write prescription prior to discharge so that family/friends involved in patients transfer can get prescription filled prior to admission. This can be from Parkside Pharmacy or a pharmacy of their choice. Clexane must be obtained from CPH Pharmacy prior to arrival. 3. Doctor to write discharge note prior to transfer to rural hospital. All Clinical notes to travel with patient. 4. Prepare a new QMR0004 ie drug treatment sheet. In the case of the private hospitals we request a copy of the medication chart used during their hospitalisation be sent with the transfer note so the Medical Officers of the rural hospitals can complete a new QMR If on Coagulant therapy a copy of recent INR results and dosage for their first nights stay to be charted on drug treatment sheet as well as QMR005A i.e. Anticoagulant chart. 6. Nurse to complete patient transfer note. Page 5 of 6 Be reviewed by: November 2019

6 7. If support services are to be required when patient is to return home, a referral should also be written to ensure activation/reactivation to central co-ordination centre takes place. 8. Any surgical patients with special needs eg. Stoma, ward is to supply any ostomy products including Hollister skin gel. 9. Supplies of extra equipment and drugs need to be arranged eg. IV/PICC line equipment. 10. Any outpatient appointments during time of convalescence need to have transport arranged due to the distances required. It is the patient s responsibility to arrange transport to and from rural hospitals. 11. It is recommended that admissions to Rural Hospitals are no later than 1500hrs unless previously arranged by Social Worker and Nurse Manager. NB All medications need to travel with patient. Waikari Hospital does not have a local pharmacy. Rangiora can not take patients that require Oxygen. The Rural Hospitals have a General Admission Protocol which they must follow there are some patients that will be excluded from convalescing at these hospitals, as they may pose a risk or compromise safety so please take this into account when planning any convalescent care. Revised: June 2015 and updated November 2016 Policy Owner Nurse Managers, Rural Hospitals Policy Authoriser Community Hospital Management Team Date of Authorisation April 2000, last updated November 2016 Page 6 of 6 Be reviewed by: November 2019