MIU support will continue with staff calling the professional line as usual to book cases into the Shropdoc system.

Transcription

1 Standing Operating Procedure for Clinical Management of Patient Admissions to Community Hospital Inpatient Wards Ludlow, Bridgnorth, Bishops Castle & Whitchurch Document Details Title Clinical Management of Patient Admissions and Transfers to Community Hospital Inpatient Wards Ludlow, Bridgnorth, Bishops Castle & Whitchurch Trust Ref Authors Andrew Thomas Head of Nursing and Quality (Adults) Andy Matthews SDG Manager (Adults) Related Trust Policy Community Hospitals Admission and Transfer Policy Approval process Approved by (Committee/Director) Steve Gregory Director of Nursing and Operations Dr M Ganesh Medical Director Approval Date 5 th April 2018 Review date 5 th April 2021 Amendments History Date Amendment 1 New SOP following Shropdoc notification 2 Removal of direct liaison between A&E and Shropdoc for A&E admissions and A&E documentation added Reviewed and Amended. GP changes at Whitchurch included Amendments regarding staff reporting and support V Version 7 Changes to Shropdoc Provision to Clerking in of Patients Version 8 includes clerking in of patients out of hours from the Emergency Departments Version 9 re-enforces that the patient s GP (unless they are working within the capacity as a community hospital GP) will not be required to complete the clerking in of the patient. Purpose This procedure identifies the procedure for clinical management of admissions and transfers including clinical handover, clerking in, and appropriate prescriptions, medical management plans including DNAR where appropriate. 1

2 Introduction GP Provision by location: 1. Bridgnorth Shropdoc GP based at weekends (10.00hrs to 19.00hrs). 2. Bishops Castle - resident Shropdoc GP. 3. Ludlow - Shropdoc GP based at the hospital Monday to Friday (19.00hrs to midnight) and at weekends and bank holidays (14.00hrs to midnight). 4. Whitchurch Shropdoc GP based at the hospital Monday to Friday (19.00hrs to midnight) and at weekends and bank holidays (09.00hrs to 15.00hrs and 19.00hrs to midnight). Shropdoc will provide ward-based clerking for Bridgnorth, Bishops Castle, Ludlow and Whitchurch Community Hospitals for patients who require clerking in from 1900 hrs onwards on weekdays, and at all other times at weekends and bank holidays. This is for admissions from home and transfers from the Emergency Departments. It is not for ward transfers from SaTH as the patients should have all associated paperwork completed prior to transfer and will be clerked in by Community Hospital GP s the next working day. MIU support will continue with staff calling the professional line as usual to book cases into the Shropdoc system. Scope For direct admissions from the patients usual place of residence or A&E and transfers from acute providers into SCHT community hospital inpatient beds. Responsibilities Shropdoc Appropriate assessment by a Doctor of patient and completion of all SCHT community hospital documentation including SCHT drug charts, and DNAR forms as appropriate and this documentation should arrive with the patient on the ward or the patient be clerked in upon arrival to the ward. A&E clinician - Appropriate assessment of patient and completion of a photocopied A&E card / frailty assessment, appropriate prescription chart and medication, VTE assessment, medical management plans and DNAR (if required). Clinical handover to receiving ward staff. Transferring Ward from an Out of County Hospital Transferring staff must arrange transport to facilitate arrival to a community hospital bed Mon to Fri 9am - 3pm. For patients travelling a long distance or repatriation, a prior agreement on time of arrival is required. SCHT Staff Receive patients, monitor appropriate transfers, report missing documentation, inform GP of arrival for in hour s transfers and respond as appropriate to any deterioration or unstable patient. Staff should complete incident forms for any exceptions to the SOP and have the right to refuse admissions if the SOP is not followed. The nurse in charge will escalate incidents to the Clinical Services Manager or on call manager as appropriate. 2

3 Referring GP The referring GP assesses their patient to be medically stable and within the community hospital inclusion criteria and early warning score guidance. Contact is then made to the CCC who will arrange for the transfer to the community hospital via the capacity hub. The patient s GP (unless they are working within the capacity as a community hospital GP) will not be required to complete the clerking in of the patient.. 3

4 Admissions from Home In-Hours The patient has been assessed as medically stable by a GP and are within community hospital inclusion criteria and early warning score guidance t appropriate or unable to be admitted to a community hospital bed. The attending GP will contact CCC who will arrange for the transfer to the community hospital via the capacity hub. The CCC will confirm the patients expected time of arrival. If before 3pm the community hospital GP will be contacted and will complete the admission documentation.. If after 3pm the community hospital GP will be contacted to confirm their availability to complete the admission documentation.. If no GP capacity consider alternate options: Shropdoc clerk in patients Support at home until the next day Admit to A&E 4 The capacity hub will contact the ward and forward patient details.

5 Admissions from Home Out Of Hours The patient has been assessed as medically stable by a GP and are within community hospital inclusion criteria and early warning score guidance t appropriate or unable to be admitted to a community hospital bed. The attending Shropdoc GP will either complete all of the hospital documentation which will accompany the patient to the community hospital ward or will arrange to clerk in the patient within 4 hours of arrival. The GP will contact CCC who will arrange for the transfer to the community hospital. Admitting Shropdoc GP will complete a verbal clinical handover with the community hospital senior nurse if the hospital documentation is complete and does not require clerking on the ward. 5

6 Admissions from SaTH A&E The patient has been assessed as medically stable and are within community hospital inclusion criteria and early warning score guidance Patient identified as stable and appropriate for community hospital (usually by at least a middle grade Doctor) and a bed confirmed as available t appropriate or unable to be admitted to a community hospital bed. The attending A&E clinician must confirm the appropriateness of the patient with Nurse in charge and record it. A verbal clinical handover must take place with the ward nursing staff by the admitting clinician or appropriate clinician in the A&E department. The attending Doctor should complete and send with the patient a photocopied A&E card / frailty assessment, appropriate prescription chart and medication, VTE assessment, medical management plans and DNAR (if required). 6 The Shropdoc GP will clerk in the patient within 4 hours of arrival on to the ward.

7 Procedure Transfers from an Acute Hospital Ward The patient has been assessed as medically stable and are within community hospital inclusion criteria and early warning score guidance Patient identified as stable and appropriate for community hospital bed, and a bed confirmed as available. t appropriate or unable to be admitted to a community hospital bed. Is the patient from out of county? Transferring from out of county, staff must arrange transport to facilitate arrival to a community hospital bed Mon to Fri 9am - 3pm. Transferring from out of county, staff must arrange transport to facilitate arrival to a community hospital bed for the next appropriate day Mon to Fri 9am - 3pm. The transferring ward should clinically handover to the receiving ward nursing staff usually in the form of a telephone conversation 7 Patient arrives with either documentation completed from SaTH or If in hours the receiving ward nursing staff informs the duty GP to admit and complete documentation including prescription chart if from out of county. Stable transfers from SaTH can use SaTH prescription charts until next GP working day

8 If a patient is acutely unwell on the community hospital ward out of hours then staff should call the Shropdoc professional line as usual. If a ward visit is deemed necessary then an Urgent Care Practitioner or a GP. If medication requires changing then this must be made clear upon referral to Shropdoc. NOTE: FAXED PRESCRIPTIONS FOR CONTROLLED DRUGS CANNOT LEGALLY BE ACCEPTED (NMC Standards for medicines management: Standard 11: Remote prescription or direction to administer) Telephone Advice - will continue for prescription queries, clinical advice, and lab results across all community hospitals. Shropdoc professional line Medical emergencies should be managed as current, using the 999 service if necessary for urgent transfer to an acute hospital Monitoring Monitoring will be by DATIX reports, regular tripartite meeting between Shropdoc, SaTH and SCHT, monitoring of readmissions, mortality reviews, complaints, NHS to NHS concerns, patient feedback. References Community Hospitals Admissions and Transfer of Care Policy NHS/PSA/RE 2016/005 Patient Safety Alert 8