Post holder responsible for Procedural Document Author of Policy Division/ Department responsible for Procedural Document Contact details General Manager, Operations Support Unit Helen Hooper, Head of Access and Patient Flow Operations Support Unit x4676 Date of original policy October 2007 Impact Assessment performed Yes/ No Ratifying body and date ratified Safety and Risk Committee: 27 th June 2014 Review date (and frequency of further reviews) December 2015 (every 2 years) Expiry date June 2016 Date document becomes live 18 th November 2014 Please specify standard/criterion numbers and tick other boxes as appropriate Monitoring Information Strategic Directions Key Milestones Patient Experience Waiting Assurance Framework Privacy and Dignity Monitor/Finance/Performance Efficiency and Effectiveness CQC Regulations/Outcomes: Other (please specify): Delivery of Care Closer to Home Infection Control Note: This policy has been assessed for any equality, diversity or human rights implications Controlled document This document has been created following the Royal Devon and Exeter NHS Foundation Trust Development, Ratification & Management of Procedural Documents Policy. It should not be altered in any way without the express permission of the author or their representative. Review date: December 2015 Page 1 of 30
Full History Status: Final Version Date Author (Title not Reason name) 1.0 October 2007 2.0 January 2010 Routine revision 3.0 June 2014 Head of Access & Patient Flow Revised Policy (replacing December 2013 version) Associated Policies: In consultation with and date: Infection Prevention & Control Policy Safeguarding Children Policy and Procedures Safeguarding Vulnerable Adults Policy Medicines Management Policy Incident Reporting, Analysing, Investigating and Learning Policy and Procedures Standards of Discharge Working Group, June 2014 Good Outcomes on Discharge (GOOD) Steering Group, June 2014 Governance Managers, May 2014 Divisional Directors, May 2014 General Managers, May 2014 Associate Medical Directors, May 2014 Assistant Directors of Nursing, May 2014 Senior Nurses, May 2014 Policy Expert Panel (Chair s approval), 14 th July 2014 Safety and Risk Committee: 27 th June 2014 Review Date (Within 3 years) December 2015 Contact for Review: Head of Access and Patient Flow Executive Lead Signature: (Only applicable for Strategies & Policies) Chief Nurse/Chief Operating Officer Review date: December 2015 Page 2 of 30
CONTENTS 1. INTRODUCTION... 4 2. PURPOSE... 4 3. DEFINITIONS... 5 4. DUTIES AND RESPONSIBILITIES OF STAFF... 5 5. STANDARDS OF DISCHARGE... 7 6 THE TRANSFER OF PATIENTS IN EMERGENCY SITUATIONS... 8 7. INFECTION CONTROL TRANSFERS... 8 8 SIMPLE DISCHARGES... 8 9 ELECTIVE ADMISSIONS... 9 10 COMPLEX DISCHARGES OR TRANSFERS... 9 11. SELF DISCHARGE... 11 12 RELUCTANT DISCHARGES... 11 13 TRAINING... 11 14. ARCHIVING ARRANGEMENTS... 12 15. PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF THE POLICY... 12 16. REFERENCES... 12 18. ASSOCIATED TRUST POLICIES... 13 APPENDIX 1: DISCHARGE ASSESSMENT & CARE PLAN... 14 APPENDIX 2: WARD WHITEBOARD FUNCTIONS... 15 APPENDIX 3: SIMPLE DISCHARGE FLOWCHART... 16 APPENDIX 4: RAPID INTERVENTION CENTRE... 17 APPENDIX 5: ELECTIVE DISCHARGE FLOWCHART... 19 APPENDIX 6: COMPLEX DISCHARGE FLOWCHART... 19 APPENDIX 7: COMPLEX CARE TEAMS... 21 APPENDIX 8: NURSING REFERRAL DISCHARGE /TRANSFER FORM... 22 APPENDIX 9: SELF DISCHARGE FORM... 24 APPENDIX 10: RELUCTANT DISCHARGE LETTERS... 25 APPENDIX 11: RAPID IMPACT ASSESSMENT SCREENING FORM... 28 Review date: December 2015 Page 3 of 30
1. INTRODUCTION 1.1 Structured individualised discharge plans for patients can result in a reduction in their length of stay and reduce the likely hood of re-admission in to hospital. Effective discharge planning therefore is a key part of the operational management of beds which is not only beneficial to the Royal Devon and Exeter NHS Foundation Trust (hereafter referred to as the Trust ), but it is also beneficial to patients (Shepperd, S. et al 2013). 1.2 It is the stated aim of the Trust is to ensure a safe and timely discharge/transfer for all patients. This will be achieved through proactive management, planning, cooperation and communication between the multidisciplinary teams, social care agencies, community hospitals and other private care providers and by the active involvement of patients and their families and/or carers. 1.3 Many patients especially those who are vulnerable have a window of opportunity in which they are at their optimum to be discharged from the acute hospital environment. If this opportunity is missed the consequences for the patient and the hospital can be significant. Any delay also significantly impacts on effective bed management within the trust. 1.4 Health and social care communities need to work together to ensure appropriate care is available to avoid unnecessary admissions and provide for timely discharge or transfer. There should be a framework of integrated multidisciplinary and multiagency team working to ensure a co-ordinated management of patient discharge and transfer planning processes. 1.5 The Community Care (Delayed Discharges) Bill was introduced into the House of Commons in November 2002 and received Royal Assent in April 2003. The Community Care (Delayed Discharges) Act places duties upon the NHS and local authorities in England relating to communication between health and social care systems, patients discharges and the associated communication with patients and carers. 1.6 This policy sets out the Trust s response to this bill. It also covers the processes associated with the transfer of patients to other providers for their on-going care as many of the principles governing the safe transfer of patients are the same as those associated with patient discharge 1.7 Failure to comply with this policy could result in disciplinary action. 2. PURPOSE 2.1 This policy applies to all adult in-patients being discharged / transferred from services provided by the Trust. This includes internal transfers as well as external transfers to other care providers. 2.2 The policy does not apply to Children s services or maternity services. Review date: December 2015 Page 4 of 30
3. DEFINITIONS 3.1 Simple discharge: Also referred to as a minimal discharge (NHS Choices 2013). This refers to patients: who are discharged to their own home and need only a small amount of after care; who require a reinstatement of previous care arrangement; who are returning to their previous residential or nursing home and whose care needs have not changed; 3.2 Complex discharge: Refers to patients who will require a more professional multi-agency approach to their discharge, drawing on specialist knowledge from the wider team and whose ongoing health and social care needs have changed significantly from pre admission needs/abilities e.g. patients who require an increase in community services, patients whose care needs now require a higher level of care or those who require intermediate care and or rehabilitation (for example community hospitals). 3.3 Self Discharge: Refers to patients who choose to discharge themselves from hospital with or without discussing discharge with their own, or the on-call, medical team. They may or may not sign a self-discharge form. 3.4 Maternity: Women who are admitted for inpatient care solely for the purpose of using maternity services. 3.5 Emergency Department (ED) Discharges: This category of patients differs from the Simple and Complex discharge categories, as ED patients are not admitted to inpatient services. Occasionally these patients present with complicated discharge needs. 3.6 Internal Transfers: These are formal general ward and department transfers where a new base ward or department will be established and care will be handed over from one clinical team to another (this does not include transfers to Community Hospitals but does include Mardon). 3.7 External Transfers: These are formal care provider to care provider transfers of care and include Community Hospitals and care homes 4. DUTIES AND RESPONSIBILITIES OF STAFF 4.1 Chief Nurse Director of Nursing and Patient Care has overall executive responsibility for patient discharge. 4.2 Named Consultant The consultant in charge of a patient s care has overall responsibility to ensure the patient is stable for discharge and ensuring the Discharge summary is written Review date: December 2015 Page 5 of 30
4.3 Operational Lead for Discharge The Operational Lead for Discharge is responsible for maintaining and updating the Discharge Policy and for policy monitoring, develops, implements and evaluates action plans and is the Trust lead and expert for patient transfer. 4.4 Assistant Director of Nursing (ADN) The ADN is responsible for monitoring compliance with the Policy within their division. 4.5 Senior Nurse The Senior Nurse is responsible for monitoring the discharge process within their areas of responsibility. 4.6 Matron The Matron is responsible for safe and effective discharge planning within their clinical area and to ensure that training for staff in the management of patient discharge takes place as part of induction training. The Matron is also responsible for monitoring daily discharge delays and reporting back any issues or concerns to the Senior Nurse. 4.7 The Multi-Disciplinary Team (MDT) MDT will include all professions relevant to an individual patient include clinicians, nurses, allied health professionals, specialist nurses/services, social workers and voluntary workers. They will be responsible for:- timely and appropriate discharge planning; referrals to other professionals, taking into account the estimated date of discharge, and recognising relevant legislation; planning and instigate diagnostic tests and other interventions to avoid delays in treatment and discharge; review the patient s response to treatment and their condition daily; Initiating the timely completion the discharge plan. 4.8 Onward Care Service The Onward Care Service facilitates and supports ward based staff to discharge patients within their care effectively and efficiently by sharing specialist knowledge, expertise and being a resource for information. The Onward Care Team are responsible for the assessment of patients requiring more complex discharge including transfer to a community hospital or Intermediate care setting. Their role is to provide packages of care to inform patients and relatives of complex care and continuing care packages. They also assess for direct placement to nursing residential care. 4.9 Ward Co-ordinator/Nurse in Charge The Ward Co-ordinator / Nurse in Charge is responsible for the safe and timely discharge of patients. It is the nurse responsible for the patient on the day to ensure the discharge check list is completed 4.10 Complex Care Teams Integrated Health and Social Care teams in the East of Devon working in the Community to support complex patients The Complex Care Teams have been set up as a single point of contact to provide care for patients with complex needs to prevent further decline or hospitalisation, and facilitate speedy discharge. Patients are provided with a holistic, joined-up service by the multi-disciplinary team. Review date: December 2015 Page 6 of 30
5. STANDARDS OF DISCHARGE 5.1 Key points for achieving timely discharge include: Elective patients will be informed of their predicted length of stay at preassessment - this will be confirmed on admission. The predicted date of discharge for non-elective patients will be set within 24 hours of arrival by the multi-disciplinary team at base ward, the patient and their family / carer informed and transport arrangements agreed. This will be documented on the white board, and at the patient s bed side in discharge plan A discharge assessment and care plan should be commenced for all patients within 24 hours of admission to a base ward. See Appendix 1. A discharge plan will be reviewed 12-24 hours prior to discharge and then completed on discharge. Ward/Board rounds will occur to allow a senior review of all patients. The intention is that this will happen daily with 7 day working. Patients will be medically stable at the point of discharge with appropriate ongoing care arrangements in place. Inpatient discharges should be planned with the aim of discharging Home for Lunch. A copy of the patient s medical discharge summary will accompany the patient on discharge and one sent to the Patient s General Practitioner (GP). Communication between wards for internal transfers is vital to ensure the patient experiences a consistent quality of care. All internal transfer patients will complete a patient handover check list Information about discharge including the planned date of discharge should be entered onto the electronic Ward Whiteboard. This will begin within 24 hours of admission and be completed to coincide with the patient s actual date of discharge. See Appendix 2 Medications should be ordered 24 hours in advance of the planned discharge or transfer wherever possible, following the guidance for ordering and safe storage of medication as set out in the medicines Management Policy; the process relating to controlled drugs is set out in Section 6 of the Medicines Management Policy Medications must be explained to the patient including any relevant changes by the discharging nurse The patient s home circumstances should be considered when planning their discharge The discharge of patients from a base ward after 21:00 and before 08:00 should be avoided unless it is clinically and socially safe to do so and is in the best interests of the patients All patients are encouraged to use their own transport home. If the patient fits the criteria for transport complete the form on IaN. The discharging address must be confirmed as this may be different. The discharging nurse must ensure the patient is fully clothed before discharge. The patient must not be discharged in night clothes unless the patient declines the offer of clothes, or alternative clothing is not available. Treatment Escalation Plan (TEP) forms should be considered prior to discharge All patients will have a discharge booklet on arrival to base ward unless they are an elective admission and will be given a discharge leaflet at pre assessment or on arrival to ward Review date: December 2015 Page 7 of 30
6. THE TRANSFER OF PATIENTS IN EMERGENCY SITUATIONS 6.1 In the case of patients needing transfer to another acute setting due to critical illness or urgent need, guidance and transfer forms are available in the following areas and should be completed in line with Nursing Midwifery Council guidance on good record keeping (Nursing and Midwifery Council, 2009). 6.2 ITU Transfers Complete Southwest Critical Care Transfer form available in ITU. 6.2 Cardiac Transfers Consult the Surgical Patients Transfer criteria (available in Cardiology) and if necessary please contact the Pathway Co-ordinator on bleep 808. 6.3 ED Transfers Complete Southwest Critical Care Transfer form available from ITU and attach copy of ED admission form. 7. INFECTION CONTROL TRANSFERS 7.1 For the Discharge or transfers of all patients with an Infection Control alert please consult the Infection Prevention and Control Policy, in particular the sections on Isolation, Methicillin-resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile. If in any doubt, please ring the Infection Control Team on (01392) 40 2355. 8. SIMPLE DISCHARGES 8.1 See Appendix 3 for the Simple Discharge flowchart. 8.2 The Trust promotes discharge before 11:00 am wherever possible. 8.3 The consultant and the Ward Matrons must ensure robust arrangements are in place for Predicted Date of Discharge PDDs to be reviewed and updated on a daily basis. 8.4 The patient and/or carers must agree the discharge plan. This must be documented in the discharge plan (Appendix 1). 8.5 Where care has already been in place, the MDT is responsible for nominating a member of staff to contact Care Direct Plus (CDP) or the care agency or care home directly, to arrange for care to be reinstated. http://ian.exe.nhs.uk/welcome/directorates/operations-support-unit/cdp-referrals/ 8.6 Where there is an assessed need for a short term package of care and the patient has been in 72hrs or under, contact Rapid Intervention Centre (RIC East Devon, Mid Devon and Exeter) who can provide care for up to seven days post discharge. See Appendix 4. 8.7 Where there is an assessed need for a long term package of care and the patient is not complex but needs care up to twice a day contact CDP on 01392 381206 (Professional) and record the referral on the Ward Whiteboard. 8.8 If patient need a referral to Community Nursing Service, an electronic referral can be completed on the Ward Whiteboard in hours. The patient must be housebound to receive this service. Out of hours, contact Devon Doctors 0845 504 8997. Review date: December 2015 Page 8 of 30
8.9 A sick certificate / Statement of Fitness to Work should be issued to all patients who require them by the medical team looking after the patient. 8.10 Likely equipment needs must be identified early utilising the multidisciplinary team as needed and community arrangements for pressure area management. 8.11 Medical staff must be timely in prescribing discharge medication and completing the discharge summary. 8.12 The discharging nurse from the ward must complete and sign the discharge checklist/plan. 9. ELECTIVE ADMISSIONS 9.1 See Appendix 5 for flow chart 9.2 Discharge planning commences at pre assessment clinic and the following areas will be discussed with the patient: Predicted Date of Discharge Any equipment required following admission Discharge Care Plane commenced Discharge booklet to be given to patient where applicable 10. COMPLEX DISCHARGES OR TRANSFERS 10.1 Onward Care Service 10.1.1 See Appendix 6 for the Complex Discharge flowchart. 10.1.2 Patients with complex care needs may already be known by The Complex Care teams (Appendix 7 EAST DEVON only) and will offer a PULL process supporting early discharge). 10.1.3. Patients with an Onward Care requirement will be referred to the Onward Care Service, via the electronic Ward Whiteboard referral form, by a member of the MDT. The Onward Care Service will be responsible for accepting the patient as being suitable for transfer and determining which service is the most appropriate. The active Onward Care list will be reviewed daily (Monday to Friday) by the Onward Care Service and the indicators of readiness, and the destinations for transfers will be displayed on the Whiteboard. All transfers will be co-ordinated accordingly. 10.1.4. It is the responsibility of the base ward of the Onward Care referral to ensure the medically fit status of the patient (denoted by the ambulance icon transfer symbol on the Ward Whiteboard) is accurate at all times, and the OCS are electronically informed of any changes in status. 10.1.5 The Onward Care Service may identify the need for a Community hospital bed, see section 11. 10.1.6 A Continuing Health Care checklist should be completed. Review date: December 2015 Page 9 of 30
10.2 Community Hospital (non-stroke) 10.2.1 The use of the Community Hospital is managed through the Onward Care service who will agree if this is the most appropriate onward care destination. Whilst every effort is made to ensure the patient goes to their local Community Hospital, they may be asked to go to an alternative Community hospital. The OCS will give the patient/carer a letter advising them of this. 10.2.2 Patients with an Onward Care requirement will be referred to the Onward Care Service, via the electronic Ward Whiteboard referral form, by a member of the MDT. The Onward Care Service will be responsible for accepting the patient as being suitable for transfer and determining which service is the most appropriate. The active Onward Care list will be reviewed daily (Monday to Friday) by the Onward Care Service and the indicators of readiness, and the destinations for transfers will be displayed on the Whiteboard. All transfers will be co-ordinated accordingly 10.2.3 Once the decision has been made the Community Matrons will identify bed availability with the Onward care service daily for those patients who are green to go and identify the patient. Where there is an empty bed and there are no patients identified then OCS are responsible for identifying another patient who will be asked to go out of area when the organisation is in amber or red escalation. Where the patient refuses to go the Discharge lead will be informed and discuss with the relevant patient/ carer and if they still decline then this is escalated to the Head of Access and Patient Flow or the On Call Manager. 10.2.4 The transport office will contact the ward and advise them of the pending discharge. 10.2.5 A community drug chart is required for all Community Hospital transfers. The PTS office will send a list of patients due for transfer to the general office. Ward staff are contacted and requested to send a POD to the general office who will then POD the drug chart to the relevant ward 10.2.6 To request transport for your patient complete the Patient Transport Booking request, from the electronic Ward Whiteboard (as from 20 October 2014) or if you are not a Ward Whiteboard user please use the Link on the front page of IaN. Please see Patient Transport Booking System User Guide below. For any queries, please email rde-tr.patienttransport@nhs.net). The discharging address must be confirmed as this may be different. 10.2.7 A Nursing Referral form for transfer and discharge of patients (Appendix 8) must be completed in addition to a verbal handover; a copy to be retained in patient s notes 10.2.8 A telephone call should be made by the discharging ward to the admitting Community Hospital when the patient leaves the ward 10.2.9 Buff casenotes can go with the patient and E notes will need to be photocopied 10.3 Patients Identified To be nearing the end of their life 10.3.1 Referrals made to the Palliative Discharge Team should be for those patients who are at the end of their life with a likely prognosis of less than 3 months and have complex palliative care needs. They should be evidencing a rapid deterioration. 10.3.2 The definition for a patient with complex palliative care needs is a patient that is experiencing any single or combination of the following needs: Review date: December 2015 Page 10 of 30
High level of social care needs, equipment needs and/or complex social situation directly linked to their palliative diagnosis High level of nursing needs including medication administration, pressure care, wound care, feeding/diet management, Uncontrolled symptoms associated and/or complex psychological issues directly linked to their palliative diagnosis 10.3.3 Specific requirements When a patient for whom no more active treatment is planned and have been given a short prognosis it may be the patients wish to receive their end of life care at home or in the community setting. The MDT should contact the Palliative Discharge Team by the Hospice and Palliative Discharge Team Referral form on IaN or if an urgent assessment is required contact Ext 3750. http://ian.exe.nhs.uk/welcome/directorates/cancerservices/palliative-care/?locale=en If appropriate the Palliative Discharge Team will facilitate and case manage the discharge process. If not an appropriate referral for The Palliative Discharge Team, a referral to Onward Care should be considered. The NHS Continuing Healthcare Fast Track Tool will need to be completed for patients requiring care to facilitate a discharge home or considering a nursing placement. This document is available on IaN under Palliative and End of Life Care. http://ian.exe.nhs.uk/welcome/directorates/cancer-services/palliativecare/?locale=en 11. SELF DISCHARGE 11.1 If a patient decides to take self discharge, it should be recorded that an assessment of the patient s mental capacity has been completed by staff before the self discharge takes place. 11.2 Where a patient takes his/her own discharge against medical advice, the appropriate self discharge form should be signed by the patient or doctor. Refusal to do so should be recorded in the medical notes. See Appendix 9. 12 RELUCTANT DISCHARGES 12.1 An individual does not have the right to occupy a hospital bed where the sole reason for doing so is because the individual s preferred choice is not available. 12.2 The MDT team will identify potential reluctant discharges and discuss these with the Matron and Senior Nurse. The Delayed Transfers of Care and Reimbursement Agreement and Operational Protocols will be followed and reluctant discharge letters will be implemented when appropriate. See Appendix 10. 13 TRAINING 13.1 All new clinical staff will be expected to attend as part of the local induction training and introduction to the discharge process as mandatory 13.2 All relevant Clinical staff that are involved with the discharge process can access opportunities to attend a refresher session. Review date: December 2015 Page 11 of 30
13.3 IaN will be regularly updated with information and resources relevant to the discharge process 13.4 Nursing staff and other relevant Clinical staff will be expected to be fully competent with the discharge process and ensure they remain up to date with any changes to the process.. 14. ARCHIVING ARRANGEMENTS The original of this policy will remain with the author Head of Access and Patient Flow Operations Support Unit. An electronic copy will be maintained on the Trust Intranet (IaN), D -. Archived copies will be stored on the Trust's archived policies shared drive, and will be held for 10 years. 15. PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF THE POLICY 15.1 In order to monitor compliance with this policy, the auditable standards will be monitored as follows: No Minimum Requirements Evidenced by 1. Use of Discharge Care Plan Audit Discharge Lead 2. Compliance with Training Audit Discharge Lead 3. Compliance with Predicted Discharge Audit Head of Patient Flow 4. 5. Number of Recorded Incidents relate to discharge/transfer Number of Complaints related to discharge/transfer Audit Discharge Lead Audit Discharge Lead 15.2 Frequency In each financial year, the Discharge Lead will audit the above to ensure that this policy has been adhered to and a formal report will be written and presented at the Discharge Steering Group. 15.3 Undertaken by Discharge Lead with support from the ADNs. 15.4 Dissemination of Results At the Discharge Steering Group which is held bi-monthly 15.5 Recommendations/ Action Plans Implementation of the recommendations and action plan will be monitored by the Discharge Steering Group bi monthly. 16. REFERENCES Community Care (Delayed Discharges etc.) Act 2003. London: Stationery Office. Available at: http://www.legislation.gov.uk/ukpga/2003/5/contents Department of Health (2004). Achieving timely, simple discharge from hospital - a toolkit for the multi-disciplinary team, Department of Health: London. Available at: Review date: December 2015 Page 12 of 30
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatist ics/publications/publicationspolicyandguidance/dh_4088366 Department of Health (2010). Ready to go. Department of Health: London. NHS Choices (2013). Leaving Hospital - Being Discharged from Hospital. [online] Available at: http://www.nhs.uk/nhsengland/aboutnhsservices/nhshospitals/pages/leavinghospital.aspx NHS Litigation Authority (2013). NHSLA Risk Management Standards 2013-14. London: NHSLA. Available at: http://www.nhsla.com/safety/documents/nhs%20la%20risk%20management%20 Standards%202013-14.doc Shepperd S, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000313. DOI: 10.1002/14651858.CD000313.pub4 Department of Health and Royal College of Nursing (2003). Freedom to practise: dispelling the myths, Department of Health: London. Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatist ics/publications/publicationspolicyandguidance/dh_4061524 Nursing and Midwifery Council (2009). Record keeping: Guidance for nurses and midwives. London: NMC. Available at: http://www.nmc-uk.org/publications/guidance/ 18. ASSOCIATED TRUST POLICIES Infection Prevention & Control Policy Safeguarding Children Policy and Procedures Safeguarding Vulnerable Adults Policy Medicines Management Policy Incident Reporting, Analysing, Investigating and Learning Policy and Procedures Review date: December 2015 Page 13 of 30
APPENDIX 1: DISCHARGE ASSESSMENT & CARE PLAN Refer to the Discharge Checklist. http://ian.exe.nhs.uk/easysiteweb/gatewaylink.aspx?alid=148602 (Click here for a guide on completing the Discharge Checklist) http://ian.exe.nhs.uk/easysiteweb/gatewaylink.aspx?alid=168831 Discharge_Checklist Review date: December 2015 Page 14 of 30
APPENDIX 2: WARD WHITEBOARD FUNCTIONS WARD WHITEBOARD FUNCTIONS The Ward Whiteboard performs many functions and the following guidance set out the mandatory and optional functions within the system Mandatory Functions Planned date of discharge (PDD) : Within 24 hours of admission Bed Location: Within 1 hour of admission Discharge destination: Within 24 Hours of admission Pressure Ulcer database: Within 24 hours of admission Infection control marker: Optional Functions Mobility Indicator Report Indicator The Ward Whiteboard is the Trust recognised system for recording the predicted date of discharge for every inpatient. It is the consultant s and matron s responsibility to ensure that every patient has their first PDD set within 24 hours except for clinical exceptions. It is the responsibility of the matron to ensure either the nursing or administrative team enter the mandatory data onto the Ward Whiteboard within the time prescribed. It is the responsibility of the matron to ensure that the data entered onto the Whiteboard timely and accurate Review date: December 2015 Page 15 of 30
APPENDIX 3: SIMPLE DISCHARGE FLOWCHART SIMPLE DISCHARGE FLOWCHART Update patient/carers daily on progress with discharge plan document If required arrange commencement of home care support and confirm in patients documentation Complete Discharge summary Medications available and have been explained to patient/carer Yes Meets criteria for Hospital transport No Book transport via IaN Confirm and documents transport arrangements Equipment (if required) available for discharge and has been explained to the patient/carer/care home Verbal / written information given to patient/carer/care home Discharge plan completed Review date: December 2015 Page 16 of 30
APPENDIX 4: RAPID INTERVENTION CENTRE Introduction Rapid Intervention Centre Tel: 0845 600 7878 The Rapid Intervention Centre (RIC) is a referral-taking service that arranges short-term care packages, aimed at preventing hospital admissions and enabling early discharge from hospital. Formerly known as the Urgent Care Centre, it has been extended to take referrals for six different schemes across East Devon, Mid Devon and Exeter. From 1 July 2012, the centre will be open seven days a week, from 8am to 11pm. Who do we take referrals for? Scheme Current hours Hours from 1 July First point of contact Rapid Response 9am 5pm, Mon Fri 24/7 Nursing 9am 5pm, Mon Fri Marie Curie Mid Devon Pathway (Mid Devon) 9am 5pm, Mon Fri 9am 5pm, Mon Fri 8am 11pm, 7 days a week 9am 5pm, Mon Fri 8am 11pm, 7 days a week 8am 11pm, 7 days a week Rapid Intervention Centre Rapid Intervention Centre Rapid Intervention Centre Rapid Intervention Centre Review process The Rapid Intervention Centre team, in conjunction with the health or social care professional involved, will review the care at an appropriate time. The care will cease, be extended or, if necessary, a referral will be made to the appropriate service for longer-term support. Who do we accept referrals from? Any health and social care professional, including: GPs Community nurses Social workers/community care workers South Western Ambulance Trust clinicians Occupational therapists Physiotherapists Hospice Community psychiatric nurses RD&E Review date: December 2015 Page 17 of 30
Review date: December 2015 Page 18 of 30
APPENDIX 5: ELECTIVE DISCHARGE FLOWCHART ELECTIVE DISCHARGE FLOWCHART Pre-operative assessment clinic Predicted date of discharge established with patient Establish any home care arrangements which will need to be cancelled /reinstated/ Commence discharge planning/checklist documentation Review date: December 2015 Page 19 of 30
APPENDIX 6: COMPLEX DISCHARGE FLOWCHART COMPLEX DISCHARGE FLOWCHART MDT identify patient has increase in care needs MDT discuss increase care needs with patient/carer/family Complete part 1 referral to Onward Care Service No Onward Care Service identifies Community Hospital Yes Does patient need a CHC checklist? Confirm patient is medically stable Yes No Yes No Complete CHC Checklist Consider completion of Part 2 Green Red Follow Simple Discharge flow chart Complete Community Drug Chart and Nursing referral and transfer form (Appendix 9) Follow Simple Discharge flow chart Monitor medical progress & change to Green once medically stable. Review date: December 2015 Page 20 of 30
APPENDIX 7: COMPLEX CARE TEAMS Complex Care Team Co-ordinator Team Members Community Nurses Community Matron Community Psychiatric Nurse Community Rehabilitation Co-ordinator Social Workers/CCW s Voluntary Sector Rep Eastern Devon Complex Care Teams The Complex Care Teams have been set up as a single point of contact to provide care for patients with complex needs to prevent further decline or hospitalisation, and facilitate speedy discharge. Patients are provided with a holistic, joined-up service by the multidisciplinary team. Contact: Axminster Co-ordinator 01297 630114 Crediton Co-ordinator 01363 771070 Cullompton Co-ordinator 01884 836023 Exeter 1 Co-ordinators 01392 380643 / 01392 380644 Exeter 2 Co-ordinator 01392 380631 /01392 380644 Exmouth & Budleigh Co-ordinator 01395 282025 Honiton & Ottery St Mary 01404 540530 Seaton Co-ordinator 01297 626151 Sidmouth Co-ordinator 01395 519934 Tiverton Co-ordinator 01884 235520 Review date: December 2015 Page 21 of 30
APPENDIX 8: NURSING REFERRAL DISCHARGE /TRANSFER FORM Review date: December 2015 Page 22 of 30
Review date: December 2015 Page 23 of 30
APPENDIX 9: SELF DISCHARGE FORM SELF DISCHARGE FORM Royal Devon and Exeter NHS Foundation Trust Barrack Road, Exeter EX2 5DW THIS IS TO CERTIFY that I leave this Hospital at my own request, and entirely against the advice of my Medical Officer. I understand the consequences of self discharge. Signed: Date: Review date: December 2015 Page 24 of 30
APPENDIX 10: RELUCTANT DISCHARGE LETTERS Letter One For all adult patients and/or who may be reluctant to discharge and to. This an example letter that could be amended to meet patient or family situation Our Ref: Your Ref: Date Name Address 1 Address 2 Town County Postcode Dear <Name> As you will know from discussions with the team looking after you since you were admitted to hospital, and staff involved in your care, you are now fit for discharge from hospital. It is now necessary to ask you to transfer to alternative accommodation for the next stage in your care. We are sorry that we have to ask you to do this, but it is important that you are able to leave hospital as soon as you are fit so that you do not risk further medical complications caused by a prolonged hospital stay. It also enables the hospital to provide treatment for further patients that need hospital care. We appreciate that this may be a difficult time for you, and your family, as the home of your choice/care package may not be available for you immediately. We can therefore arrange for you to be placed in alternative accommodation whilst you wait for a vacancy/care package to become available. You and your family will be supported throughout this time to ensure that the transfer is made as smoothly as possible. Please be assured that placement in alternative accommodation will hopefully be short-term and that when a vacancy does arise, arrangements will be made for you to transfer. We may also be able to help with the associated transport costs. Throughout this period, the ward sister and (if needed) a social worker will be available to help you and answer any of your questions. Yours sincerely NAME Matron & Adult Social Care Manager - Job Title Review date: December 2015 Page 25 of 30
Letter Two For patients and/or carers 7 DAYS after Letter 1 (i.e. nearest working day). This is an example letter that could be amended to meet patient or family situation. Our Ref Your Ref: Date Name Address 1 Address 2 Town County Postcode YOUR DISCHARGE FROM HOSPITAL As we said in our last letter, we are pleased that you are now well enough to leave hospital. We understand that up to now, you have been unable to secure a place in the home of your choice. It may be that your home choice does not have a vacancy at this time or you want to consider alternative funding arrangements. We do not wish to cause you or your family undue anxiety or distress, but you will be aware that there are many people needing hospital care and we need to be able to offer treatment to others requiring care at the earliest opportunity. We would like to complete your move out of hospital as smoothly as possible. We are therefore providing you with a listing of homes (enclosed with this letter), with vacancies, that would be able to support you whilst you identify or finalise your home of choice and other arrangements or until a place becomes vacant in the home you have chosen. Each of these homes could provide you with the level of care and support that you currently require. The Trust will, therefore, formally discharge you to your choice of one of these homes within the next week. All members of the multi-disciplinary team will assist you with the transfer and answer any questions about your care. Alternatively, if you, or someone representing you, would like to discuss this decision with a Senior Trust Manager, please do not hesitate to contact me at the above number. If you are unhappy with the place that we find with you after you have been discharged, we will discuss your concerns together and involve your nurse, Doctor and (if needed) a Care Manager/Social Worker. If you are still dissatisfied, you are entitled to have your complaint investigated under the NHS Complaints Procedure. Please contact your Ward Manager if you wish to obtain further details of this procedure. Following your discharge to one of these homes, your Community Social Worker will help you to transfer to your home of choice when a place becomes available. Review date: December 2015 Page 26 of 30
I would like to take this opportunity to offer you my best wishes for the future and to thank you for your co-operation. I hope that you will be happy in your new home. Yours sincerely NAME Senior Nurse/Onward Care Service Manager Review date: December 2015 Page 27 of 30
APPENDIX 11: RAPID IMPACT ASSESSMENT SCREENING FORM RAPID IMPACT ASSESSMENT SCREENING FORM Name of procedural document Directorate and Service Area Operations Support Unit Name, job title and contact details of person completing the assessment Helen Hooper Head of Access and Patient Flow Date: 27 th May 2014 EXECUTIVE SUMMARY Impact Action Result No impacts identified n/a n/a 1. What is the main purpose of this policy / plan / service? To ensure safe and timely discharge 2. Who does it affect? Please tick as appropriate. Carers Staff Patients x Other (please specify) Other Health and Social Care providers 3. What impact is it likely to have on different sections of the community / workforce, considering the protected characteristics below? Review date: December 2015 Page 28 of 30
Please insert a tick in the appropriate box Protected Characteristics Positive impact -- it could benefit Negative impact -- it treats them less favourably or could do Negative impact -- they could find it harder than others to benefit from it or they could be disadvantaged by it Non-impact missed opportunities to promote equality Neutral -- unlikely to have a specific effect Age x Disability x Sex including Transgender and Pregnancy / Maternity x Race x Religion / belief x Sexual orientation including Marriage / Civil Partnership x In identifying the impact of your policy across these characteristics, please consider the following issues: - Fairness - Does it treat everyone justly? - Respect - Does it respect everyone as a person? - Equality - Does it give everyone an equal chance to get whatever it is offering? - Dignity - Does it treat everyone with dignity? - Autonomy - Does it recognise everyone s freedom to make decisions for themselves? If you have any negative impacts, you will need to progress to a full impact assessment. Review date: December 2015 Page 29 of 30
In sections 4 and 5, please copy and repeat the tables below, for each protected characteristic considered. Alternatively, you can use one table for more than one protected characteristic, if the outcomes are similar. 4. If you have identified any positive impacts (see above), what will you do to make the most of them? Protected characteristic affected: Issue Who did you ask to understand the issues or whose work did you look at? What did you find out about? What did you learn or confirm? Action as a result of above Action By who? When? 5. If you have identified any missed opportunities ( non-impacts ), what will you do to take up any opportunities to promote equality? Protected characteristic affected: Issue Who did you ask to understand the issues or whose work did you look at? What did you find out about? What did you learn or confirm? Action as a result of above Action By who? When? 6. If you have identified a neutral impact, show who you have consulted or asked to confirm that this is the case, in the table below: Who did you ask or consult to confirm your neutral impacts? (Please list groups or individuals below. These may be internal or external and should include the groups approving the policy.) Standards of Discharge Working Group Good Outcomes on Discharge (GOOD) Steering Group Governance Managers Divisional Directors General Managers Assistant Directors of Nursing Senior Nurses Policy Expert Panel If you need help with any aspect of this assessment, please contact: Tony Williams Equality and Diversity Manager Ext: 6942 anthony.williams1@nhs.net Review date: December 2015 Page 30 of 30