Procedure for Discharge from Inpatient Units including 48 hour Follow Up (Wotton Lawn only) Version: Version 3 Consultation: Ratified by: Date ratified: Name of originator/author: Date issued: July 2012 Locality Directorates Director Quality and Performance Notification of format change to Governance March 12 Vikki Tweddle and Tim Coupland Review date: 2 years March 2014 Audience Wotton Lawn Patients Vikki Tweddle/Tim Coupland Page 1 of 7 13/07/2012
Version History Version Date Reason for Change 1 April 10 Created Vikki Tweddle / Tim Coupland 2 May 11 Minor review 3 March 12 Format change & Policy Review Vikki Tweddle 1. Policy Statement Discharge from inpatient units to community settings can pose a time of increased risk of self harm for service users. This policy outlines the process to follow to ensure that all service users are seen in a timely way following discharge from the trust inpatient units. 2. Introduction In-patient care is seen and recognised as one element of a service that may be needed to help support someone with their mental health difficulty. Critical to a service user s experience of inpatient care is to ensure that mechanisms are in place to safely support someone throughout the admission and to the point of discharge. The National Confidential Inquiry into Suicides and Homicides recommended that : All discharged service users who have severe mental illness or a recent (less than three months) history of self harm should be followed up within one week 3. Purpose The main purpose is to ensure that the service user is discharged with a care plan that identifies a care coordinator, lists specific needs match needs to people or agencies meeting them and define arrangements to safely follow up the service user within a defined time period. 4. Scope This policy applies to all staff involved with the discharge of service users from Wotton Lawn Hospital Care Practice policies are posted on the trust intranet site. They are not routinely available on the internet site but most are available if requested. 5. Context 5.1 Discharge planning should be sensitive to the individual s needs. The process should be transparent, consistent and reflect best practice in providing consistent Care Coordination. Good care planning is central to this and is required to facilitate smooth transition between locations where care is delivered and provided. National developments within CPA practice continue to affirm that additional support in an inpatient or residential setting should Vikki Tweddle/Tim Coupland Page 2 of 7 13/07/2012
prove no barrier to continuity of care planning. Locally, procedures for Care Coordination also describe the requirements for transfers and the interface with inpatient care. Overall, the imperative has been to ensure that protocols are developed to: - Ensure consistent care planning; - Reduce variation in practice in managing the transition from inpatient to a community service; - Improve cross-pathway care co-ordination and discharge planning. 5.2 Specific targets identified within Saving Lives: - Our Healthier Nation (Department Health 1999) is to reduce the suicide rate by at least 20% by 2010. Health and Social Services are expected to play their full part in helping to achieve this, which is reflected in Standard 7 of the National Service Framework for Mental health. One of the particular requirements for preventing suicide among people suffering severe mental illness is to ensure that follow up of those discharged from inpatient care is treated as a priority and that care plans include follow up on discharge. 5. This has been reinforced by guidance in the National Suicide Prevention Strategy for England and is the Local Delivery Plan target (PSA05B) for 2005 2008. In addition this is the Health Care Commission key target for Primary Care Trusts and forms part of the Annual Health Check. 5.4 48 hour follow up is a standard set out within the contract with NHS Gloucestershire Commissioners for people being discharged from Wotton Lawn. 6. Duties 6.1 Responsibility for the development, maintenance, review and ratification of this document lies within the Director of Quality and Performance (Nursing, Social Care & Therapies) Directorate. The Director of Quality and Performance (Nursing, Social Care & Therapies) has board level responsibility for the development of this document and may delegate this responsibility to a subordinate. 6.2 The Governance Committee The Governance Committee will be notified of the ratifying this policy 6.3 All staff All staff who have contact with service users are responsible for using the policy correctly to ensure patient safety. 7. Definitions CPA Care Programme Approach Wotton Lawn is a inpatient unit that has general acute admission wards for adults with acute psychiatric needs and a psychiatric intensive care ward and low secure ward Vikki Tweddle/Tim Coupland Page 3 of 7 13/07/2012
8. Ownership & Consultation Responsibility for the development, maintenance, review and ratification of this document lies within the Director of Quality and Performance (Nursing, Social Care & Therapies) and Medical Director; however this has been delegated to the Deputy Director of Nursing. Each policy will be sent to the locality and clinical directors for consultation. This will be for a one month period. This will them be notified to the trust Governance Committee. Where a review only results in very small changes to a policy or procedure there will be no formal consultation and the review will be uploaded on to the intranet and notified at the next update. 9. Ratification Details The Director of Quality and Performance has the authority to ratify polices. This can be delegated to the Deputy Director of Nursing. The governance committee will be notified of any care practice policy reviews. 10. Release Details Care Practice Policies are not routinely placed on the trust public website. Upon request most are available to members of the public if requested. This policy is on the trust intranet under Care Practice Policies, general. An article appears in News in Brief which notifies of significant reviews and updates of Care Practice Polices. 11. Review Arrangements The policy will be reviewed every 2 years to ensure that it is contemporaneous to modern mental health practice and research. 12. Process for Monitoring Compliance To ensure compliance of this guidance an audit of the implementation of this document will be undertaken every two years, commissioned by the Director of Quality & Performance (Nursing, Social Care & Therapies). This will involve auditing a random sample of in-patient health & social care records and discharge summaries. The audit criteria will include assessing compliance against the following standards. Duties Requirements for discharge /transfer within the care planning process Documentation to accompany the service user when being discharged /transferred from impatient care to the community and vice versa It is expected that all documents audited will comply with this guidance. The results of the audit will be presented to the Governance Committee who will be responsible for the development and monitoring of any identified actions within the scope of the audit. The policy will be reviewed every 2 years to ensure that it is contemporaneous to modern mental health practice and research. The 48 hour follow-up of service users discharged from inpatient units is monitored as part of the Trust clinical key performance indicators by the Delivery Committee. Vikki Tweddle/Tim Coupland Page 4 of 7 13/07/2012
13. Main body of policy Within Wotton Lawn a business meeting will be held once a week. At this meeting representatives from the locality teams and base ward will be present. All admitted service users (including those on leave and/or receiving treatment at home via the crisis teams but formally recorded as an inpatient on the Rio system) will be discussed with regard to discharge planning. The team representative at the meeting will take responsibility for ensuring that an existing care coordinator of those service users in inpatient care are informed that the service user requires contact to arrange an after care plan. In situations in which a patient moves to a different locality team and that team could not expect to be represented usually at the meeting. It is necessary first to get a team to accept that they are responsible and then to get them to a meeting/liaise with them to provide a care coordinator. For those service users without a care coordinator or transferring to a new team the team representative at the meeting will be responsible for discussing the case with the team and ensure that within 5 working days the ward has the name of the care coordinator. For both known service users and new allocations the care coordinator MUST contact the ward within 2 working days and make arrangements to develop an after care plan including contact arrangements once discharge has taken place. This must be within 48 hour post discharge. (Or nominated deputy where the care coordinator is on leave). The care coordinator should work with the service user and family/carers and draw on the knowledge of the ward team to write a care plan, which is recorded on Rio, to take account of the service users needs when planning discharge from the inpatient unit. It is the care coordinators responsibility to draw this care plan up. No service users should leave hospital without a care plan. No service users should leave hospital without a timed appointment to be seen within 48 hours including those being sent on leave for more than 48 hours. For those service users not previously known to service or without a care coordinator, such as people who had been discharged from services, and who are discharged within a few days of being admitted the crisis team will act as interim care coordinators. For monitoring purposes the contact post discharge from inpatient unit will be the first contact on the day after discharge. The care coordinator should record the plan on the care planning screen / function in Rio. Vikki Tweddle/Tim Coupland Page 5 of 7 13/07/2012
13.1 Leave Leave must carefully be considered as an alternative to discharge. The risk of suicide can remain high and therefore 48 hour follow up will occur if the leave is greater than 48 hour. 13.2 Mental Health Act Tribunals and Mental Health Act Managers Meetings The named staff member preparing a report for the tribunal or managers meeting must identify which community worker will complete the 48 hour follow up if the service user is discharged. Any difficulties identifying a member of staff must be brought to the attention of the Ward Managers prior to the hearing. The Ward Managers must liaise with the Matron/ Community Services Manager if this process is not taking place in a timely manner. 13.3 Discharge Discharge will not be completed if 48 hour follow up arrangements are not in place. Service users will be informed of the delay and the reasons behind this delay. The service user may remain on the ward until the issue is resolved. Contact can be made with the MDT including duty medical staff resulting in a short period of leave being agreed (less than 48 hours) until the issue is resolved. For Discharge out of hours please refer to self discharge policy 13.4 Follow up refused Where an informal service user is discharged and refuses a 48 hour follow up appointment a post discharge letter (appendix 1) will either be given to them before they leave the hospital or sent advising them how to contact the appropriate services. The inpatient nurse at the MDT meeting will be responsible for completing with a copy being uploaded to the patients notes on Rio and documented in the patients progress notes. 13.5 Care Coordinator The care coordinator or nominated deputy from the care team will be responsible for maintaining contact with the service user throughout the inpatient admission. There should be a minimum weekly contact with the ward to keep updated on the progress with the care coordinator being aware of the planned discharge date. 13.6 Breaches Breaches of 48 hour follow up will be recorded on Datix and reported to the Service Director. Upon receipt of the report an internal Serious Untoward Incident meeting will be convened to establish the reason for the breach and identify any appropriate action. Vikki Tweddle/Tim Coupland Page 6 of 7 13/07/2012
14. References Safety First. Louis Appleby. 2001. The National Institute for Clinical Excellence. Saving Lives Our Healthier Nation Department of Health - 1999 National Service Framework for Mental Health Department of Health - 1999 Suicide Prevention Strategy for England Department of Health - 2003 Preventing Suicide: A Toolkit for Mental Health Services Department of Health - 2003 Care Programme Approach revised policy Department of Health 2008 Five year report of National Confidential Inquiry into Suicide and Homicide by people with mental illness Department of Health 2001 15. Associated Documentation Equality Impact Assessment Care Coordination Policy Vikki Tweddle/Tim Coupland Page 7 of 7 13/07/2012