Adult Discharge Policy Excluding Prisons PROV 24 October 2008 1
Document Management Title of document Adult Discharge Policy Excluding Prisons Type of document PROV 24 Description Target audience A policy outlining the steps that should be taken to ensure the safe, effective and timely discharge of adult patients. All staff involved in the care and discharge of adult patients. Author Department Directorate Rita Reeve/Sian Roberts Professional Practice and Development Provider Services Approved by Clinical Governance and Effectiveness Group Date of approval September 2009 Version Number 1 Next review date October 2010 Related documents Policy for Transfer of Patients into Acute Care Safeguarding Adults Policy Superseded documents Internal distribution External distribution Availability All staff None All ratified policies, strategies, procedures and protocols are published on the Trust Intranet and Public Website. Contact details (of main contact for this document) Name: Rita Reeves Address: Dantre Hospital, Daventry Tel: 01327 708133 E-mail: rita.reeves@northants.nhs.uk 2
Adult Discharge Policy Excluding Prisons Contents 1 INTRODUCTION 5 2 PURPOSE OF THIS POLICY 5 3 SCOPE OF POLICY 5 4 EQUALITY AND DIVERSITY 6 5 RESPONSIBILITIES 6 5.1 Chief Executive 6 5.2 Directors/Associate Directors 6 5.3 LSDM s/pathway Leads 6 5.4 Staff employed by PCT 6 6 GENERAL PRINCIPLES OF SAFE AND TIMELY DISCHARGE 7 7 NURSE/THERAPY LED DISCHARGE 8 8 AT RISK PATIENTS 8 9 MULTI PROFESSIONAL/AGENCY DISPUTE 8 10 DELAYED DISCHARGE/DISCHARGE REFUSAL 9 11 DISCHARGE AGAINST MEDICAL ADVICE 9 12 URGENT DISCHARGES 9 13 TRANSFER OF PATIENTS INTO ACUTE CARE 9 14 INCIDENT REPORTING 9 15 NTPCT REVIEW AND MONITORING 10 16 REFERENCES 10 Appendix One:- Letter A template Appendix Two Nurse/therapy led discharge Appendix Three Process for managing preferred choice of nursing or residential home Appendix Four Self discharge form Appendix Five Impact Assessment 3
1 INTRODUCTION Good discharge planning is fundamental to the provision of efficient and effective health care and helps equip patients and carers with the knowledge, understanding and support to prevent or minimise further episodes of ill health. The costs of poor discharge planning include; inefficient use of beds, longer waiting lists, readmission to hospital, increased patient and carer distress and increased workloads for community nurses. This policy has been formulated with reference to the wide range of legislation, health circulars, codes of practice and advice from statutory and non-statutory agencies concerned with the process of patient discharge. These include The NHS Plan (2002), the National Service Framework for Older People (2001) and Discharge form Hospital: pathway, process and practice (2004) 2 PURPOSE OF THIS POLICY The purpose of this policy is to ensure that: Patients are discharged in a planned and co-ordinated manner to an appropriate environment in which they can be as independent as possible with appropriate support and care. Patients, carers and family (if the patient wishes) are at the centre of the planning process and are in agreement with any decisions being made for their future care. Cultural, racial and religious needs of patients are an integral part of the discharge planning process. People have a right to have all information given to them in a way they can understand. Where English is not the patient s first language the ward will arrange an interpreter promptly to ensure the patients full involvement in the discharge planning. If there are other communication difficulties then aids to effective communication must be sought The appropriate information, medication, equipment and minor environmental adaptations are available to enable independence for the patient and carer. 3 SCOPE OF POLICY The policy is relevant to all health care professionals employed by Northamptonshire Teaching Primary Care Trust (NtPCT) involved in the discharge of adult patients. This includes discharge from an inpatient facility but can equally be applied to discharge from a case load eg from a District Nurse, Physiotherapist etc. The principles of the discharge policy are to adopted Trustwide but it is expected that each area will develop their own specific discharge procedure including examples of documentation. 4
4 EQUALITY AND DIVERSITY NtPCT recognises the diversity of the local community and those in its employment; and aims to provide a safe environment free from discrimination and a place where all individuals are treated fairly, with dignity and appropriately to their need. NtPCT recognises that equality impacts on all aspect of its day to day operations and has produced an Impact Assessment Framework for all its policies. This policy has been assessed against this framework. 5 RESPONSIBILITIES 5.1 Chief Executive The Chief Executive has ultimate accountability for ensuring the provision of high quality, safe and effective discharge within NtPCT. 5.2 Directors/Associate Directors The Managing Director and Associate Directors of Provider Services are responsible for ensuring that the discharge policy is implemented within NtPCT and that it is regularly audited. 5.3 Locality Strategic Development Managers/ Pathway Leads Managers are responsible for ensuring that all staff who are involved in the discharge process (including medical, nursing, professions allied to medicine and some clerical staff) are familiar with the requirements of this policy and that local discharge procedures are in place. 5.4 Staff employed by PCT All staff are responsible for ensuring they adhere to the principles of the policy when discharging patients. 6 GENERAL PRINCIPLES OF SAFE AND TIMELY DISCHARGE Discharge planning must commence either on or prior to admission with an estimated date of discharge documented as soon as possible following admission.. The single assessment process is commenced in conjunction with other multiprofessional assessments. Care planning must be carried out as soon as possible to support the discharge planning. The information collected must be verified with the patient and carer(s). Identification of any potential discharge problems should be assessed at the same time. Each patient will have a designated team of nurses/therapists who are responsible for ensuring that all the necessary information for managing the 5
patient s discharge is recorded, communicated to other professionals and used in the patient s best interests. Patients and their carer(s) (with the patient s consent) must be involved in setting the planned date of discharge. The patients and their carer(s) will be given as much notice as possible of an anticipated discharge date, normally not less than 24 hours. Discharge should not take place until the responsible clinician, in consultation with the multi disciplinary team, states the patient is medically fit for discharge. Patients should not be discharged until, where required, there is a multiprofessional agreed care plan to meet their health and social needs and everything reasonably practicable has been done to organise the services the patient will need upon discharge. Particular care should be taken to ensure that patients and/or relatives are kept fully informed during this process of assessment. In order to aid this communication written documentation should be provided, an example is included in Appendix 1 (Letter A template). Consideration must be given on whether patients meet the criteria for assessment under the PCT s eligibility criteria for continuing healthcare. If patients do meet this criteria, verbal and written information outlining what this means will be given to the patient/carer. The patients and carer(s) will be encouraged to undertake nursing and rehabilitation tasks to facilitate discharge following teaching and support by an appropriate member of the team. The patient and their carer(s) will be made fully aware of the circumstances under which any self care would (or would not) be appropriate. The patient and their carer(s) (with the patient s consent) must be kept informed and involved in plans made for discharge and will be given written information regarding their continuing care. A written plan of care will be issued on discharge with the relevant names and contact numbers of the staff who will be involved with continued care following discharge. It important to ensure that the patient and carers clearly understand every stage of the discharge planning before decisions are made. This may require the assistance of an interpreter and other patients may require specialist assistance pertinent to a disability (learning disability, sight or hearing impairment) 7 NURSE/THERAPY LED DISCHARGE The development of nurse/therapy lead discharge is intended to provide patients with a timely and more efficient discharge process, responding to patient needs, reducing discharge delays and to make best use of nurse/therapist skills. 6
The principles of nurse/therapy led discharge are only to be incorporated into local discharge criteria where mechanisms and competences exist to support implementation. Further information on nurse/therapy led discharge can be found in Appendix 2 8 AT RISK PATIENTS Certain categories of patients are particularly at risk on discharge. It is impossible to make a definitive definition of all patients who are at risk on discharge but people with the following characteristics have been identified as those most likely to be at risk. People who are frail or elderly People who live alone, including those in sheltered housing and warden assisted accommodation People who are alone for long periods of the day or night People who are isolated from family and friends or who are homeless or live in hostel accommodation People with a serious illness who may be returning to hospital for further treatment People who are terminally ill People with a continuing disability or communication difficulties People who are confused, have a mental illness or impairment People who are known to require continuing medical nursing, therapy or social care People who have been in hospital for an extended stay. People living with carers who may have difficulty coping People who usually care for others at home People with special needs Member of travelling families or the homeless People with language difficulties, including those for whom English is not their first language People with a temporary or permanent disability Detailed information must be collected by the multi professional team so that patients who may be at risk can be identified promptly and preparations made for their discharge including early referrals to other professionals or agencies eg care managers, occupational therapists. Patients who are at risk due to actual/suspected evidence of abuse must be managed as outlined in Northamptonshire Teaching PCT s Safeguarding Adults Policy (October 2007). Further information on abuse of adults can be found on the following website: www.elderabuse.org.uk 9 MULTI PROFESSIONAL/AGENCY DISPUTE In the event of an interagency dispute, the appropriate Director/Associate Director of the PCT should be contacted. 7
10 DELAYED DISCHARGE/ DISCHARGE REFUSAL The process for managing preferred choice of nursing or residential home should be followed in order to minimise delays in discharge for all adult patients assessed as needing long term nursing or residential home care (see Appendix 3). In the event of a patient/carer refusing discharge or transfer, the Matron and Principal Care Manager should meet with the patient/carer as soon as possible in order to try to resolve the matter. 11 DISCHARGE AGAINST MEDICAL ADVICE Discharge may take place at the insistence of a patient, before the full discharge planning process has taken place and before a programme of assessment, care and treatment has been completed. All events leading up to the unplanned discharge and all conversations and actions taken must be documented immediately in the patient s health care record The risks of discharge before it is recommended must be explained to the patient/carer and the patient asked to sign the self discharge form (see Appendix 4). The patient s GP and other relevant agencies must be informed. 12 URGENT DISCHARGES Under the Countywide Protocol for Managing a Major Incident, there is a requirement to identify patients who could be discharged promptly from hospital to home (with the necessary support) or an alternative residential setting. This process must be carried out in conjunction with the medical staff. 13 TRANSFER OF PATIENTS INTO ACUTE CARE There may be occasions when a patient needs to be transferred to an Acute Trust. In these cases NtPCT s Policy for Transfer of Patients into Acute Care (October 2007) must be followed. 14 INCIDENT REPORTING If the process for the discharge of a patient goes wrong, the staff involved must ensure that an Incident form is completed and the incident investigated in line with the NtPCT s Incident and Near Miss Policy If ambulance staff consider that arrangements are unsafe when they transport the patient they may return the patient to hospital/hospice. An incident report must be completed and the necessary agencies notified. 8
15 NTPCT REVIEW AND MONITORING A review of the contents of this policy will take place two years from the date of approval. An earlier review may be warranted if one or more of the following occurs: as a result of regulatory/statutory changes or developments due to the results/effects of critical incidents or any other relevant or compelling reason It is the responsibility of the Primary Care Trust, in collaboration with Social Services and other relevant agencies to monitor the Trust s discharge process. Problems in relation to discharge procedures will be monitored and reported through the incidents and complaints processes. Disharge documentation must be made available for audit purposes and a local process for audit established. Where nurse/therapist led discharge occurs from an in-patient setting, an audit will be carried out six monthly comparing medical led and nurse/therapist Led discharge, looking at patient satisfaction and re-admission rates. 16 REFERENCES The NHS Plan, Department of Health. July 2000 Discharge form Hospital: pathway, process and practice, Department of Health. January 2003 National Service Framework for Older People, Department of Health. 2001 Achieving Timely Simple Discharge form Hospital. A toolkit for the multidisciplinary team, Department of Health. 2004 9
Appendix 1- Letter A Template Kettering Parkway South Venture Park Kettering NN15 6XR Tel : 01536 480300 Dear During your time in this hospital, the team responsible for your care will try to ensure that you are kept fully informed of your clinical progress and when the time is right, will begin to plan your discharge from hospital. This process involves a multi-disciplinary team assessment of your needs, including information from Doctors, Nurses and, where appropriate, Therapists and Care Managers. They will discuss your needs and options with you and, with your permission, involve close relatives or friends who support you at home. They will decide with you on the most suitable discharge arrangements. The assessment will consider the following options: 1. Direct discharge home. 2. Direct discharge home with formal support (a care package). 3. Rehabilitation in a residential setting. 4. Discharge to a nursing/residential home. There are a number of people available to help you with your discharge and wherever possible, they will assist you to return home. If you are going to need care in a nursing/residential home, a Care Manager will help you to find an appropriate home. Because of the high demand for hospital beds, only a limited time can be allowed for this (usually 7 days) and it might be necessary for you to transfer to an interim placement at short notice. I am sure you will appreciate that acute hospital beds are needed for patients who are acutely ill. Unfortunately you may not continue to occupy a bed in the hospital once you are ready for discharge. Depending upon the number of acute/urgent admissions it may be necessary for you to accept a temporary placement until your preferred choice of care can be found. If at any time during your stay in hospital you have any queries or concerns about your discharge arrangements, please discuss these with a member of the team in charge of your care. Yours sincerely, John Parkes Chief Executive Northamptonshire Teaching Primary Care Trust 10
Appendix 2 Nurse/Therapy Led Discharge Principles of Nurse / Therapy Led Discharge The development of nurse/therapist led discharge is intended to provide patients with a timely and more efficient discharge process, respond to patient needs quickly, reduce discharge delays and to make best use of nurse/therapist skills. The key principles underpinning the role include the following: To ensure patient safety To improve the quality of care and enhance the patient experience. To streamline the processes of discharge by ensuring they are efficiently coordinated. To enable effective communication between all involved in discharge process To promote voluntary partnership working e.g. Age Concern To enhance multi-disciplinary care. Implementation of nurse/therapist led discharge must be supported by a local procedure which outlines the actions of the nurse/therapist who is leading the process and ensures the discharge plan is comprehensive, robust and that discharge occurs in a timely manner. Local procedures must be available for audit. Local discharge plans/checklists/care plans must be developed and must be used to document planned discharges. These must be audited regularly. Where a GP/Consultant has overall medical responsibility for a patient admitted under their care (inpatient areas), they are responsible for signing and dating that the patient is medically fit for discharge. Once this is completed, the nurse/therapist will then take full responsibility for discharge. The undertaking of this role will be performed by a specifically trained and experienced practitioner in Nurse/Therapist Led Discharge. The responsibility for ensuring that agreed/suitable arrangements have been organised for the patient s discharge, rests with the discharging nurse/therapist, following multiprofessional agreement, if involved. On the day of discharge, the nurse/therapist is responsible for completing the discharge criteria checklist or care plan to determine that the patient remains fit for discharge, an example is given on page 17. If the criteria are not fulfilled, the patient will not be discharged until the patient s GP or Consultant has been consulted. Local area managers are responsible for devising appropriate discharge criteria in consultation with the multiprofessional team. Education and Training (Nurse/Therapist Led Discharge) All practitioners must comply with their professional organisations guidance on expanding roles and their code of conduct. You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. 11
Appendix 2 As a healthcare practitioner, you are personally accountable for your practice. In caring for patients and clients, you must maintain your professional knowledge and competence You must keep your knowledge and skills up-to-date throughout your working life, taking part in activities that develop your competence and performance. To practice competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent. If an aspect of your practice is beyond your level of competence or outside your area of registration, you must obtain help and supervision from a competent practitioner until you and your employer consider that you have acquired the requisite knowledge and skill. Training and Accreditation (Nurse/Therapist Led Discharge) No nurse/therapist will be required to undertake the role of the lead responsible for discharge, unless competent to do so. In inpatient units the undertaking of this role should have the full support of their manager and should be performed by staff of Band 5 or above with a least six months experience in post and two years post registration with a proven ability to assess and make critical decisions regarding discharge. Other areas should identify their own nurse/therapist bands and experience. Each specific area of practice must develop their own standard for best practice to ensure that the nurse or therapist undertaking this extended role is competent and confident to undertake the task. An example of a competency framework can be found on page 14. All practitioners: Undertaking this extended role must attend the approved PCT training as outlined in this policy. Must have an accredited mentor/assessor to support and assess your skills in practice. Must undergo a period of supervised practice with your accredited mentor/assessor will follow in the clinical environment. Assessment and the individual s personal accountability determine the length of supervised practice. Complete the Department of Health discharge module programme Learning Materials for Effective Hospital Discharge available by using the following link - www.changeagentteamlorgluk/index.cfm?pid=18§orid=11 Must successfully complete the work based competency package for nurse/therapist led discharge and assessed by the mentor/assessor. Evidence of competence will be documented by the completion of the Scope of Professional Practice form (see page 18). This should be signed by the practitioner and assessor as verification of the individual s competence in nurse/therapist led discharge. A copy is kept in the training records and the original is returned to the practitioner. The Trust Scope of Professional Practice form will be forwarded to the individual s line manager for approval. Maintenance of competence is the practitioner s responsibility and will be reviewed at annual appraisal. 12
Appendix 2 Nurse/therapist led discharge competency framework Experienced practitioner - able to make decisions independently Please place the following codes in the boxes to assess your competence: C = Competent P = Partially competent N = Not yet had experience 1. Multi-disciplinary team working The practitioner demonstrated Leadership of a multi-disciplinary team effectively. Demonstrate collaborative working and has respect of senior colleagues. Communication effectively with team/other HCP/patients and carers. Development/implement of a clinical management plan. (CMP) Identification and achievement of shared goals. 2. Estimating expected date of discharge The practitioner is competently able to: Undertake full assessment of the patient including physical, physiological, social and functional. Demonstrate excellent knowledge of the clinical condition and the investigations/interventions required. Estimate the length of stay needed to complete interventions to achieve fitness and medical stability of patient. Review and revise estimated date of discharge based on further assessment/data. 3. Development, implementation and review of clinical management plan The practitioner is competently able to: Develop clinical management plan based on full assessment. Implement and review CMP developed by another member of the MDT. 13
Appendix 2 Review patient progress and adjust the plan in response to patient need. Identify EDD within the plan. Demonstrate ability to make effective discharge decisions. 4. Making referrals The practitioner is competently able to: Demonstrate excellent ability to identify when a referral is needed. Initiate referral to other members of MDT. Follow up actions and results from referrals. Co-ordinate and run MDT review of patient. Use outcome of MDT review to adopt CMP and EDD. 5. Documentation and discharge process The practitioner is competently able to: Demonstrate legible, contemporaneous and accurate completion of: 1. The unit s discharge checklist with a satisfactory interpretation of all the information required. 2. The unit s discharge criteria. Demonstrate a safe knowledge base when reviewing patient medications to take home, and provide education for patient/carer as required. Identify when future discussion and review by medical colleagues and other members of the MDT is necessary. Take responsibility for the discharge decision. 14
Appendix 2 6. Patient decides to self-discharge against healthcare and professional advice. The practitioner is competently able to: Attempt to persuade the patient to remain in hospital if this is in the clinical interest of the patient. Explain the risks and potential consequences of self discharge to the patient and carers. Rapidly co-ordinate care package if accepted by the patient. Document events accurately within patient record. Communicate with GP and members of MDT. 15
Appendix 2 EXAMPLE Nurse/therapist led discharge check list. PATIENT STICKER. Patient has agreed to be nurse/therapist led discharge. All medication for discharge are discussed with the patient/carer. Patient has reached optimum safe level of mobility. Patient is comfortable and pain well controlled Nutritional status stable Continence status is stable Last bowel action Date: Last passed urine Time: All continuing discharge support arranged as discharge plan and checklist Record observations ensuring all within patients normal. Patient is informed of follow up arrangements. COMMENTS B/P= Reps= Temp= Pulse= Additional comments........ DISCHARGING NURSE/THERAPIST....(print) SIGN.... DATE. 16
Appendix 2 SCOPE OF PROFESSIONAL PRACTICE Name: Directorate / Specialty: Activity: I declare that I am willing to take on this activity, being fully aware of the scope of professional practice and the accountability associated with this, and the relevant Primary Care Trust s policy, protocol and standards. Signed:. (Practitioner) Date:.. I have ratified the collection of evidence relating to this activity and deem this practitioner as competent to undertake this duty. Signed:. (Competent Practitioner) Name:.. Date : Approved:.. (Line Manager) Date:. Review Date:. Copy to employee (date): Copy to personal file (date): 17
Appendix 3 Introduction Process for managing preferred choice of nursing or residential home The purpose of this process is to minimise delays in discharge for all adult patients assessed as needing long term nursing or residential home care. It is recognised that all patients are entitled to a preferred choice when selecting a Nursing or Residential home. This process does not prevent patients exercising choice. This process will be followed after the multi-disciplinary assessment has been carried out and a decision has been make that the patients future needs will be best met in a Nursing or Residential Home. Often the home selected by the patient does not have an immediate vacancy and it is not possible for the patient to remain in a hospital bed once they have been assessed by the multi-disciplinary team and a decision has been made that they are fit for discharge therefore an interim placement may be required until there is a vacancy in the home of their choice. The consequences of patients remaining in a hospital bed are: The patient is exposed to the unnecessary risk of infection. A frustrating wait for patients and relatives can leave them feeling unsettled. Increasing dependence. A hospital bed is inappropriately used which has a detrimental effect on accepting other patients which will increase unnecessary referral to acute hospitals. Purpose This process has been developed to ensure: The patients needs are met in the most appropriate environment. That hospital beds are used appropriately and efficiently. That this process is discussed with all patients and relatives once the patient is assessed as needing residential or nursing home care, or an interim facility if discharge home is delayed. Timely discharges and outline the procedure to be followed to prevent unnecessary delays. Process The flowchart on the following page outlines the process that should be followed. Further information on the letters mentioned in the flowchart can be found on page 21. 18
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Appendix 3 Description of Letters Letter B -NHS CHC, Adult Services Funding (see page 22) This letter is to be issued following a multidisciplinary decision with involvement with the patient and/or carer, that the patient requires residential or nursing home placement which is funded/or funding has been applied for, but the patient and/or carer is reluctant to proceed in finding a suitable placement, or if their first choice has a waiting list and another home has a bed available immediately offering the same facilities. This letter would be issued following verbal and documented consultation with the patient and/or patient and the Care Manager. This letter would be issued only after consultation with the Matron, Care Manager. The relevant Locality Strategic Development Manager must be informed. Letter B1 -Self Funders (see page 23) This letter is to be issued following a multidisciplinary decision with involvement with the patient and/or carer, that the patient requires residential or nursing home placement which is not funded, but the patient and/or carer is reluctant to proceed in finding a suitable placement, or if their first choice has a waiting list and another home has a bed available immediately offering the same facilities. This letter would be issued following verbal and documented consultation with the patient and/or patient and the Care Manager. This letter would be issued only after consultation with the Matron, Care Manager. The relevant Locality Strategic Development Manager must be informed. Letter C (see page 24) This letter would be issued only if all other avenues have been explored and either letter B or B1 had already be issued. This letter would be issued only after consultation with the Matron, Care Manager, appropriate Director and the final decision will be made by the Chief Executive. Letter C1- Interim placement in Residential / Nursing Home setting whilst awaiting arrangements for discharge home (see page 25) This letter is to be issued following a multi-disciplinary decision with involvement with the patient and/or family carer, that discharge arrangements to home are delayed and an interim placement in a Nursing or Residential Home is required whilst arrangements for discharge home are finalised. This letter will only be issued after it has been established that an exaggerated delay in discharge arrangements is occurring, for instance, awaiting home adaptions, extended care package or carer/family delay. It must be established if NHS CHC, Adult Care Services funding or self funding is required before applying for an interim placement and the issuing of the letter. 20
Appendix 3 Letter B Template Kettering Parkway South Venture Park Kettering NN15 6XR Tel : 01536 480300 Dear I have been advised by the Matron that you are now ready to leave hospital. This has been confirmed by the Medical Doctor who has been responsible for your treatment whilst in hospital. Your health and social care assessment has been completed and the Nurses, Doctors, Therapists and Care Manager have discussed and agreed with you what your needs will be when you are discharged. The staff who have been involved in your care now believe that your needs could be better met in a more appropriate environment than the hospital and we are mindful of those risks to patients remaining in hospital longer than necessary. Your discharge assessment has shown that you are no longer in need of hospital care and it is recommended that your needs would be best met in a nursing/residential home (delete as necessary). Your Care Manager will now assist you to identify an appropriate home. I am sure you will understand that hospital beds are in great demand and that we need to ensure that they are available for patients who need in-patient care. Therefore, the hospital expects that within 7 days of you being informed that a suitable placement has been identified, you will accept this placement at least on a temporary basis, even if the home identified would not have been your first choice. Funding will then be applied for, and within 3 days of this being available, you will be discharged. Please note that because of potential heavy demand on hospital beds, you might be required at any stage in the process to transfer at short notice to a temporary placement. I recognise that this letter may cause you some anxieties. If you wish to talk things through with someone who can help and support you, please contact your Care Manager or a member of the team responsible for your care. Yours sincerely John Parkes Chief Executive Northamptonshire Teaching Primary Care Trust 21
Appendix 3 Letter B1 Template Dear Kettering Parkway South Venture Park Kettering NN15 6XR Tel : 01536 480 300 Re: Leaving Hospital I have been advised by the Matron that you are now ready to leave hospital. This has been confirmed by the Medical Doctor who has been responsible for your treatment whilst in hospital. The staff who have been involved in your care believe that at this point your needs could be better met in a more appropriate environment than the hospital and we are aware of the risks to patients of remaining in hospital longer than necessary. Your discharge assessment has shown that you are no longer in need of hospital care. It is recommended that your needs would be best met in nursing/residential (delete as necessary) care and that you will be required to pay the full cost of your care (if you are unsure whether or not you should be paying the full cost, please ask a Care Manager for a financial assessment). A Care Manager will be able to assist you to identify an appropriate residential/nursing placement whether or not you choose to have an assessment of your social care needs (this assessment is optional for service users paying the full cost of their care). I am sure you will understand that hospital beds are in great demand and that we need to ensure that they are available for patients who need in-patient care. Therefore, the hospital expects that within 7 days of you being informed that a suitable home has been identified, you will accept this home at least on a temporary basis, even if the home identified would not have been your first choice. Due to the heavy demand on hospital beds, you might be required at any stage in your discharge process to transfer at short notice to a temporary home. I recognise that this letter may cause you some anxieties. If you wish to talk things through with someone who can help and support you, please talk to the ward manager or ask the nurse in charge of your care to put you in touch with a Care Manager. Yours sincerely John Parkes Chief Executive Northamptonshire Teaching Primary Care Trust 22
Appendix 3 Kettering Parkway South Venture Park Kettering NN15 6XR Tel : 01536 480 300 Letter C Template Dear Re: Leaving Hospital: We understand that you have been unable to confirm arrangements for your transfer to residential/nursing care. I am now able to confirm that a temporary alternative placement has been secured for you at: starting on: I would like to reassure you that whilst you are there, you or your representatives will be able to continue to view other homes to identify a place of your choice and the Care Manager will continue to assist you. You must be aware that you should accept this temporary placement, as you cannot continue to occupy a bed in this hospital once you are ready for discharge and a suitable place has been offered. If you wish to talk things through with someone who can help and support you, please contact your Care Manager, Ward Nurse, Ward Manager or the Matron. Thank you for your co-operation. Yours sincerely John Parkes Chief Executive Northamptonshire Teaching Primary Care Trust 23
Appendix 3 Letter C1 Template Kettering Parkway South Venture Park Kettering NN15 6XR Tel : 01536 480 300 Dear Re: Leaving Hospital: We understand that you have been unable to confirm arrangements for your discharge home. I am able to confirm that a temporary interim placement has been secured for you at: starting on: I would like to reassure you that whilst you are staying there, you or your representatives will be able to continue planning for your discharge home and your Care Manager will continue to assist you. You must be aware that you should accept this temporary interim placement, as you cannot continue to occupy a bed in this hospital once you are ready for discharge and a suitable placement has been offered. If you wish to talk things through with someone who can help and support you, please contact your Care Manager, Ward Nurse, Ward Manager or the Matron. Thank you for your co-operation. Yours sincerely John Parkes Chief Executive Northamptonshire Teaching Primary Care Trust 24
Appendix 4 Self Discharge Form Patient: - Location: - Sticker Here Admission Date Discharge Date Ward.. Doctor Contacted.. Time Doctor Attended.Time I the undersigned accept that my discharge is against medical and hospital professional advice. Northamptonshire Teaching PCT will no longer accept responsibility for the consequences of my actions. Signed Print Name.. Date Witnessed Print Name.. Date Advice to patient: Issues to be considered Public Health Risk Yes No Action taken.. Vulnerable Adult Yes No. Mental Health Yes No. 25
Appendix 4 Other risks Yes No... Police informed Yes No.... Notified By Print name.. Signature. Time... GP. Next of Kin.. District Nurse.. Warden. Carer. Care Manager. Other (please state)..... 26
Appendix 5 Policy Impact Assessment Screening Tool Name of Directorate: Provider Services Date of Assessment: 2 March 2009 Policy being assessed Adult Discharge Policy Excluding Prisons Assessment Carried out by: Siân Roberts Policy Title Who is affected Statutory requirements Full Assessment Needed Yes / No Priority High / Medium / Low Discharge Policy All PCT staff who have contact with patients Patients who have been admitted to inpatient facilities and their carers The NHS Plan (2002) The National Service Framework for Older People (2001) Discharge form Hospital: pathway, process and practice (2004) Yes High 27
Appendix 5 Policy Impact Assessment Full Assessment Tool Name of Directorate: Provider Services Date of Assessment: 2 March 2009 Policy being assessed: Adult Discharge Policy Excluding Prisons Assessment Carried out by: Siân Roberts 1. What consultation process will be undertaken? 2. Where will records of this consultation be kept? 1. What existing monitoring arrangements are in place? 2. Are these sufficient? 3. Are any additional arrangements required 1. How will the results of the assessment be published? Senior Clinicians and managers within Provider Services Provider Services Incident reporting, complaints No Need to monitor on a local basis and compare to nationally collected data to ensure that no section of the community is being excluded. Through the minutes of Provider Services Clinical Governance and Effectiveness Group which is held 2 monthly 28
Appendix 5 Policy aims and outcomes Evidence for assessment Difference in Outcomes Assessing Impact Proposed action The purpose of this policy is to ensure that: Patients are discharged in a planned and coordinated manner to an appropriate environment in which they can be as independent as possible with appropriate support and care. Patients, carers and family (if the patient wishes) are at the centre of the planning process and are in agreement with any decisions being made for their future care. Incidents Complaints Ensure that policy is treating everyone equally regardless of; Age/Gender Mental Health Needs/Disabilities Race, Ethnicity, Religion, Language or Culture Arrangements will be needed to monitor usage of the formal processes for discharge and these need to categorise age, gender, mental health needs/disabilities and ethnicity Annual summaries of this data will be evaluated to ensure equality of the discharge process and determine appropriate actions to redress any imbalance Arrangements will be needed to monitor usage of the formal processes and these need to categorise age, gender, mental health needs/disabilities and ethnicity Annual summaries of this data will be evaluated to Ensure that correct data is being collated and monitored in order to monitor that all people within the county are being treated equally with regards to discharge from hospital Determine which committee will be responsible for monitoring the quality of the discharge process from the Trusts inpatient areas Ensure that information, leaflets, letters and advice are available in alternative formats and languages and that staff are aware of where to obtain them. 29
Appendix 5 ensure equality of the discharge process and determine appropriate actions to redress any imbalance All information given must be in an appropriate format and understandable. 30