Discharge and Transfer Policy Reference
CL/CGP/036
Approving Body
Trust Board
Date Approved Implementation Date Version Supersedes
4 Version 3 March 2010
Consultation
Date of Completion of Equality Impact Assessment Date of Completion of We Are Here Assessment Date of Environment Impact Assessment (if applicable) Target Audience
Emergency Department Clinical Director and Matron Clinical Leads NUH Discharge project leads Infection Prevention and Control Team Directors Group Integrated Discharge Team Transport Manager 5 th July 2011 5 th July 2011 Not applicable
All staff involved in Discharge and Transfer Planning for patients.
Supporting Documents/References Refer to References page 28 Review Date Lead Executive
Director of Nursing, Midwifery and Service Jim Murray, Clinical Lead
Author/Lead Manager Integrated Discharge Team Further Guidance/Information
Discharge And Transfer Policy & Procedure Version 4, January 2012
CONTENTS Paragraph Title
Page
1.
Policy Statement
4
2.
Background
4
3.
Scope
4
4.
Aims
5
5.
Principles
6
6.
Responsibilities
10
7.
Transport
15
8.
Dressings and care products to take out
17
9.
Equipment to take out
17
10.
Medical Certificates
18
11.
Medical device (inc. cannulae)
19
12.
Specialist nurse involvement
19
13.
OutPatient appointments
19
14.
Patients taking their own discharge against medical advice
20
15.
NHS Continuing Care (CHC) & NHS Funded Nursing Care (FNC)
21
16.
Fast Track Pathway for Continuing Healthcare
22
17.
Mental Capacity and Independent Mental Capacity Advocates 23
Discharge And Transfer Policy Version 5 January 2012
Page 2 of 47
18.
Patients Advocacy and Voluntary Arrangements
23
19.
Carers
23
20.
Discharge / transfer to a Care Home (new) or uprating from Residential to Nursing Home.
24
21.
Delayed transfer of care (‘delayed discharge’)
25
22.
Out of Hours Discharges, Transfers or SelfDischarges
25
23.
Patient refusing to be discharged
26
24.
Transfer to other hospitals / care setting
27
25.
Patient moves (in Hospital)
28
26.
Discharge of Day Case Patients
29
27.
Discharge of Emergency Department Patient
29
28.
Prisoner Patients
31
29.
Discharge of Homeless Persons
31
30.
Asylum Seekers/Refugees and displaced persons
31
31.
Training
32
32.
Implementation and Monitoring
32
33.
Equality & Diversity Statement
32
34.
Equality Impact Assessment Statement
33
35.
Here For You
34
36.
References and Related Policies & Procedures
34
Appendix 1 Glossary of Terms
35
Appendix 2 Equality Impact Assessment
36
Appendix 3 We are Here For You
45
Appendix 4 Policy and procedure implementation plan
47
Appendix 5 Certification of Employee Awareness.
48
Discharge And Transfer Policy Version 5 January 2012
Page 3 of 47
THE DISCHARGE AND TRANSFER OF INPATIENTS POLICY 1
Introduction
1.1 Nottingham University Hospitals (NUH) recognises the importance of discharge as a key component of high quality hospital care. By following the principles of safe discharge we can identify predictable problems and reduce the risk of adverse events and readmissions. 1.2 Discharge is not an isolated event. It requires planning at the earliest opportunity between primary care, hospital and social care organisations, and that patients and their carer(s) understand and are engaged in careplanning decisions. 1.3 It is crucial that the patient is central to an individual, customised discharge and not made to ‘fit’ a standard process. 1.4
This policy is drawn up to comply with relevant current Department of Health policy and guidance, National Health Service Litigation Authority (NHSA) standards, local standards and local joint agreements, for all inpatients.
2
Background
2.1 NHS and Social Service departments are required to comply with the regulations and obligations created buy the Community Care (Delayed Discharges etc.) Act 2003. 2.2 This act places duties on the Trust regarding communication with patients their carers and with social care departments. 2.3 The Act introduced a system of reimbursement to hospitals by the local Authority for hospital discharges which are delayed because the LA is unable to assess or put in place the services the patient or their carer need for the discharge to be safe. 2.4. Continuing Health Care 2009 NHS Continuing Healthcare (CHC) describes an adult’s entitlement to care that meets physical or mental health needs that have arisen as a result of disability, accident or illness and that meets local Eligibility Criteria. Broadly, to meet the criteria for NHS continuing care an individual’s needs must be intense, complex, unpredictable, unstable and deteriorating. If a multidisciplinary assessment suggests that a Discharge And Transfer Policy Version 5 January 2012
Page 4 of 47
patient may meet the criteria, referral is made to a team of Assessors. They will carry out their assessment and apply the criteria to determine eligibility. The NHS is responsible for arranging and funding NHS CHC services for eligible patients who are in a hospital, a care home, or their own home. 3
Scope
3.1 This policy applies to all Emergency and Elective inpatients of the Trust, regardless of age or diagnosis. 3.2 For Children and Young People (under the age of 18) who are patients of the Trust, including those 1418 year olds who may be seen in adult areas this Policy should be considered alongside the Safeguarding Children (including those in need of protection) Policy. 3.3 This policy describes all stages of the discharge/transfer process. 3.4 This policy is supported by detailed procedures and guidelines. 3.5 This policy applies to all patients in general or specialist beds, to those outlying (the responsible consultant and bed are in different specialties), and to those attending the Emergency Department and medical admission areas. 4
Aims
4.1 All patients experience wellorganised, safe and timely discharge from hospital with an agreed, smooth transfer to communitybased health and social services. 4.2 Each patient is encouraged and supported in self care activities and helped to achieve the highest possible level of independence. 4.3 Patients, carers and staff are supported to set realistic expectations of hospital stays. 4.4 Patient and carer and family are prepared, physically and psychologically for transfer home or to an agreed alternative environment.
Discharge And Transfer Policy Version 5 January 2012
Page 5 of 47
4.5 There is effective and timely involvement of patients and relatives in discharge and transfer planning. 4.6 There is effective and timely communication of relevant information re discharge and transfer plans to patients and their carers. 4.7 Patients receive appropriate skilled and timely assessments of their care needs. 4.8 Carers are supported and assisted throughout the process. 4.9 There is continuity of care between hospital and agreed discharge care environment, with seamless service transition. 4.10 Improved patient outcomes by promoting understanding of, and concordance with, followup arrangements and discharge medication. 4.11 To support effective and efficient use of the hospitals’ inpatient bed capacity by reducing unnecessary delays in transfer of care or discharge. 5
Principles
5.1 Discharge planning is an element of a patient’s treatment, and due consideration must be given to a patient’s consent for the process. Where patients do not wish other individuals or agencies to become involved, NUH staff (and staff of other agencies working with NUH patients) should respect those wishes, except where there are compelling grounds for believing that the patient lacks the necessary competence to give or withhold consent for the proposed action (e.g. interagency referral, discussion or intervention). [See Consent to Examination or Treatment Policy]. 5.2 Patient choice. Patients should be discharged to a safe and adequate environment, or accepted risks should be highlighted and recorded. However, competent patients have freedom to choose their discharge destination and care [see Mental Capacity Act Policy and the Consent to Examination or Treatment Policy]. 5.3 Staff will maintain an awareness of an individual’s gender, religion, sexual orientation, race, ethnicity, disability, age and culture throughout the discharge process, and consider implications for discharge that may arise due to these factors. Discharge And Transfer Policy Version 5 January 2012
Page 6 of 47
5.4 Discharge planning must involve the patient and/or relatives/carers. 5.5 The discharge process should be a multidisciplinary / multiagency activity, during which the needs and resources of patients and carers are at the centre of assessment, planning and implementation. 5.6 A clear plan, including arrangements for services after discharge, will be prepared and agreed for each patient prior to discharge. 5.7 A Predicted Date of Discharge (PDD) should be identified within 24 hours and communicated to the patient and relatives. Changes to this date should be communicated to the patient and relevant agencies and updated on Notis. 5.8 Planning for discharge should begin on admission for urgent or emergency admissions and at the preadmission stage for planned admissions. 5.9 Patients should remain in hospital only for as long as is necessary to complete those aspects of their treatment (including rehabilitation and discharge planning), which require inpatient management. 5.10 Necessary referrals for (and receipt of) specialist advice or services must be timely, and should not unnecessarily delay discharge or transfer of care. 5.11 Staff should work within a framework of integrated multidisciplinary and multiagency team working to manage all aspects of the discharge process. All patients must have their discharge plans recorded within the medical casenotes and the nursing documentation. 5.12 The process of discharge planning should be coordinated by a responsible, named person. This will usually involve liaison with those involved in the patient’s care after discharge, and perhaps those who may need to be involved in the future. 5.13 The discharge process must be underpinned by robust assessment of a patient’s continuing health and social care needs. 5.14 Predicted discharges after overnight stays should be as soon after 8am as is practical (such discharges should take place before 11am). 5.15 Patients’ discharge documentation (including prescription, ‘TTO’ (Tablets to Take Out) should be written as early in the patient’s pathway Discharge And Transfer Policy Version 5 January 2012
Page 7 of 47
as is consistent with safety. For elective admissions where no change in routine medication is anticipated as a result of the operation / admission, the TTO may be written at preop assessment. For emergency admissions the TTO should be completed at the time the decision to discharge is made (and no further changes in medications are anticipated), or 24 hours before discharge, whichever is longer (i.e. at least 24 hours before planned discharge). 5.16 The final decision for discharge remains with the Consultant responsible for the patients care. 5.17 Nurse Facilitated Discharge (NFD) is promoted in NUH, and is supported by specific documentation and local procedures. 5.18 All NUH staff will work to improve patient pathways (including the discharge process). 5.19 There will be effective training on discharge policy and procedures for all staff involved. 5.20 The Trust expects patients to make their own way to and from hospital unless there is a clearly defined clinical need for transport to be provided. 5.21 Communication to relevant community services will take place within 24 hours of discharge.
6
Patient groups
6.1 All professionals must consider risk with their patients and relatives as part of the discharge process. The risks of discharge must be balanced against the risks of the person remaining in hospital. 6.2 For the majority of patients discharge is simple and uncomplicated. However those patients whose needs are more complex need to be confident that their discharge will be based on thorough assessment of their individual social, psychological, environmental, and functional needs in addition to their current medical and nursing needs. 6.3 Particular care must be taken to assess and plan for the discharge of patients in the following groups who often have complex needs 6.3.1
Patients who live alone and/or are frail, or live with a frail carer
Discharge And Transfer Policy Version 5 January 2012
Page 8 of 47
6.3.2
Patients recently bereaved or moved home or have a change in carer circumstance
6.3.3
The main carer for another dependant person or who would rely on a child or young person for care
6.3.4
Patients who are homeless, or live in hostel accommodation, or live in poor housing [Section 30]
6.3.5
Patients with a longterm condition which requires frequent admissions
6.3.6
Terminally ill patients who meet the Fast Track criteria for continuing healthcare or end of life care. (See discharge planner for end of life care or refer to the national framework for NHS continuing healthcare). http://nuhnet/cancer_associated/palliativecare/Documents/Fast%20 %Track%20Nottingham%20version%201.10.09.doc
6.3.7
Patients with Healthcare Associated Infections (HCAI). Staff should comply with the guidance outlined in the Trust Infection Prevention and Control Policy, the twelve core clinical care protocols outlined in the Code of Practice for the Prevention and Control of HCAI (Department of Health 2006), and the Trust policies and guidelines on specific infections and their management. Information about HCAIs and their management must be included in ALL discharge communications (e.g. GP, District Nurse or care home). Where patients are transferred to another healthcare provider, or to a nursing or residential home, such HCAI must be communicated in advance of the patient transfer or discharge. Advice from the infection control team is available to support the discharge of patients with known transmissible illness.
6.3.8
Children and Young People under the age of 18 (See Safeguarding Children (including those in need of protection) Policy). Where there are concerns regarding a child’s emotional or psychological wellbeing, a CAMHS (Child and Adolescent Mental Health Services) assessment is required. Contact 0115 8440505.
6.3.9
Patients at risk of abuse (incl neglect)
6.3.10
Patients who may require health and or social care support post discharge. In these cases a continuing health care needs checklist (CHNC) and Section 2 must be completed. Where the local authority (Social Services) is responsible for providing or commissioning aftercare, the predicted discharge date should be conveyed to them formally on a section 5.
6.3.11 Patients who may be confused, forgetful, prone to wandering, or at risk of self harm or neglect Discharge And Transfer Policy Version 5 January 2012
Page 9 of 47
6.3.12 Patients with learning disabilities (advice can be sought from the learning disability team via switchboard) or physical disability 6.3.13 Patients who lack (or may lack) mental capacity to make decisions regarding future care and have no one to act on their behalf a referral for an independent mental capacity advocate (IMCA) should be made Referral line 0845 650 0081 (See Mental Capacity Act 2005). 6.3.14 Patients unable to comply with medication regimen 6.3.15 Patients known to mental health services 6.3.16 Patients presenting with drug or alcohol related problems can be referred to the Alcohol Liaison Nurse (via Notis) or their GP. Compass provide targeted and specialist interventions for young people up to the age of 18 years contact details are 0115 9248232. 6.3.17 Patients with sensory impairments/deprivation 6.3.18 Patients with communication difficulties 6.3.19 Patients discharged from long term care to return to the community 6.3.20 After an extended stay in hospital 6.3.21 Patients who need special assistance (e.g. for continence management ). 6.3.22 Patients from HM Prisons. [Section 29] 6.3.23 Asylum seekers or refugees [Section 31] 7
Responsibilities
7.1 Discharge is a complex and teambased process. There are often joint responsibilities, notably around assessment and sharing information. Where procedures and processes are described in this section the responsibility includes necessary training for appropriate staff. All staff must adhere to the principles of confidentiality and consent. 7.2 The Deputy Chief Executive and Director of Nursing and Midwifery has overall responsibility for ensuring that there is an appropriate NUH policy, and effective systems and processes, to underpin the safe discharge of patients. 7.3 The Medical Director is responsible for ensuring that effective systems and processes are in place to allow Medical Staff to discharge the responsibilities described below. Discharge And Transfer Policy Version 5 January 2012
Page 10 of 47
7.4 The responsible Consultant is accountable for all medical aspects of the patient’s pathway (including the discharge or transfer of care). S/he may delegate to appropriately competent medical or other staff. 7.5 The Consultant is responsible for ensuring that medical staff carry out duties (see 6.8). 7.6 If a patient is discharged to an address other than his or her own, the patient’s GP should be informed. 7.7 If the address is outside the patient’s GP practice area, the patient should register with another doctor, whose practice covers that area, as a permanent or temporary resident. 7.8 Where the patient is discharged to a residential or nursing home a copy of the discharge summary should be sent to the ‘Medical Officer’ at the home’s address. 7.9 For those patients not registered with a G.P seek advice from the Integrated Discharge Team, PCT, or Social Services. 7.10 Medical staff will : ·
·
·
·
·
Review and document the patient’s readiness for discharge in the medical notes. Assess, review, record (in the medical record) and communicate as soon as practicable to patients, relatives and MDT members the likely outcome of the admission, predicted discharge date, and level of support likely to be needed on discharge, based on a diagnostic formulation, and consideration of the impact of recuperation and rehabilitation. Undertake morning discharge rounds each weekday to identify patients ready for discharge to the nurse in charge. Patients potentially ready for discharge should be reviewed as early in the day as is consistent with clinical priorities (i.e. at the beginning of wardrounds wherever possible). The frequency of individual patient discharge reviews will reflect the clinical condition of the patient and the nature of the discharge plans. Make timely referrals to other specialist teams or services necessary to formulate comprehensive diagnostic, treatment (including rehabilitation) and discharge plans. Maintain written records of decisions made at MDT meetings (principally on the diagnostic, treatment and discharge plans).
Discharge And Transfer Policy Version 5 January 2012
Page 11 of 47
·
·
·
·
·
·
Delegate to Nurse Facilitated Discharge (NFD) where appropriate. Ensure that prescriptions for discharge are written at least 24 hours before a predicted discharge, and as soon as practicable when discharge is confirmed with less than 24 hours notice. Ensure that appropriate and adequate written information (TTO/Etto; Electronic Tablets to Take Out.) is available for dispatch to the GP at the time of discharge. Ensure that the Trustwide hospital discharge meeting is informed of all predicted discharges over the coming weekend (and those which are NFD). Review the effects of altered medication, check for discrepancies in discharge medication, and ensure that recommendations are made for timely safe medicines management review, including adherence, following handover at discharge. Adhere to the NUH Medicines Code of Practice .
7.11 The Duty Nurse Manager will: ·
·
Monitor bed pressures on an hourbyhour basis, and escalate actions and contingencies (including those around discharge) as required and according to NUH procedures (including informing Silver Oncall Director) Attend escalation meetings in response to bed pressures
7.12 Matrons will : ·
· ·
Ensure implementation and systems to support this policy in their area of responsibility (including for outlying patients), and their regular evaluation Take appropriate action when delays in patient pathways occur Undertake the relevant discharge actions as identified within the Winter plan and the escalation policy
·
Review weekly discharge report and challenge performance
·
Attend regular Trustwide discharge meetings, or send a deputy
7.13 Ward Managers will : Discharge And Transfer Policy Version 5 January 2012
Page 12 of 47
·
·
·
·
·
·
·
·
Ensure that practice and an effective discharge planning process operates in the ward Ensure that processes are in place for commencing planning for discharge on admission or soon after (e.g. referrals to MDT, Social Care, predicted discharge dates) Ensure that ward staff are up to date with their training in support of discharge processes and internal and external transfers Ensure qualified nursing staff have the relevant competencies to promote safe and effective discharge (e.g. Nurse Facilitated Discharge) Ensure appropriate communication and information sharing with patients and relatives/carers by all involved nursing staff. This will include providing a copy of information about medicines upon discharge, treatment received during admission and any follow up plans, where appropriate. Attend regular Trustwide discharge meetings or send a deputy (who may be the discharge coordinator). At the meeting they will identify the number of predicted discharges over the coming weekend and be able to state how many will be NFD Inform the relevant matron of any issues which are impacting on the effective discharge from their ward Attend escalation meetings as required
7.14 Registered ward nurses / midwives will : ·
·
·
Help plan a safe and timely discharge and / or transfer for their patients Start discharge planning at preadmission or within 24 hours of admission / transfer Ensure timely referral to other nonmedical services identified as necessary for discharge / transfer planning. For bariatric/ heavy patients see discharge assessment in the ‘Handling of Bariatric/ Heavy Patients’ (over 25 stone) procedure. Ensure within adult nursing that a continuing care checklist where appropriate is discussed with patient/carer and completed when making a social work referral. The continuing care checklist is located at the nurses station on each ward.
·
Communicate with the patient, relatives/carers, MDT and other agencies about agreeing and predicting the discharge / transfer date and plans
Discharge And Transfer Policy Version 5 January 2012
Page 13 of 47
·
·
·
·
·
·
·
·
Ensure that the outcome of nutritional screening, and where appropriate, a recommendation for action by the primary care team and/or other carers on discharge, is included in discharge / transfer documents for every patient. Prior to discharge ensure that the patient has access to their discharge address Ensure relevant information from this admission with regard to infection, notably MRSA (Methicillian Resistant Staphylococcus Aureus), is recorded on the discharge documentation Implement the planned discharge / transfer (including transfer of documentation and necessary transport arrangements) Ensure they are up to date with their training needs that support discharge and transfers Ensure they have the relevant competencies to promote safe and effective discharges Inform the relevant matron of any issues which are impacting on effective discharge from their ward Ensure appropriate referrals to the District Nurse or the Children’s community nursing team are made in a timely manner, and any corresponding documentation is completed as soon as a discharge date has been organised. Ensure that the Overseas Team are contacted via switchboard if patients have been out of the country for more than 6 months.
7.15 Allied Health Professionals (PAMs) will : ·
Help plan a safe and timely discharge / transfer
·
Treat patients with specific needs to maximise their independence
·
Refer to other services as appropriate
·
·
·
Communicate with the patient, relatives/carers, MDT and other agencies about agreeing and predicting the discharge date and plans Ensure they are up to date with their training needs which support discharge Inform their line manager of any issues which are impacting on effective discharge from their ward
7.16 Discharge Coordinators will: ·
Ensure that ward discharge processes are coordinated
Discharge And Transfer Policy Version 5 January 2012
Page 14 of 47
·
·
·
·
·
Ensure that patients, carers and members of the MDT are fully involved at all stages of the admission/discharge process Help ward staff to improve discharge by optimising the use of IT and information Work with clerical and clinical staff to maximise the efficient and effective utilisation of the Trust’s beds Attend regular Trustwide discharge meetings (at request of ward manager). At the meeting identify the number of predicted discharge over the coming weekend, and be able to state how many will be NFD Inform the ward manager of any issues that are impacting on effective discharge from their ward
7.17 Integrated Discharge Team (IDT) Members will: ·
Support staff in discharge or transfer of adult patients
·
Advise and help train staff about the discharge planning process
·
Advise on complex discharge and continuing health care needs
·
Assess patients’ for suitability for short/long term rehabilitation
·
·
· ·
Manage and control the waiting list and transfers to other care setting Collate and report information re Delayed Discharges / Transfers of Care Attend regular Trustwide discharge meetings Inform their line manager of any issues that are impacting on effective discharge processes
7.18 Pharmacists will: · ·
Ensure that TTOs are checked and dispensed in a timely manner Ensure that the final check box on the discharge prescription is signed off indicating that the checking of medications is complete.
·
Advise patients and staff relating to discharge medication
·
Attend regular Trustwide discharge meetings
·
Inform their line manager of any issues that are impacting on
·
Effective discharge processes
Discharge And Transfer Policy Version 5 January 2012
Page 15 of 47
8
Transport
8.1 An assessment should be made of how the patient is going to get home (or be transferred) when they are discharged. The discharging professional must ensure that the correct ambulance and crew are requested (appropriate to the patient’s mobility/or access difficulties at the receiving address). The discharging professional must consider the patient’s weight: a risk assessment by the ambulance service may be required. 8.2 The presumption is that patients will make their own arrangements for transport home using the support of relatives, friends and carers or taxis (not paid for by the Trust). 8.3 Staff should encourage patients to make their own arrangements which will allow discharge by 11am (to support effective management of bed capacity). 8.4 Where a patient has no means of transport, or requires an ambulance on clinical grounds, arrangements can be made via the Patient Transport / Ambulance Service at least one day in advance of discharge where possible [please refer to the Patient Transport Policy for further details and instructions]. 8.5 Long distance transport must be preplanned. 8.6 When arranging transport for discharge it is vital that the discharge address has been confirmed and checked (it may differ to the patient’s home address). 8.7 The discharging professional must consider if any equipment needs to be sent with the patient. 8.8 The discharging professional must ensure the patients belongings (including house keys), valuables, medications, and documentation are ready well in advance. 8.9 The discharging professional must consider the patient’s weight: a risk assessment by the ambulance service may be required. 8.10 The discharging professional must ensure that the correct ambulance and crew are requested (appropriate to the patient’s mobility and/or access difficulties at the receiving address). Discharge And Transfer Policy Version 5 January 2012
Page 16 of 47
8.11 The discharging professional must ensure that if the patient is not for attempted resuscitation this is communicated to the transport crew. A completed ‘Do Not Attempt Resuscitation’ (DNAR) form must accompany the patient. 8.12 Where a patient is returning to a discharge address via hospital transport (particularly ambulance), any significant amount of property should be returned via relatives/carers prior to (or at) discharge wherever possible. If not possible, transport suppliers should be contacted.
9
Dressings / Care Products to take out
9.1 Patients requiring wound management or continence products i.e. Catheters, Catheter bags and sheaths, should have them prescribed as take home medication on the Patient Discharge/Transfer form. 9.2 Nonprescribeable items such as pads and pants should also be provided to the patient (sufficient for 7 days), and the District/Community Nurse informed. In the case of children’s services school age children are provided with pads and pants by their school nurse. Take into account prescribing and supply restrictions that may apply for some products in the community. 9.3 If there are queries contact the District/Community nurse to clarify dressings supply or the Continence Advisory Service based at Ropewalk House for continence products. 10
Equipment to take out
10.1 If appropriate, arrangements should be made prior to discharge for: ·
any equipment considered essential for discharge
·
any essential equipment/alterations to be delivered and installed in the patient’s home
·
instructions for use should be given to patient and relative
·
any necessary training for patient/carer should be arranged and contact numbers provided
10.2 A PIN number is required to order equipment from the British Red Cross and can be obtained by the Ward Manager from the British Red Discharge And Transfer Policy Version 5 January 2012
Page 17 of 47
Cross Society , training and a PIN number can be obtained on 0845 127 2911. 10.3 Each individual profession will order and complete a British Red Cross request form, regardless of whether the equipment is going with the patient or being delivered directly to the patient’s home. 10.4 Sticks Crutches and Frames If a patient is being discharged with (e.g.) crutches or a frame as advised by a physiotherapist a British Red Cross order should be completed. If the patient is using hospital transport the equipment must be booked onto the transport. 10.5 Wheelchairs and Prostheses For assessment and provision of wheelchairs or specialist prosthetic services the MDT (usually the Physiotherapist or Occupational Therapist) should contact the Nottingham Mobility Centre, City Campus. 10.6 Nursing equipment If the patient requires ONLY nursing equipment (e.g. bed, mattress, bed pans etc) and does not require specialist OT equipment (e.g. hoist, chair raisers, raised toilet seat), then the Ward Nurse should order the equipment from British Red Cross. 10.7 Tissue Viability and Pressure Relieving Equipment Please consult information sheets or contact the Tissue Viability Service. 10.8 Occupational Therapy equipment If items such as hoists, chair raises or raised toilet seats (or home alterations) are required ward staff should refer ASAP to Occupational Therapy for assessment. OTs can order such equipment from British Red Cross. 10.9 The Disability Living Centre, Middleton Court, Glaisdale Parkway off Glaisdale Drive West, Bilborough, Nottingham, NG8 4GP – Tel 0115 9855780 provides independent advice and demonstration for patients, carers and staff requiring information about disability equipment.
Discharge And Transfer Policy Version 5 January 2012
Page 18 of 47
11
Medical Certificates
11.1 Medical certificates are issued to inpatients on request to cover the period of time they are in hospital. 11.2 A ‘med 10’ certificate (yellow) is issued by a registered nurse or a doctor and covers only the duration of the inpatient episode. 11.3 From April 2010 the ‘statement of a fitness to work’ has replaced Med 3 and Med 5; it allows the doctor 2 options; · Not fit for work or the patient should refrain from work for a given period. · May be fit for work, where the doctors’ assessment is that the patient health condition does not necessarily mean that they are not fit to return to work. 12
Medical device removal (e.g. cannulae)
12.1 All patients leaving the hospital must have all medical devices which are no longer required removed (e.g. cannulae). If a patient is discharged and a medical device is mistakenly not removed, the patient should be contacted and asked to return to the discharging ward for its removal. Appropriate documentation recording the incident should be completed according to the NUH Incident reporting policy and procedures. 12.2 If a patient leaves the ward without being discharged with a device still in situ it is the Trust’s (the discharging nurse or whoever identifies that the device has not been removed) responsibility to ensure that the patient is asked to return to the Hospital or to their GP for removal. It may be appropriate to report the patient as ‘vulnerable’ or ‘missing’ to the police if the patient cannot be readily contacted. 13
Specialist Nurse Involvement Where a specialist nurse has been involved in inpatient care, the discharging nurse should ensure they are aware when discharge is being arranged (to enable any necessary follow up requirements to be organised). However a patient’s discharge should not be delayed if the Specialist Nurse cannot be contacted, as long as they are informed at the earliest opportunity.
14
Outpatient Appointments
Discharge And Transfer Policy Version 5 January 2012
Page 19 of 47
14.1 When a patient requires outpatient followup refer to the NUH out patients’ policy. Wherever appropriate the appointment should be made before discharge. 14.2 When an outpatient appointment is required after an in patient stay ward receptionists should make the appointment with the patient before they leave the ward. 14.3 The following information is required to book an OP appointment: · · · ·
Whose Clinic, i.e. Consultant’s Name Specialty Clinic, if appropriate When for, i.e. number of weeks away Patient’s name and hospital number
14.4 Transport should NOT routinely be arranged for outpatient appointments. Patients should be given the Transport Booking Office number to call 0115 8405898. 14.5 ED staff can arrange for ED patients requiring an OP appointment for fracture clinic, ED clinic or ENT. 15
Patients taking their own discharge against medical advice
15.1 A patient with capacity cannot be detained in hospital against their will except (1) under the provisions of the Mental Health Act or (2) under the common law in extreme cases where their or another’s safety is immediately threatened. 15.2 Where mental capacity is in doubt, patients should be assessed in accordance with guidance given in Appendix 3 of the Trust’s Mental Capacity Act 2005 Policy (two stage test). If there is a clear need to detain in hospital a patient who lacks capacity then the provisions of the Mental Capacity Act should be used. However, if the detention is likely to be ongoing, or the patient is making repeated requests to leave the clinical area, then a Deprivation of Liberty authorisation needs to be considered. 15.3 When a patient is determined to discharge himself or herself from Hospital against medical advice the ward nurse should try to persuade the patient to stay and summon a doctor, who should likewise seek to persuade the patient to stay.
Discharge And Transfer Policy Version 5 January 2012
Page 20 of 47
15.4 It may be helpful to engage the help of relatives in efforts to persuade a patient to stay. 15.5 If the patient cannot be persuaded to remain in hospital they should be asked to sign a 'Self Discharge from Hospital' form or to sign in the medical record to indicate that they are discharging themselves against medical advice (copies should be forwarded to the Directorate Manager and filed in the patient’s medical record). 15.6 If the patient refuses to sign the form the nurse and/or doctor involved MUST document this in the patient’s notes. 15.7 The ward nurse should inform next of kin where appropriate. 15.8 The ward nurse should inform community services where appropriate. 15.9 An incident form may be completed at the discretion of the nurse in charge of the ward or doctor. 15.10The medical staff should document 'own discharge' in the medical record and inform the patient’s G.P with a degree of urgency commensurate with the patient’s clinical problems and condition. 15.11If a patient registers at the Emergency Department but does not wait for treatment or discharges themselves from ED against medical advice following assessment or treatment, a record should be completed and filed in the patient notes. Where applicable, the Emergency Department Missing Persons policy should be followed. 15.12In the case of parents or guardians taking their child home against medical advice the nurse should try to persuade the patient to stay and summon a doctor, who should likewise seek to persuade the patient to stay. Staff should comply with Safeguarding Children (including those in need of protection) Policy. and the Local Safeguarding Board Interagency Guidance, consulting with the Safeguarding Children team and social services if appropriate. 16
NHS Continuing Care (CHC) and NHS Funded Nursing Care (FNC)
16.1 The NHS Continuing Healthcare Checklist (CHC) is a screening to help practitioners to work out whether needs might possibly be of a level or type that might make an individual entitled to NHS CHC. Patients should be informed that an assessment for continuing care is taking Discharge And Transfer Policy Version 5 January 2012
Page 21 of 47
place and should participate in the process taking into consideration communication and language needs. If the checklist suggests there is a possibility that the patient is eligible for NHS, the assessor should arrange for a multidisciplinary team member to carry out a needs assessment. 16.2 The patient and relatives should be informed that NHS continuing funded healthcare is fully funded by the NHS, but it cannot be assumed that this is for life. Funding is subject to regular review (at least annually), when the person’s health needs are reassessed. 16.3 The eligibility for NHS funded health care is based on the person’s needs, and the nature, complexity, predictability and intensity of these needs, and not on the medical diagnosis. 16.4 Patients and their family must be informed if they are not eligible for NHS continuing funded healthcare and that they may have to pay for necessary ‘social’ care either at home or in a nursing home pending the outcome of a financial assessment carried out by their local authority (social services). 16.5 A patient’s care may be funded fully or in part by the relevant local authority if their financial position is below the threshold set by the relevant local authority. 16.6 Some patients who are not eligible for NHS CHC will be eligible for NHS funded nursing care if they are assessed as requiring accommodation in a care home with nursing. An assessment is required and referral for this is made as one of the choices on the checklist. 17
Fast Track Pathway for Continuing Healthcare The Fast Track provides more rapid access to support than the usual procedures for patients with significant care needs and a rapidly deteriorating condition who wish to return home. The pathway tool bypasses the checklist and decision support tool and should be only used for terminally ill patients who have increased level of care needs and a rapid deteriorating condition. For children the Community Matron will generate this End of Life Care (EOL).
18.0 Mental Capacity and Independent Mental Capacity Advocates 18.1 All professionals working with adults in health and social care must be aware of their duties under the Mental Capacity Act where there are Discharge And Transfer Policy Version 5 January 2012
Page 22 of 47
any concerns that a patient may not be fully able to participate in discharge planning for reasons of mental incapacity. Readers are referred to NUH Mental Capacity Act Policy 2011, and to the DoH website [www.dh.gov.uk/mentalcapacityact] Code of practice where these duties are described in detail. Please refer to 5.23. 18.2 If a patient is deemed not to have capacity to make a decision (capacity is decisionspecific) then a family member, carer (not statutory services), or friend acting in the patient’s best interest can make the decision. 18.3 Where there are no relatives, carers or friends willing to decide in the best interests of a patient who lacks capacity, the Mental Capacity Act places a legal duty on the NHS (and Local Authority) to refer patients to an Independent Mental Capacity Advocate (IMCA). The IMCA supports people who lack capacity to make important decisions (e.g. medical treatment and long term placements). The IMCA service in Nottingham (City and County) is provided by; ‘Voice Ability’ DBH House, Carlton Square, Nottingham, NG43BP Voice Ability have provided a national IMCA hotline for information and referrals: 0845 650 0081. Children and Young People under the age of 18 (See Safeguarding Children (including those in need of protection) policy). Following the admission of a young person or child where there are concerns regarding their emotional or psychological well being a CAMHS (Child and adolescent mental health services) assessment is required. Contact details 0115 8440505.
19
Patients Advocacy and Voluntary Arrangements Information will be available on every ward/unit detailing advocacy schemes and services for patients, and carer support from other agencies.
20
Carers
20.1 Carers often have knowledge, expertise and experience of caring for the patient prior to admission. The importance of their role should be acknowledged. Early engagement can avoid delays in the discharge. Discharge And Transfer Policy Version 5 January 2012
Page 23 of 47
Carers should be kept informed and involved in all stages of the discharge process. 20.2 If there is a carer involved, they can be offered (and have a right to receive) a separate assessment of their own needs by Social Services. This should be a genuinely separate assessment to consider their need for support, especially if they have not previously identified themselves as a carer. 20.3 In planning discharge it should be recognised that carers have a choice about whether to continue to be a carer. 20.4 Consideration should be given in discharge planning to schedule or unscheduled short term/respite caring breaks. 20.5 Special care should be taken to consider the individual needs of young carers and carers who may themselves be vulnerable [see Safeguarding Children & Young People and Safeguarding Vulnerable Adult Policies].
21
Discharge / transfer to a Care Home (new) or uprating from Residential to Nursing Home.
21.1 The Integrated Discharge Team (IDT) will be involved in many such discharges/transfers and is readily available for advice. 21.2 Before transfer to a Residential or Nursing Home a patient should have had a health and social care assessment, including consideration of eligibility for fully funded continuing healthcare 21.3 Where the patient is assessed by Social Services as selffunding, they should not be discharged prior to their assessment for eligibility for fully funded continuing healthcare. 21.4 A patient should not be transferred until authority has been given by Social Services (or by a representative of the PCT in the case of fully funded continuing healthcare). 21.5 The patient should be offered (by Social services) an ‘Interim Care’ placement if they are medically fit to be discharged but a place, appropriate care, or funding is not available (or has not been identified) within a reasonable time. This should be offered jointly with NUH health staff. Discharge And Transfer Policy Version 5 January 2012
Page 24 of 47
21.6 Once placement has been arranged and funding confirmed the principles of the Discharge Planning Process described in this policy should be applied. 21.7 Where the patient is assessed as selffunding for their placement, it is vital that good communication is maintained with the persons responsible for arranging placement, to ensure that the arrangements are made in a timely manner. 21.8 It is essential that good communication be maintained between the discharging ward and the receiving care home to ensure continuity of care. A Patient Care Plan should be completed with all the relevant details and one copy sent with the patient on discharge. 22
Delayed transfer of care (‘delayed discharge’)
22.1 The Trust reports any delayed discharges/transfers of care to the East Midlands Strategic Health Authority weekly. The report is a ‘snap shot ‘of the number of patients whose discharge/transfer of care is delayed. 22.2 A delay occurs once a patient has been deemed medically fit for discharge and is considered safe for discharge to a described level and package of care and equipment by the multidisciplinary team but is unable to be discharged or transferred to his/her destination for any reason. 22.3 Any queries regarding the reporting of Delayed Discharges/Transfers of Care should be directed to the Integrated Discharge Team.
23
Out of Hours Discharges, Transfers or Self Discharges
23.1 Out of Hours Discharge This policy seeks to ensure that all patients, including those with complex needs, are discharged safely with a planned, timely and appropriate care package. Wherever possible discharges should be during the normal working day. The Trust recognises that outside the normal working day there may be limited availability of NUH staff and of communitybased services. Nonetheless safe and effective discharges can take place outside normal working hours provided that they adhere to the Discharge And Transfer Policy Version 5 January 2012
Page 25 of 47
principles described in this policy, and that those implementing the discharge are mindful of the need for assessment of and provision for patients needs (and an appropriate timeframe for this assessment and provision). Where discharging staff have concerns about the safety or effectiveness or appropriateness of a discharge plan they should discuss these with a senior member of staff (Ward manager, Matron, Duty Nurse Manager or Consultant).
23.2 Out of Hours Transfers. The Trust considers that all nonurgent transfers to other hospitals or care settings should be within normal working hours. The Trust does however accept that there will be circumstances where clinical need requires emergency transfers out of normal working hours. In such circumstances staff need to discuss and agree the transfer arrangements with a Senior Member of Staff (Matron, Duty Nurse Manager or Consultant). The Duty Nurse Manager will act as the link with EMAS to authorise the use of private ambulance transport. NUH staff must inform the receiving hospital or care home that the patient is being transferred. NUH medical staff must ensure that appropriate information is relayed to the receiving clinical team with a degree of urgency commensurate with the clinical condition of the patient. 23.3 Out of Hours SelfDischarge Where a patient with mental capacity chooses to take their own discharge against medical advice, primary care services should be alerted with a degree of urgency commensurate with the clinical circumstances. It may be appropriate to contact the primary care emergency services (this should be by medical staff). More usually the patients GP should be contacted the following working day. 23.0 Patient refusing to be discharged
Discharge And Transfer Policy Version 5 January 2012
Page 26 of 47
24.1 If a patient is refusing to be discharged and is not eligible for a Health Authority review of their case under the Continuing Health & Social Care criteria, consideration must be given to each individual case, as the patient does not have the right to occupy an NHS bed indefinitely. 24.2 The Directorate Head Nurse/Matron, on behalf of the Clinical Director, must be consulted. 24.3 Out of hours, the Duty Nurse Manager must be involved (contacted via the hospital switchboard). 24.4 The outcome of discussions must be recorded in both the medical and nursing notes. 24.5 For further information and guidance on patients refusing to be discharged see information sheets. 24.6 If necessary, legal advice is available via the Trust Secretary
25
Transfer to another hospital / care setting
25.1 For all transfers a Patient Care Plan should be completed by the transferring nurse with all the relevant details. All relevant aspects of the Discharge Planning Process should be applied. The transferring / discharging medical team are responsible for the transfer of appropriate clinical information. 25.2 Lings Bar Hospital For transfers to Lings Bar Hospital the patient’s medical notes, xrays and own named medication must accompany them. The patient should whenever practicable be transferred in the morning, but if an afternoon transfer is being considered contact must be made with the receiving ward/matron at Lings Bar Hospital. 25.3 Kings Mill, Newark General and Ilkeston Hospitals and nonweight bearing beds at Lings Bar Hospital The Trust has arranged with these health care providers to provide and retrieve NUH records back to the NUH by taxi in an emergency. Therefore original medical and nursing notes (including pharmacy card) can accompany a patient, but must be tracked to their destination on the HISS/PAS system. Discharge And Transfer Policy Version 5 January 2012
Page 27 of 47
25.4 Intermediate Care Residential Rehabilitation Relevant records should be photocopied and accompany the patient. The patient must also take with them 14 days medication, a Patient Care Plan, and all necessary equipment (e.g. walking aids, nebulisers, dressings and continence equipment). Approved Intermediate Care Assessors will have referred the patient to a Consultant in Health Care of the Older Person who will provide a transfer letter, which should accompany the patient. 25.5 Intermediate Care at Home Rehabilitation The requirements are the same as for Intermediate Care Residential Rehabilitation except that a copy of the relevant patient records need not accompany the patient. Patients have to be transferred in the morning and good communication between the discharging ward and the Intermediate Care team are essential. 25.6 For transfers between Critical Care Units, there are specific guidelines and arrangements. Please refer to the procedures for the discharge of patients from Adult Critical Care Services. 25.7 For patients who are to be transferred to hospitals in other districts (repatriation) please refer to the Trust Repatriation Policy. 25.8 Where the necessity to consider the transfer of a mother to another maternity unit (e.g. for neonatal care) and where there are complex safeguarding concerns for mother, or baby, these should be taken fully into account before the decision to transfer is made. Please refer to the maternity service In Utero transfer policy. The NUH Safeguarding Team must also be made aware of the possibility of transfer, prior to transfer. 26
Patient Moves (in Hospital)
26.1 For information regarding patient moves in hospital please refer to the internal transfer of the adult patient throughout Nottingham University hospitals CL/CGP/067 27
Discharge of Day Case Patients
27.1 Before a day case patient is discharged from the Day Surgery Unit, they must satisfy the criteria listed in the checklist that forms part of the NUH Discharge And Transfer Policy Version 5 January 2012
Page 28 of 47
Day Surgery Unit Patient Assessment Questionnaire updated December 2004. 27.2 In addition to the checklist, the discharging nurse must ensure that the following information has been obtained at preassessment or been clarified since admission: ·
·
there is someone to collect the patient in their own transport or willing to escort the patient in a taxi there is a responsible and physically fit person to look after the patient for the first 24 hours after their operation
27.3 All patients will receive an information leaflet on discharge relating to the procedure they have had, which contains useful contact numbers and advice
28
Discharge of Emergency Department Patients
28.1 Before any patient is discharged it is vital that arrangements are made to ensure a smooth transition from care in the Emergency Department to care in the community. A well organised plan should be prepared and agreed for each individual patient prior to discharge. 28.2 Once it has been agreed that the patient is medically fit for discharge, the following should be considered: · Assessment of mobility · Assessment of whether discharge can be made to a safe and suitable home environment. · Special care will be necessary for the frail, confused or disabled patients living alone. If applicable a referral to the Integrated Discharge Team should be arranged. An assessment should be made whether or not the patient is likely to have social or health care needs on discharge. These needs may range from advice, information, or home care services (e.g. meals on wheels through to intensive carer support). If a patient is referred to the Integrated Discharge Team while in the Department it is the responsibility of the Emergency Dept nurse to inform the receiving ward of the referral and to document this in the notes. 28.3 Child Protection issues should be dealt with as per the NUH Safeguarding Children (including those in need of protection) Policy Discharge And Transfer Policy Version 5 January 2012
Page 29 of 47
28.4 Domestic violence issues should be dealt with as per the NUH domestic violence policy. 28.5 Vulnerable adults should be dealt with as per the NUH safeguarding vulnerable patient’s policy. Patients requiring assessment under the Mental Health Act or patients with self harm injuries should be referred directly to the Department of Psychological Medicine (DPM) team 28.6 Patients presenting with drug or alcohol related problems can be referred to the Alcohol Liaison Nurse or to their GP. 28.7 Transport. For a large number of patients a relative or friend will be able to collect them from the Emergency Department, but confirmation is needed that this can be done. Ambulance transport will be provided for patients who require inter hospital transfer or where there is an identified clinical need for an ambulance to take the patient home (the decision about the mode of transport home is the responsibility of the nurse in charge of the department). 28.8 Items to take Home. Apart from any patient's property, consideration must be given to the following: · Medicines / Drugs. are dispensed from pharmacy after 1800hrs TTO’s can be dispensed by ED nursing staff. Payment for prescriptions should be made via pay machine in ED reception. Proof of entitlement to free prescriptions must be shown. · Dressings are not provided. Patients are given verbal advice to attend their GP for wound checks, dressing’s clinics and advice. GP letters must be sent out within 24 hours. · Information. All patients and carers should be given full information about arrangements for ongoing treatment and social care, including who to contact in the event of an emergency / relapse. All patients should be given the relevant advice cards on discharge. Where appropriate information should be given regarding how to contact the relevant Self Help Group. 28.9 Notification to other health professionals · GPs will be sent a computergenerated letter advising them of patient’s attendance to ED and any treatment given. · Where patients are entering or returning to residential or nursing home care, the home staff must have all necessary information to adequately Discharge And Transfer Policy Version 5 January 2012
Page 30 of 47
care for the patient. This should include phoning the care home to confirm discharge and ongoing care arrangements, and (where appropriate) a followup letter should also be sent. · Health visitors will be sent a computergenerated letter advising them of any attendance for children under the age of 5. 28.10 Discharging a Child from Paediatric ED. When discharging a child home the discharging nurse must ensure that they are discharged to the immediate care of a person who has parental responsibility for them, or someone who has been given permission to supervise the child by those with parental responsibility (i.e. leave the department with them). If legal guardians are unaware of the child’s presence in the department all efforts must be made to contact those with parental responsibility prior to discharge (ideally as soon as the child arrives in the department). Full definitions of parental responsibility are found at http://www.direct.gov.uk/en/Parents/ParentsRights/DG_4002954 28.11 Where the number of patients awaiting discharge threatens the Emergency Department’s capacity to admit, treat and transfer new patients safely (and within four hours), the Duty Nurse Manager and Silver on call should be contacted via switchboard. 29
Prisoner Patients
29.1 Contact should be made directly with the facility. Where there are on going health needs these may not be able to be met within the facility and may need further consideration. Support from IDT can be sought. 30
Discharge of Homeless Persons
30.1 For those persons who declare at admission that they are of ‘no fixed abode’ (NFA), specific discharge plans should be considered. It is best if the patient can go to stay with a friend or relative when ready for discharge, even as a temporary measure. This possibility should be explored as soon after admission as possible and the patient is to be encouraged to help to resolve the problem of their discharge destination. 30.2 If a patient has no friend or relative to go to stay with, please contact the Integrated Discharge Team.
31
Asylum Seekers/Refugees and displaced persons
Discharge And Transfer Policy Version 5 January 2012
Page 31 of 47
31.1 Asylum Seekers, Refugees and displaced persons often have very complex and chaotic circumstances and therefore each person’s discharge must be dealt with according to individual need and circumstance. 31.2 Information and advice should be sought from NUH Integrated Discharge Team or from Social Services as soon a sit becomes apparent that discharge may be difficult. Other resources are the Refugee Service and The Community Relations Officer.
32
Training / Awareness
32.1 Ongoing training will be offered by the Integrated Discharge Team on simple and complex discharge assessments and needs. Regular updates will also be provided to ward staff via the Trust operational discharge meetings. Training on key aspects of the discharge policy and delayed discharges will be provided as part of the Trust induction programme for clinical staff. 32.2 Competencies assessments for nurse facilitated discharges (NFD) should be completed by ward managers. Staff should be reassessed for their competencies for NFD in line with IPR.
33
Implementation and Monitoring
33.1 Monitoring of the implementation and effectiveness of this policy is undertaken at ward level, using a number of performance indicators. Examples of monitoring include Trust documentation audits and monitoring of reported incidents relating to discharge. 33.2 At Directorate level, each directorate must undertake appropriate review which will include consideration of patient and carer experience. 33.3 The Delayed Transfers of Care (DTOC) will be monitored on a daily basis (Monday to Friday) by the Integrated Discharge Team (IDT). This information is then reported to the SHA and the Department of Health (DH) via unify 2 website monthly.
34
Equality and Diversity Statement
Discharge And Transfer Policy Version 5 January 2012
Page 32 of 47
34.1 All patients, employees and members of the public should be treated fairly and with respect, regardless of age, disability, gender, marital status, membership or nonmembership of a trade union, race, religion, domestic circumstances, sexual orientation, ethnic or national origin, social & employment status, HIV status, or gender reassignment. 34.2 All trust polices and trust wide procedures must comply with the relevant legislation (non exhaustive list): · · · · · · · · · · · · · · ·
35
Equal Pay Act Sex Discrimination Act Race Relations Amendment Disability Discrimination Act Employment Relations Act Rehabilitation of Offenders Act Human Rights Act Trade Union and Labour Relations (Consolidation) Act Code of Practice on Age Diversity in Employment Part Time Workers Prevention of Less Favourable Treatment Regulations Fixed Term Employees Prevention of Less Favourable Treatment Regulations Employment Equality (Sexual Orientation) Regulations Employment Equality (Religion or Belief) Regulations Employment Equality (Age) Regulations Equality Act (Sexual Orientation) Regulations
Equality Impact Assessment Statement
35.1 NUH is committed to ensuring that none of its policies, procedures, services, projects or functions discriminate unlawfully. In order to ensure this commitment all policies, procedures, services, projects or functions will undergo an Equality Impact Assessment. 35.2 Reviews of Equality Impact Assessments will be conducted inline with the review of the policy, procedure, service, project or function
36
Here for You
36.1 The Here for You standards have been introduced to ensure that employees are aware of the acceptable standards of behaviour that Discharge And Transfer Policy Version 5 January 2012
Page 33 of 47
are expected and in doing so we have made a pledge to each other. We pledge that all day, everyday we will all do our very best to ensure: · You are appreciated, with a polite and respectful attitude, from kind and helpful colleagues, who value everyone who takes responsibility for doing a good job · You are supported to make the best use of your time, by simplifying processes, eliminating waste, and streamlining communication to ensure everyone can be focused on high quality care for patients · You are encouraged to improve the quality of our service to patients, by listening to patients’ needs and through evidenceled improvement, team working, training and personal development
37 · · · · · · · · · · · · · · · · · · ·
References and Related Policies & Procedures Care Quality Commission Outcomes Community Care Act & Community Care (Delayed Discharge) Act Discharge from Hospital: pathways process and practice. NUH Consent to examination or Treatment Policy NUH Incident Reporting Policy and Procedures Manual NUH Medicines Management hen patients are discharged from hospital. Medicines Code of Practice. NUH Missing Patient Procedure Mental Capacity Act 2005 Policy and Associated Deprivation of Liberty Safeguards Policy and Codes of Practice National Carers Strategy. National Service Frameworks National Framework for NHS Continuing Healthcare and NHS funded Nursing care NHSLA. Risk Management Standards for Acute Trusts. Patient Transport Policy High Impact Changes for Service Improvement & Delivery. Trust Policy and Procedure for the Safe and Effective Handling of Discharge Medication Trust Policy for Maternity Service in Utero Transfer Policy Trust Policy for Safeguarding Children Trust Policy for Safeguarding Adults. Trust Policy for the internal transfer of the adult patient throughout Nottingham University Hospitals.
Discharge And Transfer Policy Version 5 January 2012
Page 34 of 47
Appendix 1 GLOSSARY OF TERMS ABBREVIATION CAMHS CCO CHC DNAR DN ETTOS EOL GP ICES IDT
FULL NAME
MRSA
Child and adolescent mental health services. Community Care Officer (Social Services) Continuing Healthcare Checklist Do Not attempt to resuscitate District Nurse Electronic Tablets to Take Out End Of Life General Practitioner Integrated Community Equipment Store Integrated Discharge Team Members include: Interface Nurses, OT, CCO’s Independent Mental Capacity Advocate Information Technology Multi Disciplinary Team Members may include: Nurse, Doctor, OT, PT, SW, Dietician, Speech Therapist Methicillian Resistant Staphlococcus Aureus
NFD NHSLA OT PALS PCT PDD PT SS SSD SW TTOs
Nurse Facilitated Discharge National Health Service Litigation Authority Occupational Therapist Patient Advice and Liaison Service Primary Care Trust Predicted/Proposed Discharge Date Physiotherapist Social Services Social Services Department Social Worker Tablets to take out
IMCA IT MDT
Discharge And Transfer Policy & Procedure Version 3, March 2010
35
Appendix 2 Equality Impact Assessment Report Outline 1.
Name of Policy or Service NUH Discharge and Transfer Policy
2.
Responsible Manager Jim Murray
3.
Name of Person Completing Assessment Helen Gregory and Lorraine Anderson
4.
Date EIA Completed 5 th July 2011
5.
Description and Aims of Policy/Service This Policy is designed to ensure managers and workers are aware of their roles and responsibilities around the discharge of patients from NUH. This policy provides clarity for managers and employees in how to handle discharge safely.
6.
Brief Summary of Research and Relevant Data N/A
Discharge And Transfer Policy & Procedure Version 3, March 2010
36
8.
Results of Initial Screening or Full Equality Impact Assessment:
Equality Group
Assessment of Impact
Age
Potential high positive, low negative Impact identified
Gender
Potential high positive, low negative Impact identified
Race
Potential high positive, low negative Impact identified
Sexual Orientation
Potential high positive, low negative Impact identified
Religion or belief
Potential high positive, low negative Impact identified
Disability
Potential high positive, low negative Impact identified
Dignity and Human Rights
Potential high positive, low negative Impact identified
Working Patterns
N/A
Social Deprivation
Potential high positive, low negative Impact identified
9.
Decisions and/or Recommendations (including supporting rationale)
Following the initial screening, with the exception of working patterns, which is not relevant to this policy, the above strands of equality show the potential for a high positive impact and low negative impact. Please refer to the initial screening grid for further information
10. Equality Action Plan Discharge And Transfer Policy & Procedure Version 3, March 2010
37
N/A 11. Monitoring and Review Arrangements This policy together with any associated procedures and its Equality Impact Assessment should be next reviewed inline with NUH guidelines unless there is a change in any relevant legislation. 12. Equality Statement All patients, employees and members of the public should be treated fairly with respect, regardless of age, disability, gender, marital status, Membership or nonmembership of a trade union, race, religion, Domestic circumstances, sexual orientation, ethnic or national Origin, social & employment status, HIV, or gender reassignment.
Discharge And Transfer Policy & Procedure Version 3, March 2010
38
Screening Grid Equality Key Is this Area Equalities policy or Legislation service / Policy RELEVANT to this equality area? YES / NO Age
Assessment of Potential Impact: HIGH MEDIUM LOW NOT KNOWN positive negative
Age Regulations 2006
Reasons
This policy applies to Children and Young People (under the age of 18) who are patients of the Trust, including Children and Young people seen in paediatric service settings, and those 14 18 year olds who may be seen in adult areas.
Yes
High
Low
The policy also states that considerations are to be made when planning discharge to those who are frail or those who are under the age of 18 in relation to Safeguarding Children (including those in need of protection) policy) No further assessment is required
Discharge And Transfer Policy & Procedure Version 3, March 2010
39
Equality Area
Gender
Race
Key Is this Assessment of Equalities policy or Potential Impact: Legislation / service HIGH Policy RELEVANT MEDIUM to this LOW equality NOT KNOWN area? positive negative YES / NO Sex Discrimination Act 1975 Equal Pay Act 1970 Equalities Act 2006 Gender Recognition Act 2004
Race Relations Act 1976 Race Relations (Amendment) Act 2000
Yes
Yes
High
High
Low
Low
Sexual Equalities Act orientation 2006 Relevant employment legislation No
High
Low
Reasons
The policy does not discriminate as the decision to discharge or transfer a patient will be made on their fitness and/or medical wellbeing and not based upon their gender. No further assessment is required The policy does not discriminate as the decision to discharge or transfer a patient will be made on their fitness and/or medical wellbeing and not based upon their race. No further assessment is required The policy does not discriminate as the decision to discharge or transfer a patient will be made on their fitness and/or medical wellbeing and not based upon their sexual orientation. No further assessment is required
Discharge And Transfer Policy & Procedure Version 3, March 2010
40
Equality Key Equalities Area Legislation / Policy
Religion and beliefs
Is this Assessment of policy or Potential Impact: service HIGH RELEVANT MEDIUM to this LOW equality NOT KNOWN area? positive negative YES / NO
Equalities Act 2006 Relevant employment legislation
Reasons
The policy does not discriminate as the decision to discharge or transfer a patient will be made on their fitness and/or medical wellbeing and not based upon their religion or beliefs.
No
High
Low
The policy also states that a patient’s beliefs, wishes and culture should also be considered when planning discharge. No further assessment is required
Discharge And Transfer Policy & Procedure Version 3, March 2010
41
Equality Key Is this Area Equalities policy or Legislation service / Policy RELEVANT to this equality area? YES / NO
Assessment of Potential Impact: HIGH MEDIUM LOW NOT KNOWN positive negative
Disability Disability Discriminati on Act 1995 and 2005
Reasons
The policy does not discriminate as the decision to discharge or transfer a patient will be made on their fitness and/or medical wellbeing and not based upon their disability.
Yes
High
Low
However the policy does state that considerations are to be made when planning discharge for those patients with continuing disability/ long term conditions, in particular those with learning disabilities, physical disabilities, sensory impairments, those who suffer from psychiatric illness and those who have communication difficulties, this includes responsibilities under the Mental Capacity Act 2005 No further assessment is required
Discharge And Transfer Policy & Procedure Version 3, March 2010
42
Equality Area
Key Is this Assessment of Equalities policy or Potential Impact: Legislation service HIGH / Policy RELEVANT MEDIUM to this LOW equality NOT KNOWN area? positive negative YES / NO
Dignity and Human Human Rights Act Rights 1998 (relevant articles)
Yes
High
Low
Reasons
All patients will be treated with dignity and respect and will not be discriminated against in any way shape or form. No further action is required
Working Patterns
The Part time Workers (Prevention of Less Favourable Treatment) Regulations 2000
Social Neighbourh Deprivation ood Renewal Strategy Tackling Health Inequalities Local Area Agreement
Discharge And Transfer Policy & Procedure Version 3, March 2010
N/A
No
Yes
High
Low
The policy acknowledges and provides guidance for staff for those patients who are of No Fixed Abode (NFA). No further action is required
43
Appendix 3 We are Here For You. Mission statement: This Trust is committed to providing the highest quality of care to our patients, so we can pledge to them that ‘we are here for you’. This Trust supports a patient centred culture of continuous improvement delivered by our staff. The Trust established the Values and Behaviours programme to enable Nottingham University Hospitals to continue to improve patient safety, outcomes and experiences. The set of twelve agreed values and behaviours explicitly describe to employees the required way of working and behaving, both to patients and each other, which would enable patients to have clear expectations as to their experience of our services.
1. Polite and Respectful
3
Whatever our role we are polite, welcoming and positive in the face of adversity, and are always respectful of people’s individuality, privacy and dignity. 2. Communicate and Listen
3
We take the time to listen, asking open questions, to hear what people say; and keep people informed of what’s happening; providing smooth handovers. 3. Helpful and Kind
3
All of us keep our ‘eyes open’ for (and don’t ‘avoid’) people who need help; we take ownership of delivering the help and can be relied on. 4. Vigilant (patients are safe)
3
Every one of us is vigilant across all aspects of safety, practices hand hygiene and demonstrates attention to detail for a clean and tidy environment everywhere.
5. On Stage (patients feel safe) Discharge And Transfer Policy & Procedure Version 3, March 2010
3 44
We imagine anywhere that patients could see or hear us as a ‘stage’. Whenever we are ‘on stage’ we look and behave professionally, acting as an ambassador for the Trust, so patients, families and carers feel safe, and are never unduly worried. 6. Speak Up (patients stay safe)
3
We are confident to speak up if colleagues don’t meet these standards, we are appreciative when they do, and are open to ‘positive challenge’ by colleagues. 7. Informative
3
We involve people as partners in their own care, helping them to be clear about their condition, choices, care plan and how they might feel. We answer their questions without jargon. We do the same when delivering services to colleagues. 8. Timely
3
We appreciate that other people’s time is valuable, and offer a responsive service, to keep waiting to a minimum, with convenient appointments, helping patients get better quicker and spend only appropriate time in hospital. 9. Compassionate
3
We understand the important role that patients’ and family’s feelings play in helping them feel better. We are considerate of patients’ pain, and compassionate, gentle and reassuring with patients and colleagues. 10. Accountable 3 Take responsibility for our own actions and results 11. Best Use of Time and Resources
2
Simplify processes and eliminate waste, while improving quality 12.Improve
3
Our best gets better. Working in teams to innovate and to solve patient frustrations TOTAL 35
Appendix 4 Discharge And Transfer Policy & Procedure Version 3, March 2010
45
POLICY / PROCEDURE IMPLEMENTATION PLAN Reference CL/CGP/036 Title Discharge and Transfer Policy Version Date Lead officer
4 January 2012 Jim Murray
Target Audience
All staff involved in discharge planning
Training and Education Requirements
Ongoing training will be offered by the Integrated Discharge Team on simple and complex discharge assessments and needs. Regular updates will also be provided to ward staff via the Trust operational discharge meetings. Training on key aspects of the discharge policy and delayed discharges will be provided as part of the Trust induction programme for clinical staff. Implementation Revised policy to be updated on NUH Intranet. Notice of Plan update to be included in Trust Briefing. Policy to be circulated to matrons for distribution via clinical areas. Timetable for Policy to be ratified in February 2012. Engagement Completion of regarding changes to take place during March and April Implementation 2012.
Appendix 5 Discharge And Transfer Policy & Procedure Version 3, March 2010
46
CERTIFICATION OF EMPLOYEE AWARENESS Document Title
Discharge and Transfer Policy
Version (number) Version (date)
4 January 2012
I hereby certify that I have: · Identified (by reference to the document control sheet of the above policy/ procedure) the staff groups within my area of responsibility to whom this policy / procedure applies. · Made arrangements to ensure that such members of staff have the opportunity to be aware of the existence of this document and have the means to access, read and understand it. Signature Print name Date Directorate/ Department The manager completing this certification should retain it for audit and/or other purposes for a period of six years (even if subsequent versions of the document are implemented). The suggested level of certification is; · Clinical directorates general manager · Non clinical directorates deputy director or equivalent. The manager may, at their discretion, also require that subordinate levels of their directorate / department utilize this form in a similar way, but this would always be an additional (not replacement) action.
Discharge And Transfer Policy & Procedure Version 3, March 2010
47
