ADMISSION / TRANSFER / DISCHARGE POLICY FOR THE INFECTED PATIENT
Amendments Date June 2010
Page(s)
Comments Updated in line with the Trust’s Policy Writing & Ratification Policy
Approved by Caroline Becher, Chief Nurse
August 2012
Policy review date due.
Suzanne Rankin, Chief Nurse
September 2014
Expiry of review date.
Heather Caudle Chief Nurse
Compiled by:
The Infection Control Team
In consultation with:
Control of Infection Committee
Ratified by:
Clinical Governance Committee
Date ratified:
November 2007
st
1 Review:
June 2010
2nd Review:
August 2012
3rd Review:
September 2014
Reviewed by:
Linda Towey
Review date:
September 2016
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Target audience:
All Trust staff
Impact Assessment carried out by:
Linda Towey, Consultant Nurse, Infection Prevention & Control
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Comments on this document to:
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Linda Towey, Consultant Nurse, Infection Prevention & Control
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ASHFORD & ST PETER’S HOSPITALS NHS FOUNDATION TRUST
ADMISSION/TRANSFER/DISCHARGE POLICY FOR THE INFECTED PATIENT See also:
1.
MRSA Policy Policy and Procedure for Control of Clostridium difficile diarrhoea Control of Tuberculosis in Hospital Infection Control Outbreak/Incident Policy including Major Outbreak Policy Isolation Policy Trust’s Admission and Discharge Policy
INTRODUCTION Treating patients in the most appropriate setting and managing bed pressures means that it is often necessary to transfer patients between wards and hospital sites however infectious patients should only be moved if deemed clinically necessary. This policy stipulates the process that must be followed for patient transfers from: Within Ashford & St Peter's Hospitals NHS Trust (ASPH) sites Local inpatient community hospitals Other hospitals Nursing / Residential homes
2.
PURPOSE To ensure all staff are aware of the patient’s infection status to reduce the risk of cross infection on admission and transfer both within (ASPH) and external healthcare establishments and ensure patient safety at all times. The member of staff responsible for the care of the patient will provide both verbal and written information advising on what precautions are required, to a senior member of staff of the receiving area, prior to transfer of the patient.
3.
GENERAL PRINCIPLES REGARDING TRANSFER OF THE INFECTED PATIENT
3.1
Admissions Emergency All patients admitted via the GP or through A&E with a known or suspected communicable disease must be placed in a single side room where possible. The Infection Control Team must be notified. Patients known to have had a previous healthcare associated infection should be isolated if appropriate and notify infection control. However all patients should be assessed for the risk of cross infection and vulnerability to infection and this is appropriately documented. This includes checking microbiology results for any past history or cross infection risk e.g. ESBL. All patients must be screened for MRSA within 24 hours of admission. Vol7 Control of Infection
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Planned All planned admissions must be MRSA screened at pre-assessment or the appropriate clinic. If patient is positive this must be communicated via the consultant secretary to the Consultant and theatres or the receiving ward and also recorded on PAS. Transfers of patients from other UK Hospitals and Abroad Patients transferred (repatriated) from within the UK and abroad to ASPH, must be highlighted to the Infection, Prevention & Control Team. Once the CSNP has allocated a bed they must inform the Infection, Prevent & Control Nurses so they can follow through on admission screening requirement. 3.2
Transfers between wards/units/departments • •
•
•
•
•
•
•
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Transfers to other wards of infected patients should be avoided if at all possible. If transfer of the patient is considered clinically necessary then the receiving ward/ department must be informed verbally and in writing whenever possible of the current status of that patient. Patients with an alert organism e.g. MRSA or Clostridium difficile must not be transferred to high risk wards unless they require care within that speciality. These wards include ITU, MHDU, Orthopaedic wards, Coronary Care Unit, Haematology and Maternity. For ward/unit to ward/unit transfers – staff from host wards must inform the Clinical Site Nurse Practitioner (CSNP) on duty of any infection control requirements prior to the transfer e.g. need for an isolation room. Ward/unit staff must inform staff on the receiving ward/unit/department of any required infection control precautions in advance of the transfer and complete the Inpatient List (IPL) on CliniNet. Real Time will also show the patient’s infection status. The CNSP and the Ward Manager will prioritise the side rooms available by risk assessment in accordance with Appendix 1 and seek advice from the Infection Control Team as required. Staff that transfer the patient, e.g. porters or other healthcare staff, who do not have physical contact with the patient, do not need to wear gloves or aprons for the transfer of patients. However, hands must be decontaminated with alcohol hand sanitiser or handwashing before contact with another patient. Protective clothing should however still be worn if contact with body fluids is likely. If physical contact with the patient is required for the transfer, a disposable plastic apron and gloves must be worn. After the transfer (before contact with another patient) protective clothing must be removed and hands washed with liquid soap and water. The trolley or wheelchair used for transportation should be cleaned with detergent wipes unless body fluid soiling has occurred, in which case clean the chair with a detergent wipe followed by 1,000ppm NaDCC (Haz-Tab solution) or Chlorine wipe. If the transfer is to a department for an investigation or procedure, please ensure that investigations are performed as soon as the patient arrives in the department First Ratified Nov. 07
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•
3.3
and that the patient is returned to the ward/unit, promptly after the procedure is complete. There is no need to empty the investigation or procedure rooms within departments, of equipment/consumables when investigating an infected patient Instruments/equipment/consumables that are not in use should be kept covered with a dust cover or be stored in a cupboard, as for all patients.
Discharge/transfer from hospital The host healthcare provider must ensure that they provide suitable and sufficient information on each patient’s infection status whenever the patient is moved from one organisation to another so that the risk of cross infection may be minimised. All relevant healthcare facilities and social agencies involved in the delivery of the patient’s continued care must be informed verbally and in writing of the patient’s current cross-infection/colonisation status. The IPL form (discharge letter) must be completed when transferring patients and the Patient Transfer Form (Appendix 2) needs to be completed for transfers to nursing/residential homes and community rehabilitation beds. Dedicated Community Nurse Referral Form (Appendix 3) for discharges to District Nursing care. When required there should be joint planning between the Infection Control Team, the CNSP’s and the Discharge Team for planning patient admissions, transfers, discharges and movements between departments and other healthcare facilities. Where necessary Ambulance Trusts may need to be involved in such planning. Infectious patients should not be transferred to another hospital or care home unless this is clinically indicated and the appropriate facilities confirmed with the receiving hospital or care home. Seek advice from the Infection Control Team if required (this does not apply to colonised patients). Transport by ambulance This should be arranged as far in advance as possible and the ambulance service/ transport must be notified of any precautions necessary.
4.
DISSEMINATION AND IMPLEMENTATION The policy has been written by the Infection Control Team, agreed by the Control of Infection Committee and ratified by the Clinical Governance Committee. The policy will be available on TrustNet and as a hard copy at ward/department level for ease of access. All staff will be taught the importance of appropriate isolation, transfer and discharge at induction and annual updates.
5.
PROCESS FOR MONITORING COMPLIANCE WITH THE EFFECTIVENESS OF POLICIES Vol7 Control of Infection
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Patients requiring isolation will be monitored daily by the Ward Managers and Matrons and overseen by the Infection Control Team.
6.
EQUALITY IMPACT ASSESSMENT The Trust has a statutory duty to carry out an Equality Impact Assessment (EIA) and an overarching assessment has been undertaken for all infection control policies.
7.
ARCHIVING ARRANGEMENTS This is a Trust-wide document and archiving arrangements are managed by the Quality Dept. who can be contacted to request master/archived copies.
8.
REFERENCES Department of Health (2010) The Health and Social Care Act 2008 Code of Practice on the prevention & control of infections and related guidance. London. DoH. Department of Health (2009) Saving Lives The delivery programme to reduce healthcare associated infections (HCAI) including MRSA, Department of Health Publications (also available on www.doh.gov.uk )
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APPENDIX 1
Prioritisation of Single Rooms for Infectious Patients Infection
Priority
Isolation/cohort Requirement
Open pulmonary Tuberculosis known or suspected
1
Essential
Chicken Pox (Varicella)
1
Essential
Clostridium difficile diarrhoea
2
Essential
Meningococcal meningitis
2
Essential
Diarrhoea & Vomiting
2
Essential
MRSA (sputum & heavy skin shed)
2
Essential
Shingles (Herpes zoster)
3
Preferable
ESBL/Highly resistant coliforms/CPE
2
Preferable
Please refer to the relevant policy for further information or when isolation can be discontinued.
If you have any queries please contact: The Infection Control Team on Ext 2128/3052 or out of hours on-call Consultant Microbiologist for further advice. Also refer to the Ward Resource Pack for further guidance.
Any infectious patient placed in isolation must have the appropriate signage placed in the plastic cover outside the room Vol7 Control of Infection
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APPENDIX 2 PATIENT TRANSFER FORM - NURSING INFORMATION Transfer from:
Transfer to:
Name:.........................................................................................
Name of Next of Kin:
Home No:
Hospital No:................................................................ NHS No: ..................................................................................... Address: ..................................................................................... ................................................................................................ ................................................................................................ ................................................................................................
Work No:
Relationship:
Mobile No: Referred to Consultant:
Referring Consultant: Is Next of Kin aware of transfer? Yes / No Is Patient aware of transfer? Yes / No
Does patient have knowledge of diagnosis?
Post code: ................................................................
Yes / No
Telephone No:................................................................
Property / Valuables with patient: Yes / No
Does Next of Kin have Knowledge of diagnosis?
Mobile No: ................................................................ Marital status: ................................................................
Yes/No Ref No
Does patient understand reason for transfer? Y/N
MOBILITY: Independent
Y/N
Walking with frame: Y / N
Walking with person / persons: Y / N
Walking with crutches: Y / N
Falls: History or Risk of falls: Y / N
Walking with stick: Y / N
Chair rest: Y / N
Wheelchair user: Y / N
PERSONAL HYGIENE: Independent Y / N
If no state assistance required:
NUTRITION: MUST Score: Tube feed
Date:
Weight:
Y / N If yes state type
Regime included Y / N
Supplements: Y / N If yes state type
Regime Sent Y / N If no why?
Food Chart: Y / N If yes date started
Special diet Y / N If yes specify INFUSIONS:
CANNULA: Y / N
1.
Date inserted:
2.
Visual Infusion Phlebitis Score: 0
URINARY CATHETER: Y / N If yes Catheter type:
Site:
1
2
3 (please circle)
ANTI-EMBOLISM STOCKINGS: Size:
Y/N
Thigh / Knee
Change date: SKIN: I(If bruises /abrasions/ ulcers/ wounds etc please complete body map page 3) Waterlow Score:
Pressure relieving aids required
Wound: (please describe) Dressings: Y / N
Y/N
In place Y / N
Sutures / drains: Type:
Date last changed:
VITAL SIGNS: Time recorded: Vol7 Control of Infection
Temperature:
Pulse: First Ratified Nov. 07
Blood Pressure:
Respiration:
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MEWS:
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Name:
Date of Birth:
Hosp. No
INFECTION: Transfer between sites or local hospitals - please complete INTER / INTRA HOSPITAL TRANSFER SHEET (downloadable from intranet) and not the section below INFECTION: for patients going to Residential/Nursing Home please complete this section Is the patient being discharged with any of the following: MRSA
Y/N
C Difficile (document current bowel action using Bristol Stool Chart) ESBL
Y/N
Any other infection Y / N Please document any further comments regarding Infection in the general condition comments: DISCHARGE SUPPORT REFERRALS District / Practice Nurse Case Manager Home Care Meals on Wheels Continence Advisor Diabetic Specialist Nurse
Y Y
N N
Frequency: Frequency:
Y
N
Frequency;
Y
N
Frequency:
Y
N
Frequency:
Y
N
Frequency:
Palliative Care Nurse Stoma Therapist Occupational Therapist CPN
Frequency:
Y Y
N N
Y
N
Frequency:
Y
N
Frequency:
Frequency:
MEDICATION: Please see copy of doctors discharge summary. NB: Please ensure medications are sent with patient. Communication difficulties Y / N If yes, details SPECIAL NEEDS (Current) Hearing impairment Y / N Sight impairment
Y/N
Hearing Aid Y / N Spectacles
Y/N
FOLLOW UP APPOINTMENTS AND TREATMENTS Date 1.
Time:
Place:
Date 2.
Time:
Place:
Appointments yet to be made? Y / N (please specify):
If transport needed, what arrangements have been made? DOCUMENTS / EQUIPMENT ACCOMPANYING PATIENT Drug Chart
Y / N If no, why not?
Healthcare record being sent to local community hospitals (ensure coded before transfer) Y / N Copy of social situation
Y / N / If no why not?
Medical Discharge Summary – Community Hospitals: Y / N. If no, why not? Equipment to be transferred with patient e.g. pumps, wheelchair. Please specify and list serial numbers: 1.
2.
3.
GENERAL CONDITION: Include relevant operations/ treatment during inpatient stay .............................................................................................................................................................................................. .............................................................................................................................................................................................. .............................................................................................................................................................................................. ..............................................................................................................................................................................................
Name of Registered Nurse completing form: Vol7 Control of Infection
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Signature:
Date / Time:
Designation:
BODY MAP Name:
Date of Birth:
Hosp. No:
Please draw on the body map in black ink, using the following key to indicate the different types of injury (shading or alphabetic code), and provide brief details for each injury, e.g. measurements of wound, colour of bruise, etc using arrows (a ruler is provided to assist with measurement):
A – Pressure Ulcer (not broken)
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D – Excoriation, red areas
B – Bruising
E – Scalds, Burns
C - Cuts, wounds
F - other (specify)
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NB: Once completed, a copy of this form and the body map goes with the patient on transfer and a copy must be placed in the patient’s healthcare record
Name:
Date of Birth:
Hosp. No:
Additional Comments:
Note any other additional comments related to the wounds or injuries as outlined on the body map. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Name of person completing Body Map: ______________________________________ Designation: _______________________________________________ ____________ Signature:
____________________________________________________________
Contact details of person completing Body Map form:__________________________ Date/ time of completion: ___________________ __________________________________ Agreement by the external person coming to assess the patient Name: __________________________________ Designation:__________________________________ Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________ Signature: _______________________________________________ Date/time: _______________________________________________ (Please retain a copy in the patient’s health care records) Vol7 Control of Infection
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APPENDIX 3
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