Nurse Led Discharge Protocol - Newcastle · PDF fileNurse Led Discharge Protocol 3. ... In...
Transcript of Nurse Led Discharge Protocol - Newcastle · PDF fileNurse Led Discharge Protocol 3. ... In...
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The Newcastle upon Tyne Hospitals NHS Foundation Trust
Nurse Led Discharge Protocol
Version No.: 1.1
Effective From: 9 October 2014
Expiry Date: 9 October 2017
Date Ratified: 23rd September 2014
Ratified By: Discharge Review Group
1 Introduction This policy has been developed to enable registered nurses to lead the discharge of patients. This can only be done following the assessment of the registered nurse against an agreed set of criteria and skills by the Directorate/Line Manager and appropriate training. 2 Scope All nurses authorised to discharge must be a level one registered nurse employed by this Trust. Nurses authorised to discharge must also;
Have successfully completed Directorate level training for nurse led discharge and be deemed as competent to undertake the role by their line manager,
Accept accountability for their practice,
Maintain up to date knowledge and skills within their clinical field,
Be familiar with and demonstrate an understanding of the following appropriate documents,
Adhere to the principles of the NMC Code of Professional Practice 2008,
Work within Trust policy, ie The Newcastle upon Tyne Hospitals NHS Foundation current Trust Discharge Policy.
This policy will not apply to non-qualified nursing staff and/or qualified nursing staff who have not yet met the necessary competencies and those working outside of their clinical area of expertise. 3 Aims To provide a firm foundation on which Clinical Directorates can take forward Nurse Led Discharge within Clinical areas and to support the Trust’s Discharge Policy. There are several advantages to nurse led discharge:
It promotes effective inter-disciplinary working
It makes effective use of nursing knowledge and skills
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It allows patients to be discharged as soon as they are ready
It increases bed availability through prompt discharge 4 Duties (Roles and responsibilities) 4.1 Directorate/Line Manager
The Directorate Manager/Line Manager will authorise those nurses who have been deemed competent by the relevant clinical educator, ward sister or matron to discharge following Directorate level training.
4.2 Qualified Nurse
The registered nurse must have:
The ability to assess and make critical decisions regarding nurse led discharge following training and competency assessment.
At least two years post registration clinical nursing experience.
The support of the Ward Sister/Charge Nurse and Matron to confirm that:
1. Directorate specific protocols and patient criteria have been developed, agreed and in operation.
2. Nurses may only discharge patients from the ward or setting in which they hold clinical responsibility.
3. They will be supported by the multi-disciplinary team. Nurses may discharge patients where it has been clearly documented no further medical reviews are required, this is the responsibility of the patients Consultant. It is the responsibility of the Nurse to ensure that all details of the discharge are within the agreed Directorate guidelines and clearly documented within the patient medical records as per the NMC Standards for records and recordkeeping.
5 Process to progress Nurse Led Discharge
1. The nurse led discharge group members should include the lead clinician, Directorate Manager, Matron/Senior Nurse and motivated/interested registered nurse.
2. Timelines should be agreed for work planning, implementation, review and audit processes.
3. The group should determine the procedures and/or clinical fields in which Nurse Led Discharge could be successfully initiated.
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4. Competencies should be drawn up to outline what will be required and asses if these are met by the individual
5. The agreed criteria should be described which would be essential for the nurses to adhere to. (See appendix 1).
6. The group should address the following:
staff selection
training/assessment
re-assessment
tools to support this process (e.g. skills matrix)
Communication
Implement the process
7. Audit patient satisfaction, re-admission/failed nurse led discharge, and impact on length of stay and/or ward utilisation.
8. React to audit outcomes.
6 Training Nurses preparing for this role will undertake a Directorate specific preparation, which will include:
Learning in practice including the provision of supervision, support and opportunities to develop competence in Nurse Led Discharge practice.
These competencies will be successfully completed and authorised by their manager during assessment and review process. See attached ‘Discharge Planning Skills Matrix’
Nurses under-taking this role will have a professional responsibility to maintain their knowledge of good practice and of co-ordination and communication with the multi-disciplinary team
The nurse holds a responsibility to inform their line manager of any reduction in confidence and/or competence of their ability and will not carry out nurse led discharge until they have been reassessed and are deemed competent.
7 Equality and Diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual
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needs and does not discriminate against individuals or groups on any grounds. This document has been appropriately assessed. 8 Monitoring Compliance
(Standard / process / issue
Monitoring and audit
Method By Committee Frequency
A review of the use / uptake of the procedure will be undertaken prior to the next policy review.
Patient Services Manager
Discharge review group
On-going
9 Consultation and review When reviewing this Policy all appropriate guidance has been taken into account. In addition to relevant subject specific guidance, the legal requirements have also been taken into account. The involvement of the Discharge Review Group and all relevant stakeholders responsible for ensuring the safe and effective implementation of the Policy have been asked to contribute, comment and agree the content of a document before it is passed to the Clinical Policy Group for approval. 10 Implementation (including raising awareness) The Discharge Review Group will disseminate any changes through their user groups.
11 Associated documents Discharge Policy
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Appendix 1
DISCHARGE PLANNING SKILLS MATRIX
Ward_________________
Fu
ll n
am
e
Gra
de/D
es
ign
ati
on
Kn
ow
ledg
e o
f th
e T
rust's
Dis
ch
arg
e P
olic
y
Kn
ow
ledg
e o
f M
DT
role
Ve
rba
l &
writt
en
info
rma
tion
to b
e g
iven
to
Pa
tien
ts/C
are
rs in
ap
pro
pria
te f
orm
ats
Ord
eri
ng
of
dis
ch
arg
e m
ed
ica
tio
n
Assessm
en
t/B
ookin
g o
f A
pp
rop
ria
te T
ransp
ort
Bo
okin
g O
ut-
Patien
t A
ppo
intm
en
ts
Bo
okin
g F
ollo
w-u
p M
edic
al In
ve
stig
atio
ns
Tru
st
Po
licy fo
r R
etu
rnin
g V
alu
ab
les a
nd
Pro
pe
rty
Clin
ica
l kn
ow
led
ge
rela
tin
g to
Nurs
e L
ed
pro
ced
ure
s/c
linic
al
co
nditio
ns r
eco
ve
ry e
xp
ecta
tion
s/p
ost d
ischa
rge
co
nta
ct
Kn
ow
ledg
e o
f P
rim
ary
He
alth
Care
Te
am
(to
inclu
de
refe
rral
pro
cess)
and
ke
y c
om
mun
ity s
up
po
rt g
rou
ps
Kn
ow
ledg
e o
f in
term
ed
iate
ca
re b
ed
an
d r
efe
rra
l
Com
mun
ica
tio
n a
nd
Docum
enta
tion
of
Dis
ch
arg
e P
lan
Issuin
g &
Expla
inin
g P
rescrip
tio
n M
ed
icin
es (
inclu
din
g s
ide
eff
ects
an
d w
ha
t to
lo
ok fo
r)
Reco
rd K
ee
pin
g –
docum
en
tatio
n a
nd
usin
g a
gre
ed
pa
pe
rwork
Tru
st
Nurs
e L
ed
Dis
ch
arg
e P
roto
co
l
Dir
ecto
rate
Nu
rse
le
d d
ischa
rge
Fo
rm (
Ap
pen
dix
2)
Nurs
e L
ed
Dis
ch
arg
e C
he
cklis
t (A
pp
end
ix 3
)
Nam
e a
nd
Sig
na
ture
of
as
ses
so
r
Date
co
mp
lete
d
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Expected Date of Discharge: ____/_____/______ Date of Discharge: ____/_____/______ Discharge nurse Signature _________________________ Print Name: ___________________ Date completed____/___/___ Time completed ______:______ Designation____________________________
Newcastle upon Tyne Hospitals NHS Foundation Trust
Nurse Led Discharge Form (to be completed with patient prior to discharge) Directorate: Hosp: Ward: Name of procedure/diagnosis:
Patient’s GP
Surname MRN
Forename D.O.B. DDMMYYYY
NHS No. Sex. Male/Female
Address
Post Code
Inclusion Criteria for nurse led discharge Satisfactory Comments
Tolerating diet and fluids
Y / N
Temperature within normal range for individual
Y / N
Pulse within normal range for individual Y / N
Blood Pressure within normal range for individual
Y / N
Voiding urine without difficulty Y / N
Post-operative instructions given verbally (and in writing where appropriate)
Y / N
Nurse Led Discharge patient checklist completed
Y / N
Additional criteria set by Consultant
Y / N
Y / N
Y / N
Y / N
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I_____________________________________ (Patient Signature) have completed the discharge form with the nurse, and confirm that I am able to go home and am fully aware of all instructions given. Copy to be stored in medical record when complete.
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Nurse Led Discharge Patient Checklist (In order that patients can be discharged efficiently and effectively, please ensure that all relevant parts of the checklist have been completed).
To be completed by member of staff responsible for discharge Date Y/N/ NA Comments
Is the wound clean and dry
Is pain adequately controlled
Are there any outstanding medical instructions/Interventions
Patient informed of planned discharge date
Any on-going care needs discussed with family/carer
Prescription sent to pharmacy 24 hrs before discharge (where possible)
If Social Services involved has referral been completed/activated
Have all follow up appointments been made
Preparation for discharge complete (please tick when checked): Heating Food Keys available Home care Meals at home Clothes available for discharge
Transport arranged: (please circle) Own Transport/Ambulance
Patient Information Provided
Community nurse informed of discharge if appropriate (please state name)
Discharge letter sent to G.P (Please state if this letter has been completed by nursing staff).
Copy of discharge letter filed in notes
Copy of discharge letter given to patient (if requested)
Discharge medication explained and given to patient
Medication brought into hospital returned to patient
Nurse Led Discharge Form completed
All personal possessions returned to patient
All relevant clinical documentation filed in notes
Signed ________________________ Print Name ___________________________
Job title ________________________ Date _____________Time________________
Copy to be stored in medical record when complete.
Hosp________ Ward _____ Date of admission___/___/____ Anticipated date of discharge ___/___/____ Date of discharge ___/___/____
Surname MRN
Forename D.O.B. DDMMYYYY
NHS No. Sex. Male/Female
Address
Post Code
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Equality Analysis Form A
This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.
PART 1 1. Assessment Date: 2. Name of policy / strategy / service:
Nurse Led Discharge Protocol
3. Name and designation of Author:
Dot Kyle, Patient Services Manager
4. Names & designations of those involved in the impact analysis screening process:
Dot Kyle, Patient Services
5. Is this a: Policy X Strategy Service
Is this: New Revised X
Who is affected Employees X Service Users Wider Community
6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your policy)
To provide a firm foundation on which Clinical Directorates can take forward Nurse Led Discharge within Clinical areas and to
support the Trust's Discharge Policy
7. Does this policy, strategy, or service have any equality implications? Yes x No
If No, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons:
26/09/14
8. Summary of evidence related to protected characteristics Protected Characteristic Evidence, i.e. What
evidence do you have that the Trust is meeting the needs of people in various protected Groups
Does evidence/engagement highlight areas of direct or indirect discrimination? If yes describe steps to be taken to address (by whom, completion date and review date)
Does the evidence highlight any areas to advance opportunities or foster good relations. If yes what steps will be taken? (by whom, completion date and review date)
Race / Ethnic origin (including gypsies and travellers)
The associated discharge policy takes race and culture into account. Interpreting policy This policy is open to all qualified nurses who meet the criteria specified in the policy.
Some patients may not understand the discharge information that is given to them in English Action In discharge planning skills matrix add ‘in appropriate formats.’ to section on verbal and written communication
Staff providing information about support groups in the community may help patients experience of discharge. Key support groups are available in the Trust Resource ‘Putting Patients at the Heart of All We Do’ –
Putting patients at the heart of everything we do.pptx
-available on line; Action In discharge planning skills matrix add ‘and community support’ to section on primary health care team
Sex (male/ female) As above re ‘open to all nurses—‘
No
As above
Religion and Belief The associated discharge policy takes religious and culture into account. Interpreting policy As above
No As above
Sexual orientation including lesbian, gay and bisexual people
As above re ‘open to all nurses—‘
No As above
Age The associated discharge policy takes age and associated needs into account. Interpreting policy As above
Some patients may not understand the discharge information that is given to them because of disabilities and dementia. Action In discharge planning skills matrix add ‘in appropriate formats.’ to section on
As above
verbal and written communication
Disability – learning difficulties, physical disability, sensory impairment and mental health. Consider the needs of carers in this section
The associated discharge policy takes the needs of disabled people and carers into account. Interpreting policy As above
Some patients may not understand the discharge information that is given to them because of disabilities and dementia. Action In discharge planning skills matrix add ‘in appropriate formats.’ to section on verbal and written communication
As above
Gender Re-assignment As above No As above
Marriage and Civil Partnership As above No As above
Maternity / Pregnancy The associated discharge policy takes religious and culture into account. Interpreting policy As above
No As above
9. Are there any gaps in the evidence outlined above? If ‘yes’ how will these be rectified?
No
10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery
System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer.
Do you require further engagement? Yes No x
11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family
life, the right to a fair hearing and the right to education?
No
PART 2 Name:
Dot Kyle
Date of completion:
26/09/14
(If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any suggestions for action required to avoid/reduce the impact.)