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Victoria Oladimeji (PhD, MA, MBA, BA, RGN, RM)Lecturer in Nursing with speciality in Health Promotion

City UniversitySt Bartholomew School of Nursing and MidwiferyPhilpot StreetWhitechapelLondonEC1 2EAEngland

Tel: 020 7040 5800Direct Line: 020 7040 5887Fax: 020 7040 5811Email V.I.Oladimeji@city.ac.uk

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Discharge Planning – Empowering Older Adult towards improved self-care.

Introduction

Every year more than five million people in Britain experience life as hospital in-patients (Chiva and Stears 2001Henwood 2004)

For the vast majority of these people the episode will be relatively straightforward.

However, the discharge process and outcomes are not always positive.

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Admission to and discharge from hospital can be a distressing time for individuals, their families and friends.

For most people, however, treatment will be successful and they will return to their usual way of life very quickly through the provision of an accurate diagnosis, treatment and rehabilitative service.

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Some people will need additional help to enable them to do so over and above their medical treatment. These needs can be many and varied and cannot be met by the NHSalone.

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Aim of study To review current practices in discharge planning

in hospital settings and to critically evaluate some of the government strategies for improving the discharge process and the transition from hospital to home for older adults.

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Global View• Studies suggest patient’s journey from hospital

to the community is not always a smooth transition.

• Grimmer and Moss (2000) (Australia) Magilvy and Congdon (2000) (USA).

• Grimmer and Moss found that community services in the first week post-discharge was low suggesting that carers and patients carried the majority of the burden immediately after discharge. This is consistent with most of the studies done in UK (Waters et al 2001)

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The key principles underpinning effective discharge and transfer of care policy are:• The avoidance of unnecessary hospital admission, good clinical outcomes and effective discharge planning is facilitated by a ‘whole system approach’ to the commissioning and delivery of services.

Characteristics of whole system working?Responsive ,, clear vision, no gaps in services, Partnerships enhanced. Organisations should work proactively, and together to review and improve performance and find solutions. (DOH 2003)

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Figure 1. A ‘virtuous’ circle of services. Source: Audit Commission (2002).                                                                                                                                                                                                                                 

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Aims of Good Discharge Practice:Local Policy

Maintaining a safe home environment Physical, Social, Psychosocial

• Maximising Independence

• Preventing Readmission

Planning and and coordination of services and resources.

(Discharge policy statement 1999)

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Discharge Planning Process

Assess

Evaluate Plan

Implement

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Flow Chart of Assessment Process

Admitting nurse – Checklist, referral (within 24 hours).

Social Work Response (within 2 working days)Various Assessments – (Single Assessment to avoid duplication).Contact with Local Community Services.Provision of Care Plan (within 7 working days).Referral to all Local Community Services.

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Flow chart of Assessment Process in an NHA hospital in England

• Admitting Nurse

• (Complete checklist – make referral if appropriate within 24 hours)

• Social Work Response (within 2 working days)

• Complex Assessment

• (Multidisciplinary, multi-agency specialist

• assessments, involving medical, OT, physio, etc)

Contact with Local Community Services

• (for simple social care needs)

• Provisional Care Plan Development (within 7 working

days)Case Conference

Multidisciplinary with clients and carers and representatives from purchasing in Social Services

• Referral to all local Community Services, e.g. Social Services, District Nurses, Health Authority etc

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Intermediate CareIntermediate Care was heavily emphasised in the

National Service Framework (NSF) for older people (DOH 2001).According to the DOH,

Intermediate care should meet these four criteria:

1. Targeted at people who would otherwise face unnecessary long hospital/residential/ stays.

2. Services provided should be based on thorough assessment (single assessment framework with one set of professional records and shared ways of working).

3. Planning should maximise independence.

4. Services should be time - orientated- maximum 6 weeks, minimum 1-2 weeks.

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The emphasis lies on the need to provide integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admission, support timely discharge and maximise

independence.

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Conclusion

Transition from hospital to home should involve:

Minimum stress

Careful assessment, planning, implementation and evaluation with full involvement of patients and carers/relatives and particular with

attention to vulnerable patient.

A collaborative, and well coordinated approach with multiple professional/agencies approach.

More intermediate care beds in line with the NSF

Education and training for nurses in Health promotion and advocacy.

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References. Audit Commission (2002) Integrating services for older people.

London: The Stationery Office.

Audit Commission (2000) The way to go home. Oxford: Audit Commission Chiva A. and Stears D. (2001) Promoting the Health of Older People. Buckingham, Open University.

DOH (2001) National Service Framework for Older Adults. London HMSO

DOH (2003) Discharge Handbook. London HMSO.

Grimmer K. Hedges G. Moss J. Staff perceptions of discharge planning: a challenge for quality improvement. [Journal Article, Tables/Charts] Australian Health Review. 1999; 22(3): 95-109. (18 ref)

Henwood M. (2004) Hospital Discharge Integrating Health and Social Care Health and Social Care in the Community. London HMSO.

Magilvy J. and Congdon J (2000) . The Crisis Nature of Health Care Transitions for rural Older Adults Public Health Nursing Vol. 17(5)Sept. Oct.

Tower Hamlets PCT 2004 Discharge policy statement

Waters K. (2001) Sources of support for older people after discharge from hospital: 10 years on, Journal of Advanced Nursing Vol 33 (5) March.