nurse led discharge15)263nurseleddischarge.pdfabove, will be assessed and supported by a nurse led...
TRANSCRIPT
Source: Lesley Standring – Service Manager – Acute Medicine 2
Sharon Basson – Specialist Discharge Planning Nurse
Issue date: April 2015 Page 1 of 16
Status: Final Review: April 2018 PP(15)263
Trust Policy and Procedure Document ref. No PP(15)263
Policy for Nurse Led Discharge
For use in (clinical areas): All clinical areas within Medicine
For use by (staff groups): All clinicians
For use for (patients): All patients suitable for Nurse Led Discharge
Document owner: Lesley Standring
Status: Approved
Introduction
Nurse Led Discharge has been identified by the Department of Health (DH) as key to shaping the future of nursing (DH, 2000).
Approximately 80% of patients discharged from hospital can be classified as ‘simple’ discharges. These are patients discharged to their own homes who have chronic healthcare needs that can be met without complex planning and delivery (DH, 2004).
The potential for nurses to improve patient discharge has long been recognised. Following on from the Chief Nursing Officer’s Ten Key Roles for Nurses, ‘to admit and discharge patients for specified conditions and within agreed protocols’ (DH, 2000), the DH recommended that senior nurses should be empowered to facilitate the discharge of patients (DH, 2004). The principle of Nurse Led Discharge is supported in Discharge from hospital: pathway, process and practice. (DH, 2003).
Purpose of the Policy
The purpose of this policy is to provide a clear framework for the appropriate level of nurse to facilitate Nurse Led Discharge within the West Suffolk Hospital.
Senior band 5 Registered Nurses (with at least one year’s post registration experience) and above, will be assessed and supported by a Nurse Led Discharge Workbook (Appendix 3). On satisfactory completion they will then be able to take on the role.
There are several advantages to nurse led discharge:
* It promotes effective inter-disciplinary working
* It makes effective use of nursing knowledge and skills
* It allows patients to be discharged as soon as they are ready
* It increases bed availability through prompt discharge
Source: Lesley Standring – Service Manager – Acute Medicine 2
Sharon Basson – Specialist Discharge Planning Nurse
Issue date: April 2015 Page 2 of 16
Status: Final Review: April 2018 PP(15)263
Contents Page
Guidelines for Nurse Led Discharge 1
Nurse Led Discharge orange sticker (Appendix 1) 6
Patient information leaflet (Appendix 2) 9
Nurse Led Discharge Workbook (Appendix 3) 12
Objectives
To expedite safe, effective patient discharge that meets the needs of patients and significant others.
To promote interdisciplinary working.
To develop the partnership between patients, carers and professionals, which are fundamental to discharge planning.
To utilise the knowledge and skills of the senior nursing teams.
To reduce length of stay and avoid untoward delays in discharge.
To whom the guidelines apply
All patients for whom the Consultant team has agreed the criteria which needs to be met prior to discharge and they have completed the Nurse Led Discharge orange sticker (Appendix 1)
All patients to be given a Patient Information Leaflet
To whom guidelines DO NOT apply
Patients who decline.
Action to be followed for patients who do not wish to comply with these guidelines
Patients Consultant to be informed, Patient to revert to medically led discharge.
Staff authorised to take responsibility for Nurse Led Discharge
Senior band 5 Registered Nurses and above (at least one year post-registration). All are aware of the NMC Code (NMC, 2015) and have been assessed as competent by Assessor using Nurse Led Discharge Workbook. (Assessor to be competent and confident in discharge policy and practice).
Nurses involved with Nurse Led Discharge must accept accountability for their practice, maintain up to date knowledge and skills and be familiar with and demonstrate understanding of the document noted above (NMC, 2015) and The West Suffolk Hospital Discharge Planning Policy.
The Nurse Led Discharge Workbook will be completed by the Assessor and kept on the nurse’s personal file on the ward with copies kept by the Matron for the area and the Discharge Planning Team.
Reassessment of skills and competence will take place after one year.
Source: Lesley Standring – Service Manager – Acute Medicine 2
Sharon Basson – Specialist Discharge Planning Nurse
Issue date: April 2015 Page 3 of 16
Status: Final Review: April 2018 PP(15)263
Doctor’s role and responsibility
Senior Doctor
The consultant is responsible for ensuring the information in the criteria to be met prior to discharge is correct and that they sign the form Nurse Led Discharge orange sticker (appendix 1).
To support senior nursing staff when identifying patients for the scheme.
Middle Grade Doctor
To work closely with the multidisciplinary team to identify suitable patients for the scheme, support junior medical staff.
Junior Doctor
To ensure investigations as required are requested in a timely fashion
To draft Inpatient Discharge Summary and TTO’s as soon as the patient is identified as suitable for Nurse Led Discharge.
Procedure
All patients must have met the set criteria agreed by the Consultant [or a person designated by them] together with a ward/unit senior nurse. This decision must be documented on the patients Nurse Led orange sticker in notes, along with the date suitable for Nurse led discharge. From this point, the Consultant and team will not review the patient during ward round, unless requested by nursing staff.
TTO’s must be prescribed, Inpatient Discharge Summary must be completed (EPRO).
The role of the Discharge Planning Team will remain the same
Community teams can be contacted via Single Point of Access referral (SPA). Discharge Health Assessment document to be completed for patients discharged to residential or nursing home settings.
At discharge the Nurse Led Discharge leaflet (Appendix 2) should be given by the nurse to the patient.
References:
Department of Health 2003 Discharge from hospital: pathway, process and practice. London. The Stationery Office. Department of Health 2004 Achieving timely ‘simple’ discharge from hospital – a toolkit for the MDT. London. Stationery Office. Nursing and Midwifery Council (2015) The Code: standards of conduct, performance and ethics for nurses and midwives. London. NMC
Source: Lesley Standring – Service Manager – Acute Medicine 2
Sharon Basson – Specialist Discharge Planning Nurse
Issue date: April 2015 Page 4 of 16
Status: Final Review: April 2018 PP(15)263
Development of the Policy
Statement of clinical evidence
The guideline is based on recognised published evidence from the Department of Health, as noted above.
Contributors and peer review
Rehab wards piloted the paperwork
Matrons
Ward managers
District Nurse (Sudbury)
No major issues arose but paperwork was amended to make it easier to use.
District Nurses were afraid that the process might increase the number of weekend discharges which it may but the fact that they would be planned has allayed their fears.
Document configuration information
Author(s): Lesley Standring, Service Manager, Acute medicine 2
Other contributors: Matrons, discharge planning, District Nurses (Sudbury).
Approvals and Endorsements: Nursing and Midwifery Practices and Policies Group
Consultation: Nursing and Midwifery Practices and Policies Group.
File name: Nurse Led Discharge Policy.
Supercedes: PP(11) 263
Equality Assessed: Nursing and Midwifery Practices and Policies Group.
Implementation: Discharge Planning Advanced Practitioner.
Monitoring (Give brief details of
how this will be done):
Audit.
Other relevant policies/documents
& references:
West Suffolk Hospital Discharge Planning Policy.
Additional Information: n/a
Source: Lesley Standring – Service Manager – Acute Medicine 2
Sharon Basson – Specialist Discharge Planning Nurse
Issue date: April 2015 Page 5 of 16
Status: Final Review: April 2018 PP(15)263
APPENDIX 1 – (stick in Patient notes on commencing nurse led discharge)
Nurse –Led Discharge TO BE COMPLETED BY CONSULTANT/REGISTRAR (Delegated responsibility)
PROBLEM LIST ACTION CRITERIA TO BE MET PRIOR TO DISCHARGE
TTO’S Prescribed: YES……. NO…….
Signed: __________________ Print Name: _________________ Date: _____________
Introduction This leaflet gives you information about this important stage in
your care in the West Suffolk Hospital.
Our Aim
Our aim is to ensure that you receive the right care in the right
place at the right time, by the staff who have the right skills to
deliver it.
Nurse Led Discharge
Your consultant has advised that you are medically fit and do not
require a doctor to be involved in your care. (Should you become ill
at any time whilst you are in the hospital you will be placed back
under the care of your consultant). You are now suitable for Nurse
Led Discharge.
From today, the consultant and his/her team will not visit you when
they do their ward round.
A nurse on your ward will be responsible for ensuring your safe and
timely discharge.
The name of the Nurse leading your discharge is
……………………………………
The team caring for you have discussed and agreed the criteria,
which needs to be met prior to your discharge. The nurse is
responsible for ensuring the criteria is met.
Nurses are best placed to discuss and plan your discharge with you.
They have close working relationships with other members of the
team including physiotherapists; occupational therapists and social
care services. They are available to discuss any concerns you may
have and to talk to your family if you wish.
Your nurse will talk to you and your family/carers about the things
needed for your discharge. She will contact your GP and ensure he
is aware of your discharge.
If the nurse responsible for planning your discharge is not on duty
then you may speak to any member of the nursing team.
Should you have any problems following your discharge please
contact you own doctor.
Author: 5142-1
Lesley Standring
Issued:
April 2015
Review date:
April 2018
Nurse led discharge (NLD) aims to empower the nurse to facilitate early decision making around the safe
discharge of patients with ‘simple’ discharge needs. The nurse is able to discharge a patient whom a senior
doctor has designated as medically fit, if certain documented criteria are fulfilled.
Staff undertaking this role must refer to the West Suffolk Hospital Policy for Nurse Led Discharge.
Knowledge and skills required to undertake this role;
• A minimum of one year post-registration experience.
• Completion of West Suffolk Hospital Trained Nurse Induction training.
• Up to date with mandatory training.
• Completion of all competencies as set out in this Workbook.
• Awareness and understanding of the Nursing and Midwifery Code of Conduct (NMC,
2008).
• Familiar with the West Suffolk Hospital Policy for NLD, and the documentation within it.
• Understanding of the accountability and responsibilities within the scope of NLD.
• Understands the process of data collection for the purpose of audit.
• Reassessment of knowledge and skills one year post completion of Workbook.
Criteria for Assessors;
• Competent and confident in NLD.
• Competent and confident in discharge planning processes.
• Familiar with WSH Policy for Discharge Planning.
• Successfully completed Preparation for Mentorship module (ENB 998), or equivalent.
Criteria - Competency 1
Understands the accountability and responsibility of
Nurse Led Discharge
Level of achievement
(date and sign)
Knowledge 0 1 2 3
Discuss the responsibilities of the Nurse Led
Discharger.
Discuss accountability of the role of Nurse Led
Discharger.
Discuss the medical responsibilities in relation to
Nurse Led Discharge.
Skills
Demonstrates familiarity and understanding of the
West Suffolk Hospital Policy for Nurse Led
Discharge.
Final level of achievement __________________________ Date __________________
Signature of Nurse ________________________________
Signature of Assessor ______________________________
Criteria - Competency 2
Can apply the principles of effective and accurate
documentation.
Level of achievement
(date and sign)
Knowledge 0 1 2 3
Familiar with and able to discuss NMC Record
Keeping Guidelines for Nurses and Midwives.
Familiar with the documentation used within the
Policy for Nurse Led Discharge.
Skills
Able to discuss the importance of documentation for
the purposes of audit.
Able to discuss the importance of accurate recording
of test results/investigations/observations.
Final level of achievement __________________________ Date __________________
Signature of Nurse ________________________________
Signature of Assessor ______________________________
Criteria – Competency 3
Understands acceptable ranges for blood
tests/investigations/observations.
Level of achievement
(date and sign)
Knowledge 0 1 2 3
Can identify acceptable ranges for:
- temperature, pulse, blood pressure.
- respirations, oxygen saturations.
- urinalysis.
Can identify normal blood values for haematology.
Can identify normal blood values for biochemistry:
U&E’s.
Skills
Is able to access test results from the Pathology
system.
Final level of achievement __________________________ Date __________________
Signature of Nurse ________________________________
Signature of Assessor ______________________________
Criteria – Competency 4
Demonstrate effective discharge planning skills.
Level of achievement
(date and sign)
Knowledge 0 1 2 3
Familiar with and able to discuss West Suffolk
Hospital Policy for Discharge Planning.
Familiar with West Suffolk Hospital Policy for Nurse
Led Discharge documentation.
Skills
Demonstrate understanding and awareness of the
multidisciplinary team.
Demonstrate understanding and awareness of
procedures for referral to outside agencies (including
Adult and Community Services).
Able to access and proficient in use of LOSPT.
Identify and effectively use the resources available to
support the safe discharge of patients.
Describe the course of action to be taken if the patient
does not meet the documented criteria set for Nurse
Led Discharge.
Final level of achievement __________________________ Date __________________
Signature of Nurse ________________________________
Signature of Assessor ______________________________
Page 16 of 16
NURSE LED DISCHARGE COMPETENCIES
This is to verify that
Name of Nurse: __________________________________________________
Clinical Area/Ward: __________________________________________
Has successfully completed all competencies within the Policy for Nurse Led Discharge.
Date: ______________ Signature of Assessor: _____________________
Name of Assessor: ______________________________________________
________________________________________ (Name of Nurse) can now undertake the role of Nurse Led
Discharger for patients within their own ward area.
Reassessment of knowledge and skills to take place by ________________________
Copies to: Discharge Planning Team
Ward Manager
Senior Matron for area