Discharge Planning-Who’s Role Is It Anyway?

Andrea FernsChildren’s Long Term Ventilation Co-ordinatorCARA Service

Children’s Assisted Respiratory Advisory (CARA) Service Andrea Ferns – Discharge Co-ordinator

Gillian Halley – Consultant Intensivist

Ruth Wakeman - Physiotherapist

PICU/HDU/NICU

R.B.H. G.O.S.H Evelina St Thomas’ Chelsea &

Westminster St Mary’s St George’s

Whittington Royal London Kings Cambridge Brighton

PCT Boundaries

London

Bedfordshire

Hertfordshire

Essex

Kent

Surrey

Sussex

Aims and Learning Outcomes Identify the role of the Community

Children’s Nurse in relation to discharge planning for children on long term ventilation

Explain the different roles of ‘key workers’

Consider the responsibilities being placed upon Community Children’s Nursing Services

Guidelines

Hospital to Home – Guidance on discharge management and community support for children using LTV (2005)

National Service Framework (2001)

Together from the Start (2003)

Key Worker - Definition

‘Federal employees who are generally responsible for distributing campaign materials’

Key Worker

Takes responsibility for organizing the discharge

planning for children on long term ventilation

Hospital Team

A named nurse/team from PICU/HDU/NICU is ‘responsible’ for co-ordinating discharge planning from acute setting

Community Nursing Team

A ‘key worker’ will be allocated and ‘responsible’ for co-ordinating discharge and management of child in the community

Starting the Process

Key worker from acute setting contacts the Key worker from the community

Key worker (Community) contacts local authority commissioners

Health Needs Assessment carried out/1st MDT meeting

Funding needs to be agreed in principle

Health Needs Assessment

Who is responsible for carrying out a health needs assessment?

Housing Assessment

Who is responsible?

Equipment List

Who is responsible?

Funding Agreed – What Happens Now?

Timescales Responsibilities Purchase of equipment Recruitment of carers/nurses 2nd MDT meeting

Training of Home Carers

PCT is responsible for training their own carers

Agency/Care Providers are responsible for training their own carers

Competency Training

Competency Guidelines

How often updates required?

Who is responsible for updating the parents/carers?

Final Discharge Arrangements

Date and time for discharge are set in agreement with family

Emergency services/utility services informed

Medical passport

Discharged Home

Implications for Community Children’s Nurses

Training Maintaining skills Resources 24 hour support for carers/parents Time

Aims and Learning Outcomes Identify the role of the Community

Children’s Nurse in relation to discharge planning for children on long term ventilation

Explain the different roles of ‘key workers’

Consider the responsibilities being placed upon Community Children’s Nursing Services

QUESTIONS?

www.longtermventilation.nhs.uk