Nurse Led Discharge15)263NurseLedDischarge.pdfabove, will be assessed and supported by a Nurse Led...

Source: Lesley Standring – Service Manager – Acute Medicine 2

Sharon Basson – Specialist Discharge Planning Nurse

Issue date: April 2015 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





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.





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





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





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: _____________

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Patient Information

Nurse Led Discharge

West Suffolk Hospital NHS Trust

Hardwick Lane

Bury St Edmunds

Suffolk IP30 2QZ

Tel: 01284 713000

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

APPENDIX 5

West Suffolk Hospital NHS Trust

Nurse Led Discharge

Competency Workbook

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.


(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.




Criteria – Competency 3

Understands acceptable ranges for blood

tests/investigations/observations.


(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.




Criteria – Competency 4

Demonstrate effective discharge planning skills.


(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.




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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

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