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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

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ap

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stig

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st

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licy fo

r R

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Com

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Issuin

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roto

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Nu

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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.)