Introducing discharge planning

In the psychiatric inpatient setting

Carmen Barnard

Discharge Planning Nurse

Spencer Clinic Inpatient Unit

Consultant psychiatristTwo CMO’sRMOPharmacistSocial workerRegistered nursesRegistered nursesEnrolled nursesAttendantsNurse Unit ManagerLegal Orders CoordinatorAdmin staff Discharge Planning Nurse

• “…a dynamic, comprehensive, and collaborative process that should be started at the time of admission and its purpose is to identify the client’s plans and the support which the client and caregiver would require after exiting from psychiatric unit” (Alghzawi, 2012, pp 1).

• “…the systematic identification and organisation of services and supports • “…the systematic identification and organisation of services and supports to assist patients to manage in the community post-discharge” (Grimmer et al, 2006, pp 1)

• “…a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location.” (Coleman and Berenson, 2004, pp 533).

1. Appropriate and timely discharge planning for each patient

2. Discharge planning is the responsibility of all health care providers involved

3. Multidisciplinary approach

4. A documented discharge plan should commence as soon as possible

5. Patient and carer should be involved during all stages

6. Discharges should be timely and linked to appropriate services

7. Ongoing communication between services and the ward

A voluntary patient, not detainable under the MHA, insisted on being discharged. the MHA, insisted on being discharged. Their home was not fit for habitation. They need new accommodation they can move into immediately.

• Creation of a draft statement of duties

• Initial role definition

• Membership on the Maximising Recovery Panel

• Getting around staff shortages

• Increasing staff understanding of role

• Learning of available community resources

• Referred to other departments for advice

• Liaised with community mental health services about identified gaps/problem areas

• Found a file on the computer with a range of • Found a file on the computer with a range of resources the social worker utilises

• Researched the principles of discharge planning

• Case managers identified a delay in receiving discharge summaries. They were often making a first appointment with the client without the discharge summary.summary.

• Trialled a discharge plan that communicated the plan and other pertinent information particularly admission details and community risk factors.

• Introduced an initiative where the DPN would call discharged clients within 72 hours to ensure that the discharge plan has happened ensure that the discharge plan has happened as arranged and if not would double check referrals had gone through. It was an attempt to fix problems before they resulted in readmission.

• Accreditation

• Procedure development

• Continuing role definition• Continuing role definition

• Quality improvement/research

• Audits

• Networking

• Alghzawi, H. 2012. Psychiatric discharge process. International Scholarly Research Network. Volume 2012. Page 1-7.

• Coleman, E, 2003, “Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs”, JAGS, 51, pp 549-555.

• Coleman, E, & Berebson, R, 2004, ‘Lost in translation: challenges and opportunities for improving the quality of transitional care’, Annals of Internal Medicine, 140, pp 533-536.

• Department of Veterans’ Affairs, 2003, Discharge Planning Resource Kit, Department of • Department of Veterans’ Affairs, 2003, Discharge Planning Resource Kit, Department of Veterans’ Affairs, Australia.

• Grimmer, K., Moss, J., Falco, J., & Kindness, H. 2006. Incorporating patient and carer concerns in discharge plans: the development of a practical patient-centred checklist. The internet Journal of Allied Health Sciences and Practice. Vol 4. No 1. Pp 1 -8.

• Walker, S, & Eagles, J, 2002, “Discharging psychiatric patients from hospital”, Psychiatric Bulletin, 26, pp 241.241

• Wikimedia Commons: http://commons.wikimedia.org/wiki/Category:Photographs

• http://www.hse.ie/eng/services/Publications/services/Hospitals/Code_of_Practice_for_Integrated_Discharge_Planning.html

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