PROCEDURE FOR THE CARE OF PATIENTS ATTENDING THE DISCHARGE LOUNGE AT THE QUEEN’S MEDICAL CENTRE CAMPUS
DOCUMENTATION CONTROL
ReferenceApproving Body
Date Approved
Implementation Date / April 2015
Version / 2
Supersedes / Version 1, July 2012
Consultation Undertaken / Director of Nursing
Matrons
Clinical Leads
Date of Completion of Equality Impact Assessment / April 2015
Date of Completion of We are Here for You Assessment / April 2015
Date of Environmental Impact Assessment (if applicable) / April 2015
Target Audience / All Trust staff involved in discharge of patients
Supporting Documents and References
Review Date / April 2016
Lead Executive
Author / Lead Manager
Further Guidance / Information
CONTENTS
Section / Title / Page1 / Policy statement and aim / 3
2 / Objectives / 3
3 / Scope of the document / 3
4 / Roles and responsibilities / 3
5 / Staffing and operational times / 4
6 / Physical environment / 6
7 / Patient criteria / 6
8 / Management of discharge lounge / 7
9 / Untoward incidents and medical emergencies / 7
10 / Catering arrangements / 8
11 / Pharmacy arrangements / 8
12 / Discharge from the lounge / 9
13 / Quality assurance and monitoring / 9
14 / Monitoring and review / 10
15 / Complaints procedure / 10
16 / References and related policies and procedures / 10
17 / Equality and diversity / 11
18 / Environmental Impact Assessment / 12
19 / We are here for you mission statement / 12
Appendix 1 / Equality and diversity report
Appendix 2 / We Are Here for You Toolkit Assessment
Appendix 3 / Certificate of employee awareness
1. INTRODUCTION
1.1 Policy statement and Aim
This document has been developed to outline the prescribed procedure to be followed routinely for the daily operation of the Discharge Lounge, based at the Queens Medical Campus, located on Ward A44, A Floor South Block.
It will define the roles and responsibilities of the staff which will support the safe and effective discharge of adult patients from the Trust.
2. Objectives
By adhering to this policy, Nottingham University Hospitals NHS Trust should achieve the following:
Ø Smooth patient transition from hospital to home or other specified destination.
Ø Improved utilization of the Discharge Lounge
Ø Timely availability of beds on inpatient wards, improving patient flow across the Trust Patients will have a positive and comfortable experience of the Discharge Lounge
3. Scope of the Document
This document applies to all staff Trust wide. This operational policy is a working document and will be subject to amendment and modification as the function and operation of the lounge evolves.
4. Roles and responsibilities
Ø The Discharge Lounge is managed within the Health Care of Older People speciality, Acute Medicine Directorate
Ø The Clinical Lead for HCOP and the Matron for Discharge Lounge have responsibility for the Discharge Lounge
Ø The Discharge Lounge Manager is responsible for the day to day running of the Discharge Lounge
Ø Clinical staff are responsible for ensuring that the criteria for referral to the Discharge Lounge are followed
5 Staffing and Operating Times
The staffing compliment for the Discharge Lounge is:
Ø Band 7 - 1.0 WTE
Ø Band 6- 0.8 WTE
Ø Band 5 nurses – 6.4 WTE
Ø Health Care Assistants/Band 2 – 13.0 WTE ( 2.0 WTE are cohort falls nurses)
Ø This staffing level allows operation of the lounge between the hours of 08:00 to 19:00 Monday to Friday, and 09.00 to 17.00 Saturday to Sunday, including bank holidays,
Ø This will be reviewed regularly as the service evolves
The lounge will open at 08.00 daily and patients will be accepted and transferred to the lounge up to 17.00. Patients requiring ambulance transport can be transferred to the Discharge lounge up to 15.30.
The lounge will close at 19.00 daily, Monday-Friday and at 17.00Saturday -Sunday including bank holidays. If it is looking likely that there may be patients in the Discharge Lounge after 19.00 Monday to Friday and after 17.00 Saturday -Sunday including bank holidays due to transport delays, the nurse in charge will escalate to the Duty Nurse Manager. This should be escalated from 5pm onwards Monday - Friday and from 3pm Saturday - Sunday including bank holidays to allow DNM time to liaise with transport providers and make appropriate arrangements for the patients
The transferring of patients to the lounge will be facilitated by the Discharge Lounge staff supported by Silver On Call, Duty Nurse Manager, Directorate Bed Managers, ward teams and Trust support staff.
The lounge staff will endeavour to collect patients in a timely manner after receiving the referral (time taken to collect is influenced by the location of the lounge and the transferring ward), but priority will be given to areas under most pressure as directed by the Silver on call.
Patients will be identified at 10.00 bed meeting who are definite and potential discharges, the RN on duty for the Lounge each day will attend the bed meetings. The RN attending the 16.00 bed meeting will identify patients for discharge who can go to the Discharge Lounge the following morning before breakfast.
The lounge and support staff can readily collect 1 piece of luggage; however it is the ward staff responsibility to encourage relatives where possible to take additional patient’s property off the ward prior to discharge, and to inform the lounge staff if there is more luggage or equipment to travel with the patient, and to assist with the transfer as required.
The lounge staff will receive a verbal handover from wards/departments prior to transfer; this will include clinical condition and information around discharge.
A daily record will be kept of all patients’ arrivals and discharge to and from the lounge, in addition to data added to Trust electronic systems.
The Registered Nurse will:
Ø Maintain the effective day to day running of the department
Ø Ensure that the criteria for referral to the Discharge Lounge are followed and maintained
Ø Attend the bed meetings and contact the wards regularly to identify the patients for transfer to the lounge.
Ø Use Horizon to assist in identifying patients for transfer to the Discharge Lounge
Ø Contact the correct medical teams to attend the lounge to amend/prescribe TTO’s if not already done so prior to leaving the ward/department
Ø Ensuring patients receive any medications they are due prior to discharge
Ø Ensure patients have a safe mode of transport home (taxi, family, hospital transport) and make necessary arrangements within Trust Policy
Ø Check medication prescriptions with all patients prior to leaving the unit using the ETTO system and ensure patient understanding of these is achieved and documented
Ø Ensure all patients leave hospital with the correct communication, equipment, and dressings
Ø Ensure all patients transferred to the lounge are admitted to both the Medway Pas, Notis and Horizon systems to capture arrival and departure times
The Health Care Assistants will:
Ø Support the registered nurse with the day to day running of the lounge
Ø Ensure the dietary and hydration needs of all patients in the lounge are met
Ø Ensure all patients requiring assistance with meeting their activities of daily living have access to help
Ø Assist with nursing care required
Ø Assist with the transfer of patients to the lounge
Ø Act as a runner to pharmacy and other departments
All Staff will:
Ø Act in a professional manner at all times and in accordance with Trust policies.
Ø Ensure all care provided during the patients stay is documented on the Trust nursing documentation in accordance with Trust standards.
6. Physical Environment
Ø The Discharge Lounge is situated on A Floor, South Block at the Queens Medical Campus, sign posted Ward A44
Ø The Lounge is a secure, swipe card access area
Ø The location is close to the A Floor entrance for South Block with easy access for ambulance transport, private transport and relatives/ carers
Ø The environment provides a comfortable seated area where 2 lounges provide single sex patients seating areas were patients can can sit, whilst waiting, in addition to 4 single sex bays of 3 beds
Ø Capacity at any one time is for 32 chairs and 12 beds (6 male & 6 female)
Ø Television, radio, games and newspapers are available.
7. Patient Criteria
The aim of the Discharge Lounge is that the criteria should be as broad as possible in order to include a wide range of patients.
It is anticipated therefore that all adult patients for discharge should be referred and transferred to the lounge with minor agreed exceptions.
Inclusion criteria:
Ø Adult patients from all wards/departments across the Trust.
Ø All patients whose discharge has been agreed and is achievable up to 18.30hrs Monday-Friday and 1630hrs Saturday-Sunday including bank holidays.
Ø All patients must be medically stable and need no further medical input
Ø Patients who are confused may be transferred to the Discharge Lounge following discussion of their individual requirements with the RN in the Discharge lounge. A cohort area is available, dependant on staffing levels.
Exclusion criteria:
Ø End stage palliative care patients
Ø Patients awaiting transfer via Paramedic transport to an acute setting.
Ø Patients who are internal transfers ie no inter hospital transfers should go to Discharge Lounge.
Ø Patients who are severely confused and at risk of absconding, or distress due to change of environment.
Ø Patients who have infections and require barrier nursing.
8. Management of the Discharge Lounge
The Discharge Lounge is part of the HCOP speciality of the Acute Medicine Directorate and Senior Management is provided by the HCOP Clinical Lead and Matron.
Operational management and policy development is the responsibility of the Acute Medicine Clinical Lead, Matron and the Discharge Lounge Manager.
Daily management of the Discharge Lounge is provided by the Lounge Manager.
9. Untoward Incidents and Medical Emergencies
All normal Trust policies will apply. Patients remain under the care of the consultant team who have provided care for them on the Wards or Departments. In the event of a relapse or medical emergency the patient’s consultant team will be contacted and arrangements made for the patient to be reviewed. If the consultant team is not available then the team on call for that speciality should be contacted. In the event of cardiac arrest in the lounge, the cardiac arrest team will be called by dialling 2222 and resuscitation commenced by the lounge staff, in line with the Trust resuscitation training policy. Full resuscitation equipment is available on the Discharge Lounge.
10. Catering Arrangements
Any special dietary requirements must be identified on referral to the lounge incorporated in the handover and recorded in the transfer letter. It is essential that the catering department are informed by the lounge staff, of those patients who require meals. This should be done as early as possible to allow meals to be ordered by the lounge and prevent service duplication
All patients will be assisted with hydration and nutrition whilst in the lounge. Light refreshments, snacks and drinks are served by the lounge staff. Hot meals can be ordered on an individual basis.
11. Pharmacy Arrangements
It is essential that pharmacy is aware of patient movements to ensure that medications reach the patient in a timely fashion.
Lounge staff will:
Ø Amend Notis/ Medway for all patients transferred to the lounge who are waiting for medications to be dispensed
Ø Discharge Lounge staff will check the status of all patients eTTO.
Ø Lounge staff will check eTTO at status 7/9 and sign off to authorise the TTO.
Ø Discharge lounge staff will check medications against the prescription
Ø Discharge Lounge staff will print off all copies of the Discharge Summary/ TTO and give the patient copy to the patient.
Ø Escalate to DNM/Silver on call if Ward teams are reporting delays in prescribing or dispensing of medications.
Pharmacy will:
Ø Contact the lounge staff regarding any queries or to inform them that medications have been dispensed and ready for collection
Ø Will complete the stages of ETTO as per e Discharge/TTO process
Ø Will support the lounge by being available to come and discuss any medication issues with patients that cannot be dealt with by the registered nurse.
12. Discharge from the Lounge
Discharge Lounge staff, are responsible for ensuring that patients are discharged safely from the hospital.
This can be achieved by:
Ø Checking with the base ward, patient and relative/carer the patient’s discharge destination
Ø Checking the patient or their relatives are aware of follow up arrangements, care packages, out patient appointments etc.
Ø All medications are sent with the patient or relatives and there is clear understanding of their use or application
Ø Ensuring that patients are transferred onwards in suitable outdoor clothing
Ø Check that arrangements are in place for the patient to be received by someone at their onward destination where appropriate and that there are facilities for food and a hot drink when they arrive there. Snack boxes can be ordered for patients being discharged to an empty house
Ø Provide all patients with the opportunity to use the toilet before they leave, where the onward journey may be prolonged depending upon traffic and the time of departure
Ø Patients may need to be accompanied to their transport and assistance with seating provided where necessary
Ø Patients must be discharged from Medway Pas/ Notis immediately following patient departure by lounge staff to maintain accurate hospital records
Ø The location of medical notes must be correctly shown on Medway Pas
It is essential that the lounge staff appraise each patient individually and fully to ensure the patients safety and security in the transfer of care process.
13. Quality Assurance & Monitoring
The quality of care will be monitored through:
Ø Essence of Care Benchmarking
Ø 4Cs: Complaints, concerns, comments and compliments
Ø Datix Incident reporting