Transfer Checklist to Ascot House IMC Beds for Hospital Discharges
Your patient has been screened and is appropriate for a rehab bed at Ascot House, Ascot Avenue, Sale M33 4GT. The Main Office at Ascot House (tel: 0161 912 2664/ 2666, fax: 0161 973 0718) will contact the ward when a bed is available for your patient. Complete this form and the Infection Control Transfer Form when you have received a call from Ascot House and you have been advised to start planning the patient’s transfer. Ascot House will advise you of what to do with the completed forms.
Patient Name:…………………………………….…….. NHS Number:…………………………
Checklist Item / Complete √ / Initials of nurse completing form1 / You have ensured that the patient still meets the criteria for admission to Ascot House.
2 / You have gained verbal consent from the patient agreeing to participate in rehabilitation at Ascot House. Signed consent will have been obtained during face to face screening.
3 / Patient has been informed about the purpose of the transfer and that the maximum anticipated stay will be 21 days.
4 / The patient’s next of kin have been informed of the transfer and location of the unit.
5 / All equipment patient currently requires comes with the patient on transfer to the unit (eg walking aid)
6 / Transport is booked, when admission date has been arranged with the Main Office at Ascot House. Where applicable, ambulance service have been informed of equipment to accompany the patient. (Tel: 0800 023 2292)
7 / Two weeks of medication is ready to accompany the patient in a way the patient is able to manage (eg venalink/ out of packets). This is to include nutritional supplements, creams and dressings.
8 / Medical discharge summary is with the patient on transfer including any summary of GP history and of current admission.
9 / Copies of therapy goals and reports to be included.
10 / Where appropriate, anticoagulation clinic is aware of the transfer. **Please send information to Trafford General Hospital**
*If a patient is on Enoxaparin please ensure that the duration for continuation is stipulated and that prescription by the appropriate person has been arranged*
11 / Please document any outstanding clinic appointments and indicate if transport has been booked
Comments:
12 / Patient is free from diarrhoea and vomiting and has been for the past 48 hours.
Infection control transfer form has been completed
13 / If patient has nursing needs, please refer to DN liaison ASAP (eg injections, pressure relief, dressings etc)
14 / If dressings are required, a supply of dressings are to be sent with patient
15 / Nursing transfer letter with patient on transfer
Clinicians Name:………………………………… Date and Time:………………….