PROCEDURE FOR THE CARE OF PATIENTS ATTENDING THE DISCHARGE LOUNGE AT THE QUEEN’S MEDICAL CENTRE CAMPUS

DOCUMENTATION CONTROL

Reference
Approving Body
Date Approved
Implementation Date / July 2012
Version / 1
Supersedes / N/a
Consultation Undertaken / Director of Nursing
Matrons
Clinical Leads
Date of Completion of Equality Impact Assessment / May 2012
Date of Completion of We are Here for You Assessment / May 2012
Date of Environmental Impact Assessment (if applicable) / May 2012
Target Audience / All Trust staff involved in discharge of patients
Supporting Documents and References
Review Date / July 2015
Lead Executive / Jenny Leggott
Author / Lead Manager / Penny Tindall/Christine Lincoln
Further Guidance / Information

CONTENTS

Section / Title / Page
1 / 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

1.1Policy 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:

Smooth patient transition from hospital to home or other specified destination.

Improved utilization of the Discharge Lounge

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

The Discharge Lounge is managed within the Acute Medicine Directorate

The Clinical Lead for Acute Medicine and the Matron for DischargeLounge have responsibility for the Discharge Lounge

The Discharge Lounge Manager is responsible for the day to day running of the Discharge Lounge

Clinical staff are responsible for ensuring that the criteria for referral to the Discharge Lounge are followed

5Staffing and Operating Times

The staffing compliment for the Discharge Lounge is:

Band 7 - 1.0 WTE

Band 5 nurses – 5.0 WTE

Health Care Assistants/Band 2 – 8.0 WTE

This staffing level allows Monday to Friday, exclusive of bank holidays, operation of the lounge between the hours of 07:30 to 20:00

This will be reviewed regularly as the service evolves

The lounge will open at 07.30 daily and patients will be accepted and transferred to the lounge up to 19.30.Patients requiring ambulance transport can be transferred to the Discharge lounge up to 18.30.

The lounge will close at 20.00 daily. If it is looking likely that there may be patients on the Discharge lounge after 20.00 due to transport delays, the nurse in charge will escalate to the Duty Nurse Manager. This should be escalated from 6pm onwards to allow DNM 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.

The lounge staff will receive a verbal handover from wards/departments prior to transfer; thiswill 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 electronicsystems.

The Registered Nurse will:

Maintain the effective day to day running of the department

Ensure that the criteria for referral to the Discharge Lounge are followed and maintained

Attend the bed meetings and contact the wardsregularly to identify the patients for transfer to the lounge.

Use Horizon to assist in identifying patients for transfer to the Discharge Lounge

Contactthe correct medical teams to attend the lounge to amend/prescribe TTO’s if not already done so prior to leaving the ward/department

Ensuring patients receive any medications they are due prior to discharge

Ensure patients have a safe mode of transport home (taxi, family, hospital transport) and make necessary arrangements within Trust Policy

Check medication prescriptions with all patients prior to leaving the unit using the ETTO system and ensure patient understanding of these is achieved

Ensure all patients leave hospital with the correct communication, equipment, and dressings

Ensure all patients transferred to the lounge are admitted to both the Notis andHorizon systems to capture arrival and departure times

The Health Care Assistants will:

Support the registered nurse with the day to day running of the lounge

Ensure the dietary and hydration needs of all patients in the lounge are met

Ensureall patients requiring assistance with meeting their activities of daily living have access to help

Assist with nursing care required

Assist with the transfer of patients to the lounge

Act as a runner to pharmacy and other departments

All Staff will:

Act in a professional manner at all times and in accordance with Trust policies.

Ensure all care provided during the patients stay is documented on the Trust nursing documentation in accordance with Trust standards.

6.Physical Environment

The Discharge Lounge is situated on A Floor, South Block at the Queens Medical Campus, sign posted Ward A44

The Lounge is a secure, swipe card access area

The location is close to the A Floor entrance for South Block with easy access for ambulance transport, private transport and relatives/ carers

The environment provides a comfortable seated area where patients can sit, whilst waiting, in addition to 2 single sex bays of 3 beds

Capacity at any one time is for 20 chairs and 6 beds (3 male & 3 female)

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 inorder to include a wide range of patients.

It is anticipated therefore that all adult patients for discharge should be referred andtransferred to the lounge with minor agreed exceptions.

Inclusion criteria:

Adult patients from all wards/departments across the Trust.

All patients whose discharge has been agreed up to 19.30hrs.

All patients must be medically stable and need no further medical input

Patients who are confused may betransferred to the Discharge Lounge following discussion of their individual requirements with the RN in the Discharge lounge.

Exclusion criteria:

End stage palliative care patients

Patients awaiting transfer via Paramedic transport to an acute setting.

Patients who are severely confused and at risk of absconding, or distress due to change of environment.

Patients who have infectionsand require barrier nursing.

8.Management of the Discharge Lounge

The Discharge Lounge is part of the Acute Medicine Directorate and Senior Management is provided by the Acute Medicine 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 transferred to 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 thepatient in a timely fashion.

Lounge staff will:

Amend Notis for all patients transferred to the lounge who are waiting for medications to be dispensed

Discharge Lounge staff will check the status of all patients eTTO.

Lounge staff will check eTTO at status 7/9 and sign off to authorise the TTO.

Discharge lounge staff will check medications against the prescription

Discharge Lounge staff will print off all copies of the Discharge Summary/ TTO and give the patient copy to the patient.

Escalate toDNM/Silver on call if Ward teams are reporting delays in prescribingor dispensing of medications.

Pharmacy will:

Contact the lounge staff regarding any queries or to inform them that medications have been dispensed and ready for collection

Will complete the stages of ETTO as per e Discharge/TTO process

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:

Checking the patient or their relatives are aware of follow up arrangements, care packages, out patient appointments etc.

 All medications are sent with the patient or relatives and there is clear understanding of their use or application

Ensuring that patients are transferred onwards in suitable outdoor clothing

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

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

 Patients may need to be accompanied to their transport and assistance with seating provided where necessary

Patients must be discharged from Notis immediately following patient departure by lounge staff to maintain accurate hospital records

The location of medical notes must be correctly shown on 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:

Essence of Care Benchmarking

4Cs: Complaints, concerns, comments and compliments

Datix Incident reporting

Quality Risk and Safety/ Governance

Patient feedback via Net Promoter.

Feedback from ward areas, colleagues and multi professional team

External visits i.e. CQC, Strategic Health Authority

Patient and Public Initiative involvement

Discharge Lounge Manager and Matron spot checks

15 Steps Challenge

14. Monitoring and Review

This Procedure, its operation and the operation of the procedures will be reviewed every three years by theTrust’s Operation Group.

15.Complaints Procedure

Grievances and complaints regarding the operation of the policy may be progressed through the Trust’s normal complaints/grievance procedures.

16. References and Related Policies and Procedures

Discharge and Transfer Policy

Patient Transport Policy

NUH Medicines Management when patients are discharged from hospital. Medicines Code of Practice

Trust Policy and Procedure for the Safe and effective Handling of Discharge Medication

Trust policy for the internal transfer of the adult patient throughout Nottingham University Hospitals

Business Continuity Policy / Internal Incident Plan

NUH Consent to examination or Treatment Policy

NUH Incident Reporting Policy and Procedures Manual

Mental Capacity Act 2005 Policy and Associated Deprivation of Liberty Safeguards Policy and Codes of Practice

Trust Policy for safeguarding Adults

Care Quality Commission Outcomes

NHSLA Risk management Standards for Acute Trusts

High impact Changes for Service Improvement & Delivery

Trust Major Incident Plan

17.EQUALITY AND DIVERSITY

17.1Equality and Diversity Statement

All patients, employees and members of the public should be treated fairly and with respect, regardless of age, disability, gender, marital status, membership or non-membership of a trade union, race, religion, domestic circumstances, sexual orientation, ethnic or national origin, social & employment status, HIV status, or gender re- assignment.

All trust polices and trust wide procedures must comply with the relevant legislation (non exhaustive list) where applicable:

Equal Pay Act (1970 and amended 1983)

Sex Discrimination Act (1975 amended 1986)

Race Relations (Amendment) Act 2000

Disability Discrimination Act (1995)

Employment Relations Act (1999)

Rehabilitation of Offenders Act (1974)

Human Rights Act (1998)

Trade Union and Labour Relations (Consolidation) Act 1999

Code of Practice on Age Diversity in Employment (1999)

Part Time Workers - Prevention of Less Favourable Treatment Regulations (2000)

Civil Partnership Act 2004

Fixed Term Employees - Prevention of Less Favourable Treatment Regulations (2001)

Employment Equality (Sexual Orientation) Regulations 2003

Employment Equality (Religion or Belief) Regulations 2003

Employment Equality (Age) Regulations 2006

Equality Act (Sexual Orientation) Regulations 2007

17.2Equality Impact Assessment Statement

17.3NUH is committed to ensuring that none of its policies, procedures, services, projects or functions discriminate unlawfully. In order to ensure this commitment all policies, procedures, services, projects or functions will undergo an Equality Impact Assessment.

17.4Reviews of Equality Impact Assessments will be conducted inline with the review of the policy, procedure, service, project or function

18.Environmental Impact Assessments

18.1The purpose of an Environmental Impact Assessment is to make sure that when carrying out its public functions (or implementing policies and practices related to those functions) the trust considers the likely impact of the policy in causing change to the environment, and whether this change is harmful or helpful. This may involve direct effects such as changes in the use of resources, waste levels, or energy, (as some examples). Further guidance on environmental impacts may be found in:

Sustainable Development - Environmental Strategy for the National Health Service (

Sustainable Operations on the Government Estate (

18.2Policies will not be accepted for ratification without a completed Environmental Impact Assessment.

19.We Are Here For You Mission Statement

19.1 This Trust is committed to providing the highest quality of care to our patients, so we can pledge to them that ‘ we are here for you’. This Trust supports a patient centred culture of continuous improvement delivered by our staff. The Trust established the Values and Behaviours programme to enable Nottingham University Hospitals to continue to improve patient safety, outcomes and experiences. The set of twelve agreed values and behaviours explicitly describe to employees the required way of working and behaving, both to patients and each other, which would enable patients to have clear expectations as to their experience of our services.

APPENDIX 1

EQUALITY AND DIVERSITY IMPACT REPORT

1.Name of Policy or Service

Discharge Lounge Operational Policy

2.Responsible Manager

Discharge Lounge Manager

3. Name of Person Completing Assessment

Christine Lincoln

4.Date EIA Completed

4th May 2012

5.Description and Aims of Policy/Service (including relevance to equalities)

This procedure is for use on Nottingham University Hospitals NHS Trust Queens campus to assist with the management of the transfer and care of patients to the Discharge Lounge.

6.Brief Summary of Research and Relevant Data