The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [54]
2 An expected date of discharge must be established and the patient should be aware of this. To ensure planning for discharge commences (Biddington 2000, C).
3 Clarify whether the patient has dependants, for example elderly relatives, children or a disabled partner, who require care/support. If so, establish who is looking after them and whether they receive any services. Arrangements may need to be made for alternative carers or an increase in services. Notification may need to be made, for example to school nurse/teacher if patient has children at school. E
4 Establish who else is involved in giving care/support and the type of help given, for example local support group, voluntary agency, church. To assess the support that the patient and carers may require at home so that appropriate services can be mobilized. To establish social network in order to co-ordinate care between voluntary and statutory agencies. E
5 Ascertain the type of accommodation the patient is living in, for example house, bungalow (council or privately owned), residential or nursing home, sheltered housing. To identify any potential accommodation needs which may entail social work intervention, adaptations or housing advice re unsuitable accommodation or homelessness. E
6 Ensure that the home address and telephone number of the patient are documented accurately in the care plan. Establish where the patient will be going on discharge and document the discharge address if different from the permanent address. Personal information may not have been updated on previous nursing or medical records. It is crucial that this information is accurate when making referrals to community services, to ensure appropriate service provision. E
7 Ensure that the patient is registered permanently with a GP, and with a GP on a temporary basis if going to a different address on discharge. Check the names, addresses and telephone numbers with the patient. Community nursing services are unable to accept the patient without medical support. Accurate information is required to establish which District Nurse will have responsibility for patient care. It is important for the patient that medical care can be provided at home. E
8 Establish whether any statutory community health or Social Services have been involved before the patient’s admission. Include the health visitor when the patient has children under the age of 5 years. To enable contact for exchange of information. Valuable information can be obtained from community services to assist in assessing potential needs on discharge (DH 2003a, C).
Procedure
9 Assess the patient’s ability to carry out activities of daily living at home prior to admission, for example were they able to climb stairs? Consider patient’s current level of functioning and whether this will change as a result of treatment and/or rehabilitation. To establish at an early stage whether an occupational therapy/physiotherapist assessment is required. Home assessment by occupational therapy may be required prior to discharge, which may involve complex planning and preparation (DH 2001c, C; Kumar 2000, E).
10 Refer to other hospital personnel as soon as potential needs are recognized, for example occupational therapist, physiotherapists, dietitian, speech and language therapist. Referral as soon as possible after admission is essential: do not wait until treatment is completed and discharge is imminent. To ensure multidisciplinary planning and co-ordination. Considerable time may be needed to arrange community services and early referral helps to prevent discharge delays. E
11 Patients identified as requiring local authority Social Services support are referred to the Social Services department. Some hospitals use a ‘trigger’ form as an aid to assessment, an example of which can be found in Box 2.15. To ensure early and appropriate referral to the Social Services department for assessment. E
12 A discharge planning care plan should