The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [56]
27 Ensure that the patient has a door key and can gain entrance to their residence. Wherever possible, ensure that someone is at home to receive the patient. The patient may have left their key with a neighbour. It is helpful for someone to be available to welcome the patient and attend to any immediate needs. E
28 Book transport if required with 48 hours’ notice, using relevant form. Specify if patient needs a stretcher or chair, or requires escort. Ensure that transport is also booked for return clinic appointment if necessary. The patient may not have private transport facilities and may be too weak to use public transport. E
29 Cancel transport if discharge date or outpatients department appointment is altered. To prevent a waste of resources. E
30 Patients should be given an appropriate supply of medication and, where necessary, a supply of wound dressings or medical equipment. The community nurses should be informed about exactly what the patient is being discharged with; they may require a signed prescription. To ensure the safe and continuous administration of medication and use of equipment at home. Time is needed to obtain supplies in the community. E
31 Discharge plans should not be altered without consultation with all the hospital personnel who have been involved in the planning, for example occupational therapist, social worker, discharge co-ordinator, and also patient/family/carers. If there is no consultation this causes considerable confusion and stress for the patient/carers, and all involved services. It may result in the patient being unsupported at home. E
32 If discharge is cancelled or postponed, or if the patient dies, ensure that all relevant community services are informed. To avoid distress to relatives. To avoid wasted visits and promote good community relations. E
33 Weekend discharge: patients who require a high level of health and Social Services support should generally not be discharged home on a Friday or Saturday or a public holiday. This applies particularly to patients who were previously unknown to community services. (NB: it may be appropriate, under the Community Care (Delayed Discharges) Act, 2003, to discharge patients if agreement has been obtained with local authority Social Services or if a patient has a poor prognosis and wishes to return home.) All community services will be operating at a reduced level and emergency medical back-up may be difficult to obtain. E
Note: assessment and planning for weekend leave are as important as for final discharge.
34 Inform the patient and carers of potential side-effects of treatment and management. To alleviate anxiety and to promote patient comfort, knowledge and safety. E
35 Ensure that patient and carers have information on local support groups or national specialist organizations as appropriate. Some patients may benefit from the kind of support offered by the organizations. E
36 Reinforce any special instructions with written information or by giving an approved patient education booklet. To promote an understanding of disease and treatment. To confirm arrangements made. To enable the patient to contact the appropriate services. E
37 Information on community services arranged, including names and telephone numbers and expected date of first visit, should be given to the patient and carers prior to discharge. This information should also be documented in the patient’s care plan. To confirm arrangements made. To enable the patient to contact the appropriate services. E
38 Ensure that arrangements have been made to provide patient with food at home on discharge and that there will be adequate heating. To supply immediate needs. E
39 Ensure that the patient and carers are given verbal and written information on the dosage, route, frequency and side-effects of any medication and how to obtain further supplies. Lack of information makes