The University for business and the professions Victoria Oladimeji (PhD, MA, MBA, BA, RGN, RM) Lecturer in Nursing with speciality in Health Promotion City University St Bartholomew School of Nursing and Midwifery Philpot Street Whitechapel London EC1 2EA England Tel: Direct Line: Fax:

The University for business and the professions Discharge Planning – Empowering Older Adult towards improved self-care. Introduction Every year more than five million people in Britain experience life as hospital in-patients (Chiva and Stears 2001Henwood 2004) For the vast majority of these people the episode will be relatively straightforward. However, the discharge process and outcomes are not always positive.

The University for business and the professions Admission to and discharge from hospital can be a distressing time for individuals, their families and friends. For most people, however, treatment will be successful and they will return to their usual way of life very quickly through the provision of an accurate diagnosis, treatment and rehabilitative service.

The University for business and the professions Some people will need additional help to enable them to do so over and above their medical treatment. These needs can be many and varied and cannot be met by the NHS alone.

The University for business and the professions Aim of study To review current practices in discharge planning in hospital settings and to critically evaluate some of the government strategies for improving the discharge process and the transition from hospital to home for older adults.

The University for business and the professions Global View Studies suggest patient’s journey from hospital to the community is not always a smooth transition. Grimmer and Moss (2000) (Australia) Magilvy and Congdon (2000) (USA). Grimmer and Moss found that community services in the first week post-discharge was low suggesting that carers and patients carried the majority of the burden immediately after discharge. This is consistent with most of the studies done in UK (Waters et al 2001)

The University for business and the professions The key principles underpinning effective discharge and transfer of care policy are: The avoidance of unnecessary hospital admission, good clinical outcomes and effective discharge planning is facilitated by a ‘whole system approach’ to the commissioning and delivery of services. Characteristics of whole system working? Responsive,, clear vision, no gaps in services, Partnerships enhanced. Organisations should work proactively, and together to review and improve performance and find solutions. (DOH 2003)

The University for business and the professions Figure 1. A ‘virtuous’ circle of services. Source: Audit Commission (2002).

The University for business and the professions Aims of Good Discharge Practice:Local Policy Maintaining a safe home environment Physical, Social, Psychosocial Maximising Independence Preventing Readmission Planning and and coordination of services and resources. (Discharge policy statement 1999)

The University for business and the professions Discharge Planning Process Assess Evaluate Plan Implement

The University for business and the professions Flow Chart of Assessment Process Admitting nurse – Checklist, referral (within 24 hours). Social Work Response (within 2 working days) Various Assessments – (Single Assessment to avoid duplication). Contact with Local Community Services. Provision of Care Plan (within 7 working days). Referral to all Local Community Services.

The University for business and the professions Flow chart of Assessment Process in an NHA hospital in England Admitting Nurse (Complete checklist – make referral if appropriate within 24 hours)  Social Work Response (within 2 working days)  Complex Assessment (Multidisciplinary, multi-agency specialist assessments, involving medical, OT, physio, etc)  Contact with Local Community Services (for simple social care needs)  Provisional Care Plan Development (within 7 working days) Case Conference Multidisciplinary with clients and carers and representatives from purchasing in Social Services Referral to all local Community Services, e.g. Social Services, District Nurses, Health Authority etc

The University for business and the professions Intermediate Care Intermediate Care was heavily emphasised in the National Service Framework (NSF) for older people (DOH 2001). According to the DOH, Intermediate care should meet these four criteria: 1.Targeted at people who would otherwise face unnecessary long hospital/residential/ stays. 2.Services provided should be based on thorough assessment (single assessment framework with one set of professional records and shared ways of working). 3.Planning should maximise independence. 4.Services should be time - orientated- maximum 6 weeks, minimum 1-2 weeks.

The University for business and the professions The emphasis lies on the need to provide integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admission, support timely discharge and maximise independence.

The University for business and the professions Conclusion Transition from hospital to home should involve: Minimum stress Careful assessment, planning, implementation and evaluation with full involvement of patients and carers/relatives and particular with attention to vulnerable patient. A collaborative, and well coordinated approach with multiple professional/agencies approach. More intermediate care beds in line with the NSF Education and training for nurses in Health promotion and advocacy.

The University for business and the professions References. Audit Commission (2002) Integrating services for older people. London: The Stationery Office. Audit Commission (2000) The way to go home. Oxford: Audit Commission Chiva A. and Stears D. (2001) Promoting the Health of Older People. Buckingham, Open University. DOH (2001) National Service Framework for Older Adults. London HMSO DOH (2003) Discharge Handbook. London HMSO. Grimmer K. Hedges G. Moss J. Staff perceptions of discharge planning: a challenge for quality improvement. [Journal Article, Tables/Charts] Australian Health Review. 1999; 22(3): (18 ref) Henwood M. (2004) Hospital Discharge Integrating Health and Social Care Health and Social Care in the Community. London HMSO. Magilvy J. and Congdon J (2000). The Crisis Nature of Health Care Transitions for rural Older Adults Public Health Nursing Vol. 17(5)Sept. Oct. Tower Hamlets PCT 2004 Discharge policy statement Waters K. (2001) Sources of support for older people after discharge from hospital: 10 years on, Journal of Advanced Nursing Vol 33 (5) March.