1. Discharge Planning- Who’s Role Is It Anyway? Andrea Ferns Children’s Long Term Ventilation Co-ordinator CARA Service

2. Children’s Assisted Respiratory Advisory (CARA) Service Andrea Ferns – Discharge Co-ordinator Gillian Halley – Consultant Intensivist Ruth Wakeman - Physiotherapist

3. PICU/HDU/NICU R.B.H. G.O.S.H Evelina St Thomas’ Chelsea & Westminster St Mary’s St George’s Whittington Royal London Kings Cambridge Brighton

4. PCT Boundaries London Bedfordshire Hertfordshire Essex Kent Surrey Sussex

5. Aims and Learning Outcomes Identify the role of the Community Children’s Nurse in relation to discharge planning for children on long term ventilation Explain the different roles of ‘key workers’ Consider the responsibilities being placed upon Community Children’s Nursing Services

6. Guidelines Hospital to Home – Guidance on discharge management and community support for children using LTV (2005) National Service Framework (2001) Together from the Start (2003)

7. Key Worker - Definition ‘Federal employees who are generally responsible for distributing campaign materials’

8. Key Worker Takes responsibility for organizing the discharge planning for children on long term ventilation

9. Hospital Team A named nurse/team from PICU/HDU/NICU is ‘responsible’ for co-ordinating discharge planning from acute setting

10. Community Nursing Team A ‘key worker’ will be allocated and ‘responsible’ for co- ordinating discharge and management of child in the community

11. Starting the Process Key worker from acute setting contacts the Key worker from the community Key worker (Community) contacts local authority commissioners Health Needs Assessment carried out/1 st MDT meeting Funding needs to be agreed in principle

12. Health Needs Assessment Who is responsible for carrying out a health needs assessment?

13. Housing Assessment Who is responsible?

14. Equipment List Who is responsible?

15. Funding Agreed – What Happens Now? Timescales Responsibilities Purchase of equipment Recruitment of carers/nurses 2 nd MDT meeting

16. Training of Home Carers PCT is responsible for training their own carers Agency/Care Providers are responsible for training their own carers

17. Competency Training Competency Guidelines How often updates required? Who is responsible for updating the parents/carers?

18. Final Discharge Arrangements Date and time for discharge are set in agreement with family Emergency services/utility services informed Medical passport

19. Discharged Home

20. Implications for Community Children’s Nurses Training Maintaining skills Resources 24 hour support for carers/parents Time

21. Aims and Learning Outcomes Identify the role of the Community Children’s Nurse in relation to discharge planning for children on long term ventilation Explain the different roles of ‘key workers’ Consider the responsibilities being placed upon Community Children’s Nursing Services

22. QUESTIONS?

23. www.longtermventilation.nhs.uk