Brighton Sussex University Hospitals NHS Trust
NHS / Health Body
Action Taken
A social worker has started attending daily "Board Round" meetings to assist in patient discharge planning. The Trust acknowledges shortcomings in the discharge planning process and is aiming to start a one year pilot scheme to focus on consistent multi-disciplinary management of frail elderly patients, in preparation for their discharge. (AI summary)
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While the Trust accepts that a change in environment increases the risk of falls, the Trust also is aware that there is a reduction in the risk of falls when someone is in a familiar environment, such as back at a Nursing Home in the room previously occupied. The Trust accepts that additional and up to date information, over and above that provided in the doctors' discharge summary together with the medication information, about Mr Watts' present condition and progress should have been provided to the Nursing Home_ This is normally done through contact between the ward and the Nursing Home on the before planned discharge, as well as through the nurse to nurse handover. The senior nursing staff agree that it is essential that a nurse to nurse discharge summary be completed for any patient leaving the hospital to go or return residential or nursing home care. They have emphasized the importance of this to the ward nurses. As part of the programme for developing the skills of junior nurses, the ward is placing increased emphasis on shadowing senior colleagues, to equip these junior staff with the skills needed to make robust decisions and to give them role models to assist with their communication skills_ Each month snapshot audit is being done of 10 sets of medical records from the ward to ensure that they reflect an acceptable standard of discharge documentation. For this ward, the April review of discharge documentation showed 100% compliance with the requirement for documentation in the discharge planner, and also on the provision of information about discharge plans to relatives. The Trust has reviewed the forms currently used for discharge planning and is devising new paperwork which is intended to facilitate timely documentation, and to encourage daily consideration of each in-patient's progress towards discharge_ There is increasing recognition among Trust staff that the nationally widely used term "Medically Fit for Discharge (often abbreviated to MFFD) can be misleading_ There is a growing ground-swell of opinion that it would be less open to misinterpretation if the phrase "Medically Ready for Discharge- (MRFD) or some similar form of words were adopted. Mr Watts was ready for discharge in as much as that he no longer required active medical treatment in an acute hospital at the time of his discharge. His last set of clinical observations taken during the afternoon immediately before he left the hospital were entirely satisfactory, with a National Early Warning Score of zero: there was therefore no reason to identify him as medically unready for discharge _ Given his co-morbidities, and his increased frailty following the significant illness with which he had been admitted, he was at high risk of acquiring new infection while he remained in hospital, and the hospital staff were confident that his ongoing care and rehabilitation needs could be met at Fir Grove Nevertheless, this does not excuse the identified shortcomings in the discharge process, especially in relation to communication with the family and Nursing Home_ The Trust is aiming to start a one year pilot scheme to focus on consistent multi- disciplinary management of frail elderly patients, led by an individual from the discipline most relevant to the individual patient's circumstances, in preparation for their discharge. Subject to successful recruitment; it is anticipated that the pilot will start in July 2014 on three wards. This pilot will be evaluated throughout the year as well as at its conclusion so that the learning from it can be extended throughout the Trust for the benefit of frail elderly patients. they day to, to, very
Thank you once for raising your concerns with senior Trust staff. We have all found it useful to review, in the light of these events, the progress that is being made to increase the safety of future patients in this Trust_ Finally, please pass on our condolences to Mr Watts' family on their sad loss. Yours sincerelv Matthew Kershaw Chief Executive Discharge Matron Consultant, Medicine Medico-legal Services Manager again
While the Trust accepts that a change in environment increases the risk of falls, the Trust also is aware that there is a reduction in the risk of falls when someone is in a familiar environment, such as back at a Nursing Home in the room previously occupied. The Trust accepts that additional and up to date information, over and above that provided in the doctors' discharge summary together with the medication information, about Mr Watts' present condition and progress should have been provided to the Nursing Home_ This is normally done through contact between the ward and the Nursing Home on the before planned discharge, as well as through the nurse to nurse handover. The senior nursing staff agree that it is essential that a nurse to nurse discharge summary be completed for any patient leaving the hospital to go or return residential or nursing home care. They have emphasized the importance of this to the ward nurses. As part of the programme for developing the skills of junior nurses, the ward is placing increased emphasis on shadowing senior colleagues, to equip these junior staff with the skills needed to make robust decisions and to give them role models to assist with their communication skills_ Each month snapshot audit is being done of 10 sets of medical records from the ward to ensure that they reflect an acceptable standard of discharge documentation. For this ward, the April review of discharge documentation showed 100% compliance with the requirement for documentation in the discharge planner, and also on the provision of information about discharge plans to relatives. The Trust has reviewed the forms currently used for discharge planning and is devising new paperwork which is intended to facilitate timely documentation, and to encourage daily consideration of each in-patient's progress towards discharge_ There is increasing recognition among Trust staff that the nationally widely used term "Medically Fit for Discharge (often abbreviated to MFFD) can be misleading_ There is a growing ground-swell of opinion that it would be less open to misinterpretation if the phrase "Medically Ready for Discharge- (MRFD) or some similar form of words were adopted. Mr Watts was ready for discharge in as much as that he no longer required active medical treatment in an acute hospital at the time of his discharge. His last set of clinical observations taken during the afternoon immediately before he left the hospital were entirely satisfactory, with a National Early Warning Score of zero: there was therefore no reason to identify him as medically unready for discharge _ Given his co-morbidities, and his increased frailty following the significant illness with which he had been admitted, he was at high risk of acquiring new infection while he remained in hospital, and the hospital staff were confident that his ongoing care and rehabilitation needs could be met at Fir Grove Nevertheless, this does not excuse the identified shortcomings in the discharge process, especially in relation to communication with the family and Nursing Home_ The Trust is aiming to start a one year pilot scheme to focus on consistent multi- disciplinary management of frail elderly patients, led by an individual from the discipline most relevant to the individual patient's circumstances, in preparation for their discharge. Subject to successful recruitment; it is anticipated that the pilot will start in July 2014 on three wards. This pilot will be evaluated throughout the year as well as at its conclusion so that the learning from it can be extended throughout the Trust for the benefit of frail elderly patients. they day to, to, very
Thank you once for raising your concerns with senior Trust staff. We have all found it useful to review, in the light of these events, the progress that is being made to increase the safety of future patients in this Trust_ Finally, please pass on our condolences to Mr Watts' family on their sad loss. Yours sincerelv Matthew Kershaw Chief Executive Discharge Matron Consultant, Medicine Medico-legal Services Manager again