Dear Colleagues

Hello, my name is Claire Carmichael and I am a newly qualified general practice nurse. I have worked within healthcare for around 12 years in total in a number of roles including; sexual health and family planning, elderly care and caring for young adults with learning disabilities. Throughout my time as a healthcare assistant, student nurse and now qualified nurse there is something I have picked up on that I would love to share with you and my ideas around this to protect the future of our patients. 

Firstly, working as a care assistant in a residential home for the elderly, we had a patient who was discharged back into our home and they ended up with a re-admission. Now, at this time, I was unskilled, I wasn’t sure why this happened and I didn’t think to question it. 

My next step was as a student nurse. Throughout my time on the wards during first and second years, I watched patient’s being discharged and wondered if it was safe to do so? Not only this, but seeing the amount of patients that were medically fit to be discharged and had nowhere to go; due to a package of care needing to be put in place. These patients needed extra care and time, but it was taking longer than usual for this to be set up. This time I asked the questions to my mentors ‘why is this patient waiting so long? What’s the process?’ and their response were always ‘we are waiting for the package to be approved’ or ‘we have had the referral form bounce back to us as it wasn’t filled out properly.’ I thought, ‘well what’s gone wrong for this to happen?’ I wanted to look a bit more into this, and I set up a day to ‘shadow’ the continuing healthcare team to see how the referral process works and gain a bit more knowledge so that I can take this with me to help others and help patients in the future. It was eye opening to see how much detail is really needed on the referral form and the process it goes through to accept and find suitable needs for a patient. 

Following this, during my management placement as a student nurse I worked in the community with the district nurse. This is where I saw how it can actually affect a patient and how wrong an unsafe discharge can go. There was one case in particular. This was a patient who was quite unwell; they were classed as end of life, they were completely bed bound, very weak and couldn’t eat and drink alone as they normally would, andhad a grade 3 pressure sore to their sacrum area. This patient had neither family nor friends to look after them at home. They already encountered repeated re-admissions to hospital as they hadn’t received the right level of care for required for their discharge. This patient was about to be discharged with only 4 calls a day and needed a lot more. We called the hospital and spoke with a number of nurses and the manager. My mentor asked them ‘do you know what 4 calls a day is and what this entails?’ They did not know. It is evident that this happens frequently and many healthcare professionals don’t really know what a package of care really entails and how it will meet the needs of their patients. It turned out that the person filling in the referral hadn’t added that this patient was bed bound or end of life on the form, so they got the wrong package of care for their needs. Attention to detail is key with this.

There seems to be an ongoing missing step between the acute sector and primary care / community which is why I am writing this today. In June 2019 the Care Quality Commissioners released their stats on ‘adult inpatient survey’, and this found that patient discharges had negatively deteriorated since 2017. Furthermore, 1 in 5 patients stated their family or home situation was not considered during discharge planning. Alongside this, 41% of patients were a delayed discharge which can have a negative effect on their health outcomes (CQC, 2019). But why is this important? Not only are patients at risk of readmission, psychological impacts of going back into hospital and the extra work load of healthcare professionals as a result. But the British Geriatrics Society (2017) published that deconditioning of older people over the age of 65 years can happen within a few hours of them lying on a bed, trolley or sitting in a chair. Not only this, but patients are at a higher risk of acquiring a hospitalised infection as a result too which can cost a higher mortality rate as well as added NHS costs (NICE, 2016)

But for me, it’s not about the statistics and cutting costs, it’s about protecting patients and ensuring we are giving them the best care possible and the best quality of life as possible. So I ask of you, please ensure your patients are safe to discharge, ask about their home life and if they have support at home. Furthermore, if they need a package of care put into place, please ensure every single detail, in full, is added to the form. And lastly, find out what that particular package of care entails and if this really does meet the needs of this patient? Because 3 calls a day may only be 3 x 20 minutes only and your patient might need more than this. This may take you a little longer to write out but it will save you and the patient a lot of unnecessary stress and prevent a failed discharge later on. Most of all, it could save a patientslife.

Thank you so much for your time; let’s protect patients, one safe step at a time.

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