Download Safe Discharge Transfer Collaborative notes and actions

Safe discharge and transfer workstream
This paper sets out the discussion notes and actions from the workshops held at the safe
discharge and transfer collaborative in September 2015.
Background
Approximately 90 delegates attended the Safe Discharge & Transfer collaborative event on
9th September 2015 at the Holiday Inn Gatwick. At this event the driver diagrams for this
workstream of the Kent Surrey Sussex Patient Safety Collaborative (KSS PSC) were
reviewed it was confirmed that at previous collaboratives it had been agreed that with such a
large topic area, for the first year this workstream will concentrate its efforts on “Safe
Discharge from Hospital to Usual Place of Residence”.
There are 3 priority areas to tackle in order that we may strive to improve the safety of
discharges from hospital across KSS, and breakout workshops took place throughout the
day covering these 3 areas:
1. Communications on discharge
2. Transport home on discharge
3. Medications on discharge.
This paper sets out the discussion points from each of those 3 topic breakouts, together with
the actions moving forwards together in each area.
Measurement:
Underpinning these 3 topic areas, a key driver for the SD&T workstream of the KSS PSC
was the need to establish good measurement, in order to obtain baseline and then enable
us all to monitor and track progress in achieving safer discharges.
A Working Group has been established to look in detail at measurement issues, to
determine what are relevant and appropriate metrics to monitor safe discharges, and the
sources of such data, in order to feedback to all with recommendations for how we establish
robust measurements for safe discharge amongst us all.
The SD&T Measurement Working Group is still looking for more volunteers to join this task &
finish group, so any interested parties, please contact [email protected] to volunteer.
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]
Communications on discharge
Key Issues:
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Communication on discharge comes in many forms and mediums (paper, faxes,
electronic, verbal etc..)
Communication on discharge occurs between different parties (e.g. clinical staff to
patients and families/carers, clinical staff to clinical staff, handover from one service
to the next, clinical staff to social care teams etc…)
The modes, types and content of communication depend on (a) who is delivering the
communication information (b) what information is being communicated (c) who the
communication is being received by; all of which results in variable forms and quality
of communications on discharge from hospital to patient’s homes
In essence, there is no one solution for everyone in every situation
Currently there are many types of communication, for example:
o Electronic discharge summaries to GPs
o Electronic or faxed or written referrals to services
o Information leaflets to patients and families/carers
o Verbal information to patients and families/carers
o Medication information leaflets
o Etc…
There are significant breakdowns in the safety of discharge when communication
fails, especially at the point of handover from hospital to home/residence care, be
that with primary care, community services and social care services and
families/carers, or even to the patient’s own care themselves at home.
There are some new initiatives that this workstream can use to help communications
on discharges, to improve safety, for example the national ‘referral to community
pharmacy’ initiative (see medications section), minimum standards for the content of
electronic discharge summaries, etc.
It is agreed that communication on discharge is a massive area of work, but one that
has to be addressed with urgency as it has a major impact on the safety of
discharges from hospital, in terms of appropriate care being continued in a safe and
effective way once a patient is discharged to usual place of residence
There are 2 sides of communication to address on discharge:
o Communication between clinical and care professionals at handover
o Communication with the patient and their families/carers so they are
informed.
Actions going forwards:
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A mapping exercise to identify the key stages and forms of communication on
discharge from hospital between care professionals and patients/families/carers.
This can then be used to identify any particular areas to target across KSS together.
Identify examples of good practice from across KSS and elsewhere in England that
can be shared with all.
Establish a portal of good examples for communicating on discharge on the KSS
PSC for all to see and learn from
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]
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Feedback progress with all via the KSS PSC website and at the monthly SD&T
Collaborative events in 2016
Sue Wales has met with patient and carer organisations in Surrey, who have
explained that communication with them is vital both during the planning of
discharge and on the day, with the desire that once home, the patient and their
family/carers simply want to be clear on what is to happen next, and what
care/support has been arranged, so they feel safe once they are back home. To this
end, the groups came up with the suggestion that we look at developing a pilot
regarding “Discharge Passports”, using examples of good from elsewhere, that is a
patient/family/carer-held booklet, that is populated with information as discharge is
planned during an admission, with all kinds of information on things like medication,
who to call if any queries, transportation home with their families/carers, signposting
for other agencies if they need them, what care has been arranged for them at
home, etc…. including a checklist for the patients to use to be sure they have all the
information they need before they leave the hospital in order that they feel safe
about their care when back home. The workstream is proposing a pilot of this in
Surrey, together with the patient & carer organisations and local hospitals and will
feedback as this unfolds.
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]
Transport home on discharge
Key Issues:
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Patient Transport Services (PTS) are provided by several different agencies in KSS
(SECAmb, Red Cross, voluntary drivers, hospital own commissioned transport,
etc….)
Figures from SECAmb show that >75% of all PTS bookings for discharges occurred
on the same day of discharge, which highlights the difficulties for PTSs to be able to
schedule vehicles and staff to meet the requested discharge times of hospitals; there
is a real need to reduce the proportion of on-day bookings for discharge transport
Volumes of discharges and PTS requests are high, with hundreds per day.
Forward planning for discharge is vital in helping to resolve the capacity issues of
PTS, such that much more PTS needs to be booked before the day of discharge (not
on the day), so PTS services can schedule pickups with the right vehicles and teams
to meet needs (e.g. 1 man-crew cars, 2 man-crew vehicles etc.)
Many felt that ward staff often have the default of offering PTS for discharges, rather
than planning this with families and carers to collect the patient to go home, and as
such the NHS is using resource it may not need to
There is a need to find ways to change the default of offering PTS for discharges on
wards, to enable families and carers to collect patients on discharge where they can,
to reduce the volume of transport journeys needed, to release capacity in PTSs
The PTS services are often made to wait up to an hour, for take home medications or
documentation when collecting a patient for discharge, which delays them for their
next pick-up, and thus is wasting the capacity of the PTSs
Discharge Lounges are now in most hospitals, and these might be better used in
terms of them being safe and comfortable places for patients to await their transport,
such that the PTS staff can quickly find them and thus reduce the waiting time for
pickups. It was felt that the quality of discharge lounges varies across hospitals and
that some hospitals do not make much use of them, especially where they are not
staffed.
Actions going forwards:
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Establish a Transport Home on Discharge from Hospital Working Party to deliver
proposals and pilots to improve planning of discharges to reduce on-day bookings
for transport and to increase the proportion of patients collected by family/carers and
make plans for 2016 (volunteers welcomed; please contact [email protected] )
Establish a pilot for reducing on-day transport bookings with an acute hospital and
SECAmb, and then share lessons and rollout with others in KSS
Work with the communications team regarding the Discharge Passport pilot, to
ensure transport home being planned with families/carers occurs as the default,
before PTS are used
Working party to look into standards for discharge lounges and how their use may
be improved for safety and efficiency.
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]
Medications on discharge
Key Issues:
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A number of issues can occur affecting discharge medication on admission,
including:
o incomplete records regarding patient medications taken prior to admission
o patient confusion over the colour and shape of their tablets
o patient non-compliance with GP prescriptions
o out of date medication.
Summary care records are often not accurate regarding current medications
Difficulties with the use of EMIS Web in A&E and EAU can leave staff not accessing
medication information
By discharge there can remain issues unresolved around a patients original
medication with the potential for errors
Need for effective communication with the patients and their families/carers regarding
their medication covering:
o counselling on new/changed medication (e.g. changed colour tablets or brand
etc.)
o how to take the medications and how often
o what the standard procedures are around out of hours services and support
with their medication once home.
Pre-discharge planning is essential
leads to high risks of poor medication information transfer on discharge from
incorrect e-discharge summaries, especially for unavailable medications
There can be delays in writing discharge summaries and discharge medications that
delay discharges
There is a need for consultants and their teams on ward rounds to understand this
process so discharge medications are written in time to enable pharmacy screening
to take place in a timely manner
There’s a lack of clarity around the process of provision of blister packs on discharge
i.e. whether a patient is suitable to have a pack and if their carers are able to
dispense their medication
Carers often aren’t provided contact details for people who can help post-discharge
specifically around administration of medication, or provided detail about the
treatment regime and potential side effects of drugs
There is a lack of clarity about the medicines reconciliation process in primary care
and how medication discrepancies are reported.
Actions going forwards:
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Establish a medications on discharge working party, with relevant members of the
Safe Discharge and Transfer workstream and the Medication Errors workstream
together
Map the complete medicines reconciliation pathway from admission through
discharge and back to usual place of residence – this will be led by Medway and fed
back to the region
Initially focus on the discharge aspect of this mapping to usual place of residence,
looking at specific issues to determine what specific actions can tackle these issues
with specific projects and identified leads
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]
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Gather examples of good practice from around the region to share on the website
and at future collaborative events.
KSS PSC – safe discharge & transfer workstream; notes from collaborative 9th Sept 2015.
For more information contact [email protected]