Download Sharing Care Discharge Guidelines

Sharing Care: Discharge Guidelines
for
South Wales Cancer Network
Document Control Sheet
Organisation
Specialty/Project
Document Title
Document Number
Version
1.0
Approved by
South Wales Haematology
Cancer Network Group
South Wales Cancer Network
Haematological Site Specific Group
Sharing Care: Discharge Guidelines
05/014
Author/s
Dr Jonathan Kell
Dr Wendy Ingram
Dr Keith Wilson
Approval date
Ratified by
South Wales
Haematology Cancer
Network Group
Date of next review
22/08/14
21/08/15
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Sharing Care – Discharge Guidelines
Non-transplant Adult and TCT chemotherapy patients
INTRODUCTION:
Following treatment with intensive chemotherapy, haematology and oncology
patients will remain at risk of infection, bleeding or other complications.
Patients frequently require correction of electrolyte disturbances and may
require blood products such as red cells and platelets. It is, therefore, imperative
that patients have clear follow-up arrangements on discharge and that both
referring hospital and the tertiary centre are in agreement regarding the
outpatient monitoring and care of chemotherapy recipients.
PURPOSE:
The aim of the document is to assist in the organisation of shared care for
recipients of chemotherapy or other treatments that place patients at risk of
infection, bleeding or other significant morbidity,
OBJECTIVES:

To identify patients requiring heightened monitoring at a local hospital
following discharge from ward B4 Haematology at the University Hospital
of Wales (UHW).

To ensure effective and timely communication between the UHW team
and the medical and nursing staff at the referring hospital, thereby
resulting in seamless post-discharge care for chemotherapy recipients.

To highlight the expected key aspects of care to be provided by the
chemotherapy centre and the referring hospital.
SCOPE:

These guidelines will apply to all medical and nursing staff who care for
patients being discharged from B4 Haematology to local hospital
monitoring.
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
This document is not intended to set down rigid guidelines for the
management of individual patients or treatment regimens, but to provide
a coherent and effective communication to improve care of patients
treated at UHW and supported and monitored at their local institutions.
In that regard, it does not make specific recommendations on blood
product support or antifungal therapies or prophylaxis, which will vary
between patient groups. For such guidance see disease or protocol
specific guidelines.
RESOURCES:

Electronic discharge summary template.

Treatment specific protocols.

South Wales Haematology Cancer Network Guidelines.
TRAINING IMPLICATIONS:

All medical and nursing staff who are involved in caring for patients
treated at UHW and monitored in local hospitals must be familiar with the
contents of this guideline, and any associated detailed disease or protocol
specific guidelines. This will be achieved through local governance
meetings and processes and at the South Wales Cancer Network
meetings.
PROCEDURE:

Following discussion of a patient at either the haematology-radiology
joint multi-disciplinary team meeting (MDT) or the diagnostic or clinical
MDTs at UHW, the accepting UHW consultant will transmit details of the
MDT discussion to the referring consultant in a local hospital.

Following completion of chemotherapy regimens, patients suitable for
monitoring locally will return to their referring consultant. It is
recognised that this monitoring will differ substantially for patients with
diverse diseases and on differing chemotherapy schedules. Network
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guidelines will detail specific follow-up requirements for each disease or
protocol and this document is designed to provide generic guidance.

On the day of discharge, the medical staff on B4 Haematology will
complete the electronic discharge form summarising the in-patient
period.

The completed summary of the patient’s admission will be faxed to the
referring hospital. It is also possible to e-mail electronically completed
forms on request. For UHW patients, the form will be e-mailed to the
relevant consultant and a copy filed in the patient’s notes.

The discharge summary will include details of any complications
encountered during the in-patient stay, blood results and medication on
discharge as a minimum. In addition, any special requirements such as
instructions for changes to medication or care following discharge will be
highlighted.

The patient will not be discharged without a follow-up appointment being
booked at the referring hospital. Details will be given of anticipated blood
product requirements and of any special orders such as HLA-matched
platelets or irradiated products.

Patients will be given a list of phone numbers to contact UHW in an
emergency and a list of numbers to contact their local hospital.

The referring hospital will be required to see the patient at least once
weekly for routine blood tests, line care and clinical review until recovery.
Specific treatment regimens or diseases may require more frequent
monitoring and this will be detailed on the discharge form or on the
disease specific network guidelines.

The referring hospital will liaise with the ward registrar or the patient’s
consultant to give notice of expected blood count recovery to allow time
to arrange bone marrow testing or trial specific investigations prior to
planned admission.

The referring hospital will be responsible for prescribing all medications
indicated on the discharge form, from the time of discharge until
readmission to UHW. The referring hospital will inform UHW of any
changes to medication.
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EMERGENCY READMISSION AFTER CHEMOTHERAPY

The patient will contact UHW for emergency advice. During normal office
hours, this would be the Haematology Day Centre. Out of hours, Ward B4
Haematology will be the first point of contact.

Advice will be given by the nursing or medical staff and a judgment made
as to where the patient is best managed. UHW is the preferred admission
site if this is safe and practical, although, for patient safety reasons, the
emergency assessment and admission of patients who live a long distance
from Cardiff will generally be performed at local hospitals.

If a patient is admitted to a local hospital, the UHW ward attending
registrar or consultant must be contacted and made aware. Any patients
subsequently requiring transfer to UHW will be discussed with the ward
registrar or consultant and arrangements made for transfer to UHW. The
referring hospital will be responsible for arranging safe and timely
transport.
CONTACTS:
Contact details are available at the following link:
http://nww.cardiffandvale.wales.nhs.uk/pls/portal/docs/PAGE/CARDIFF_AND_VALE_INTRANET/T
RUST_SERVICES_INDEX/HAEMATOLOGY_CLINICAL_CP/BLOOD_AND_MARROW_TRANSPLA
NTATION/DOCUMENTS/IN-PATIENT/CLIN-FRM-045%20SHARING%20CARE%20%20POST%20DISCHARGE%20(ADULTS)-CONTACT%20DETAILS%20V1.1.PDF
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