Discharge Planning- Who’s Role Is It Anyway?

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

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/1st 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 • 2nd 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