16. Discharging responsibility?
Hull and East Yorkshire Branch
(R) That this meeting of RCN Congress asks Council to lobby for national guidance on discharge planning and processes
Result
The resolution was passed
For: 95.57% (431)
Against: 4.43% (20)
Abstain: 3
Debate report
The overwhelming majority of delegates voted in favour of a resolution asking Council to lobby for national guidance on discharge planning and processes.
Proposer Hilary Spilsbury, Hull and East Yorkshire branch, said that some nursing staff must know of some excellent discharge procedures, but poor ones do exist.
Hilary urged Congress to support the resolution and highlighted examples where discharges were not appropriate – such as a “the woman with severe dementia sent home in a taxi late at night”.
Seconder Matthew Sidebottom, Calderdale and Huddersfield branch, said that his patients had often been on the receiving end of a poor discharge, while Philip McCaffrey, Cardiff and the Vale branch, said that funding is an essential issue. “I support this but I can’t see any merit until more funding is available,” he said.
Nurses in Management and Leadership Forum member Christopher Bulter also showed his support for the resolution, saying guidance would be helpful. “But what is more important is the practical actions we can take today in communities because actions do speak louder than words.”
Christopher Brown, Bradford and Airedale, said: “I would welcome any support at all that the college could provide in terms of structure for discharging patients”, while Rachel Ridley of the Cumbria branch urged Congress to support the resolution.
Hilary Spilsbury closed the resolution by thanking Congress for an emotional and interesting day.
Background
Although there has been no legislation or statutory regulation on planning for discharge, national guidance does exist: the NHS Institute for Innovation and Improvement has guidance on discharge planning, NHS Connecting for Health has produced a toolkit for trusts to implement standardised electronic discharge summary, and the Royal College of Physicians worked to develop a consensus on the content structure of handover and discharge forms. These tools also make allowances for patients with more complex needs, who will need further care in the community and whose care needs are more holistic rather than just medical.
However, stories do appear in the media with some regularity about patients who have not been properly discharged, for example an older lady with dementia being discharged in the early hours of the morning in a taxi. Other stories describe community nurses being unaware of vital details about a patient, such as a case where a community matron was not told a patient was discharged from hospital with a chest drain still in situ.
Increasing pressure on acute care and A&E departments means that more care is likely to be delivered in the community and in the home; if this is the case it will be even more important that discharge processes are properly followed to make sure there are no gaps between acute and community care. Nurses working in the community are required to deal with increasingly complex care and they in turn require as much information about patients as possible.
Although there is currently national guidance, it has not been pulled together and universally implemented.
In Scotland the Scottish Intercollegiate Guidelines Network (SIGN) has produced a national evidence-based discharge document. The aim of the document is to present a template for a single discharge document that can be used for every patient on the day of discharge, and as the final discharge summary/ letter for more complex cases.
In its response to the recent Transforming your Care consultation in Northern Ireland, the RCN highlighted a range of concerns over how working practices, structures and inadequate service provision can impact upon the interaction between acute and community services and thereby on patient discharge.
References and further reading
NHS Connecting for Health (2013) Electronic 24-hour discharge summary implementation London?: NHS CFH. Available at: www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/24hour (accessed 13/03/13) (Web).
NHS Institute for Innovation and Improvement (2013) Quality and service improvement tools: discharge planning Coventry: NHS Institute for Innovation and Improvement. Available at: www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/discharge_planning.html (accessed 13/3/13) (Web).
Royal College of Physicians (2013) Hospital discharge records London: RCP. Available at: www.rcplondon.ac.uk/projects/hospital-discharge-records (accessed 13/03/13) (Web).
