Discharge Prep

[nursecarlie06]

hi everyone,

i have just started up a discharge task team in my nicu and am asking for ideas to help speed along discharges. we have identified many barriers to discharge and they are as follows:

1) nurse assignment load, high census

2) parents not visiting, or live far away. this delays a) obtaining consents, b) bringing in corificeat, c) teaching, d) pediatrician consent etc...

3) float pool from picu/peds do not do discharge prep items, so this piles up for the next shift/day

4) does the discharge prep list involve too much paperwork?

5) not getting started on admit

6) stepdown unit vs icu and days vs. nights (icu thinks it can start on the stepdown unit, nights thinks it can start on days) or vice versa

7) not starting on dc prep items because there is no order for it (pedi consents, hep b consent etc)

8) unknown exact dc date

9) only one place to watch dc videos (we require 2 videos to be watched by families: cpr and corificeat safety but only have one place for them to be watched which is in a very small family lounge)

10)parents don't think to ask questions about discharge prep other than "when is my baby going home"

11)no resources other than nurses and admit folder are available to parents

12)chorio admits go home after 48 hours and discharge prep is started on late

we have discussed placing a cork board in the family lounge with information all about discharge encouraging parents to bring it up with the nurse. on the cork board will be a checklist for the families to ask themselves...do i have a corificeat? have i chose a pedi? etc. we will attach flyers and information on discharge prep to allow parents to take with them. we have also discussed placing a very simple discharge list in the admit folder in the front of all other papers for parents to read.

any ideas or suggestions on ways to get discharges speeded along so it doesn't fall on the discharge nurses.

thanks!!

[umcRN, BSN, RN]

can't really help with speeding up the process. We have a system though there are always kids who after 3 or 4 months of being there are ready for discharge with nothing done. Basically we have "baby-steps" home. Ten steps. I don't know the order of them now and they are frequently being revised as we often have to double chart stuff but its "supposed" to start on day of admission and starts with easy stuff like welcome to the nicu, how to call and get info, how to change your baby's diaper and progresses in a stepwise fashion to include car seat/temp taking/feeding/special equipment/pedi etc. Nurses are supposed to document when a step is done and in a perfect world they would all be done by discharge day. Sometimes it happens and sometimes it doesnt and the d/c nurse is left with it all.

[NicuGal, MSN, RN]

It is a universal problem it seems. People don't document what they do with parent's, so the discharge nurse does it all. Happens all the time and is my biggest pet peeve ever. Different if the parents don't come in at all.

About 2 weeks before discharge we start really getting them prepped. We have a folder we give them with handouts on what we expect from them: An appropriate corificeat, a PCP, they have to come in and watch our videos for CPR and Corificeat safety, supplies they will need, etc. In the 2 weeks before we tell them to bring in the corificeat so that they can adjust the straps to fit the baby (we are not allowed to do this per our legal department), bring the name of a doc you want, or if they don't care we will select one for them from our peds clinic. Then from there we set up monitor training if they need it, med teaching after we send the prescriptions with them or to our pharmacy (our parents have to have the meds before discharge so that we can check them, esp from outside pharmacies that seem to mess up the concentrations of a lot of meds). We get immunization consents, circ consents, etc. I will say, our NNP's and docs are very good at calling parents and letting them know all this stuff, along with us. You mentioned consents...you can get phone consent for many things. We make sure we have a circ consent on the chart before the mom leaves and we have a sheet that has to be signed by the mom or by phone consent 24 hours before the circ is done. And for parents that don't visit much we make sure to tell them that they will be here for at least 3 hours prior to leaving the building so that we can do all the teaching, etc. It isn't a swoop and scoop.

We do have a bulletin board in the visitors area with a lot of discharge info on it. We also have a discharge check off sheet that we put on the front of the chart that is checked off when things are done (Hep B, corificeat challenge, sleep study, meds, appointments, VNA, WIC, etc)

We have made it pretty clear to all shifts that it starts on admission and ends with discharge. We have recently started holding the primary nurses responsible also. If you are a primary and work nights, you better have an associate that works days so things get done, or make sure you are passing on what needs done.