The Implementation of Nurse Facilitated Discharge in Paediatrics

Maynard Sinclair Ward is an acute, twenty bedded paediatric medical ward providing care for children from 0 to 14 years, with acute short term and chronic medical conditions in the Ulster Hospital, Northern Ireland. The discharge process on the ward is often delayed by waiting for the medical staff to review the child and agree that he/she is well enough to go home. This leads to continued frustration for parents wanting to get their child home as soon as possible. Medical staff are often delayed caring for sick children in the Accident and Emergency department, meaning that on occasions, families are being discharged at inconvenient times. The project team felt that these delays could have been avoided if nurses were able to undertake the role of discharging patients, thus improving the hospital experience for the children and their families.

The aim of the project was to introduce nurse facilitated discharge under clear guidance from the medical staff and within a clear protocol. The methods and approaches used within the project were staff questionnaires, collection of parent and child stories and workshops for nursing staff to look at developing the role and the ward working practices. A steering group was formed to oversee the project and the project team presented the project at the medical directorate meeting.

Following the development of key documentation, nurse facilitated discharge was introduced in November 2013 as a six month pilot. The process involved the medical team identifying patients suitable for nurse facilitated discharge and clearly defining criteria to be met along with an appropriate time frame for attainment thus allowing the nurses to facilitate the discharge. Following introduction of nurse facilitated discharge the total number of nurse facilitated discharges was collected and the comparison was made against the total number of discharges for the six months. In this time, 46/1112 children had their discharge facilitated by the nursing team. Feedback from parents and staff has been very encouraging and has resulted in more timely discharge of patients with improved patient satisfaction. This has in turn reduced the workload for medical staff. It is hoped to continue to refine the process over the coming months and look at rolling nurse facilitated discharge out to other wards in the paediatric unit. The project team feel that the methods used to engage staff and parents alike have contributed to the success of the project.

This project was supported by the Foundation of Nursing Studies Patients First Programme in partnership with the Burdett Trust for Nursing.