Carlos Omil PazosNurse Practitioner Sidra Emergency Department

Third QPEM Conference 11-13th of January 2019

Nurse-led Discharge within the ED

I do not have any relevant financial relationship with commercial interest to disclose.

DISCLOSURE

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At the end of the presentation, the attendee will be able to identify :

Learning Objectives

What is a nurse-led discharge

The role of the nurse-led discharge

The need for nurse-led discharge within the ED

“In principle, discharge from hospital is a medical decision but as such can be delegated to another health care professional provided the necessary

safeguards are in place.”

Lees and Field (2011)

What is nurse-led discharge

Commonly misinterpreted as:

“The transference of total responsibility for the discharge decision from doctors to

nurses”

What is nurse-led discharge (NLD)

NLD is defined as the delegation of responsibility for thedischarge of a patient according to an agreed plan withspecific criteria. They also specify that the plan must beagreed by the consultant in charge, and the nurse must bewilling to accept the delegated role and have the knowledgeand expertise to execute the plan.

Lees and Field (2011)

Types of nurse-led discharge

Bespoke (Emergency)•An individual, tailored plan.

Care pathway or protocol-led (Elective)• This is for elective patients onto a pathway for theircondition.

Do´s and Don´ts of the Nurse-led Discharge

The nurse should: • Initiate and lead the discharge process. • Carry out regular and ongoing patient assessments/evaluations. • Progress-chase the results of investigations. • Follow up the patient according to the discharge plan. • Act as the patient’s advocate.

Lees (2004)

Do´s and Don´ts of the Nurse-led Discharge

The nurse should not: • Decide if a patient is fit for discharge without consulting. • Wait for the doctor to make decisions. • Discharge a patient according to different rules. • Discharge patients without preparing them adequately.

Lees (2004)

Who can do this role and what is needed

• The nurse is willing to undertake it.• At least 5 years clinical nursing experience.• The ability to assess and make clinical decisions.• Expertise, training and competency assessment.• The support of the Manager.• Specific protocols and patient criteria have been agreed.• Only discharge patients from the ED.Lees, L Evaluating the development of a nurse-led discharge scheme.VOL 101, NO 06, 08 February 2005 NT

What kind of patients

Conditions include:• Allergic Reaction and Anaphylaxis• Asthma and Viral Induced Wheeze• Croup• Gastroenteritis Rehydration• Toxic Ingestions, Poisonings• Minor Head Injuries• Post Ketamine Sedation

How it works

Ahmed, 3 year old child • Asthma viral induce wheeze on arrival • First treatment done • Reviewed after 2 hours by the Senior Attending Physician

(Improvement but not ready for discharge yet)

Nurse-led discharge criteria startStart the Protocol

• Review of the patient

• Parents/ child education

• Book follow up if needed

• Discharge Medication ready

• Form completed

How it works

Bye Ahmed !

Benefits of nurse led discharge

• Streamline patient care and flow.• Robust discharge plans: replicable & transparent.• Time and cost efficient.• Nursing autonomy, positive staff experience. • Enhanced child and family journey.• Reduces length of stay and readmission. • Improves communication.

Take home messages

Patient education is a key component

It is not the transference of total responsibility for the discharge decision from doctors to nurse

Specifics protocols and patient criteria agreed by the multidisciplinary team and executed by a registered practitioner

The ability to assess and make clinical decisionsShould have expertise, training and competency assessment.

No Questions, Thanks!