Transcript Establishing a Successful Discharge Readiness

Establishing a Successful Discharge
Readiness Program in the NICU
Presented by: Michelle Clements, RN
WakeMed Intensive Care Nursery
November 11, 2009
Goal
Discharge planning should begin
early in the hospital course. The
goal of the discharge plan is to
ensure successful transition to
home care.
NICU
Family Care
Coordination
Medical Team
D/C
Planner
Social
Work
Audiology
Radiology
Patient
and
Family
Speech
Nursing
Respiratory
Therapy
Family
Advisor
Lactation
Consultant
Case Worker
Family
Educator
Developmental
Team
Parent Survey
Discharge Experience
Majority of responses were related to
receiving more and higher quality
information. Specific informational needs
focused on consistency of information
they received from different providers
and updates on their infant’s care and
progress.
Transition to Home from the Newborn Intensive Care Unit: Journal of
Perinatal and Neonatal Nursing: July/August 2006
Discharge Teaching Begins on
Admission
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Discharge plan should be individualized
Addresses both parent and infant needs
Focus on what parent needs versus nurse
Individualized Binder
Case Manager: Can be clinical nurse specialist, discharge
planner, or nurse practitioner. Oversees all teaching and
coordination of multi-disciplinary approach
Discharge Plan continued…..
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Multidisciplinary plan for discharge readiness, with
weekly meetings to track progress
◦ Medical progress, infant behavior and special
characteristics
◦ Caregiving environment: update on parent progress in
caring for infant. Includes issues brought by parents
◦ Family organization and functioning (includes sibling
issues)
◦ Discharge planning, update on teaching, and
community resources needed and/or met
Discharge Planning Meeting
Two Key Considerations:
1. The need for parents to receive accurate
information about medical and long-term
developmental outcomes
2. The need for parents to be meaningfully
involved in decision making – including the
discharge planning meetings
Family-Centered Approach
Increasingly offer families opportunities
to participate in caregiving and decision
making throughout their infant’s
hospitalization gradually building their
confidence and competence
 Integrated into family caregiving as early
as possible
 Content individualized for families.
 Families collaborate with staff to
determine needs
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Family-Centered Approach
cont…..
Families collaborate with staff to
determine priorities
 Family advisors assist in developing and
evaluating documentation forms
 Families and staff document progress
 Families participate with multidisciplinary
team
 Families participate in goal planning
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Parent Participation in Caregiving
Remove the focus from teaching post discharge readiness
•Parents may inadvertently limit their participation in infant
care from the beginning of hospitalization if the focus is on
discharge readiness.
•Focus more on early hospitalization caregiving activities
Parental Education
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Involve parents in whatever way possible
Request return demonstrations
Avoid overstating infant’s fragility
Identify 2 responsible caregivers for education
Establish a written checklist or outline of tasks to be
mastered
Identify family strengths
Core Components of
Discharge Teaching
Feeding (breast, bottle, including formula
preparation)
 Basic infant care, including bathing; skin,
cord, and genital care; temperature
measurement; dressing; and comforting
 Infant CPR and emergency intervention
 Signs and symptoms of illness as well as
signs and symptoms specific to infant’s
condition
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Core Components of
Discharge Teaching cont…..
Infant safety precautions, including safe
sleep and proper use of car seats
 Special safety precautions (feeding tubes,
equipment, etc)
 Administration of medications
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Earlier Discharge Planning
Goal: No teaching needed on the day of discharge.
Parents should be able to celebrate this long-awaited
milestone
Resources:
•Discharge Checklist
•Discharge Planning Rounds
•Case Manager/Discharge Planner
•Timing of Discharge
•Coordination with Interpreting Services
•Flexibility in timing of discharge to include evenings and
weekends
Evaluation
•Parent Questionnaire: How’s Your Baby?
•Follow-up Phone call within first week of
discharge
References
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American Academy of Pediatrics, Committee on Fetus
and Newborn. Hospital discharge of the high-risk
neonate: guidelines. Pediatrics. 2008; 122; 1119-1126
Coates, Carolie. Evidence-Based Practice Within
Discharge Teaching of the Premature Infant. Clinician
Support Technology. April 19, 2000.
Griffin, Terry, Abraham, Marie, Transition to Home from
the Newborn Intensive Care Unit: Journal of Perinatal
and Neonatal Nursing: July/August 2006: 243-249