Factors that contribute to the diversion of patients from long-term care.

This service evaluation aimed to identify the factors at an interim care unit that contributed to the diversion of patients from long-term care to care at home. A triangulated, mixed methods approach was adopted. Data were collated from an analysis of individual patient case notes; interviews with patients, carers and relatives; and workshops with unit staff. Distinctive and overlapping core themes emerged from the data. Patients and relatives cited having extra time in the unit to adjust, with staff encouragement and persistence to tackle their main problems, in addition to achieving seamless care at home and the ability to envisage a life after hospital. The staff workshops revealed attitudes that supported patient empowerment, shared decision making and patient-centred solutions. The successful diversion of patients from long-term care is multifaceted and dynamic. It is clear that a decision to pursue a different end-point destination has to occur, with patients' and relatives' consent; that is, to avoid transfer from acute care to long-term care. The optimism and self-belief created by this decision drive staff and patients towards the same goal: improved patient outcomes and, for some, eventual diversion from long-term care.

A guide for HCAs on safe patient transfers.

This article is written predominantly for healthcare assistants. It may also be useful for anyone less familiar with transferring patients or who delegates to HCAs. It offers a definition of patient transfer and addresses considerations for patient safety and the role of HCAs throughout the three distinct phases of transfer, which are: preparation to transfer (before); considerations of transfer (during); and at the point of final handover (actual transfer) in a hospital. It also addresses the role of escorting patients, and highlights the difference between transferring and escorting. Finally, a framework for best practice is suggested, which could be applied in clinical areas where high proportions of patients are transferred, such as emergency departments, discharge lounges and admissions or assessment units. This framework is adaptable and can help in the development of local hospital policies for the safe transfer of patients. The key message of this article is that patient transfer is a process that requires adequate preparation and occurs in distinct phases, each of which must be carried out with proper care and attention if patients are to be transferred safely.

The nurse's role in hospital ward rounds.

Ward rounds are a crucial aspect of acute care, but nurses' involvement varies. While their responsibilities on ward rounds may vary from ward to ward, nurses have a vital role to play and should make it a priority to attend. This article discusses key aspects of nurses' responsibilities and the different stages in the ward-round process.

Packed and ready to go.

Timely discharge from hospital is a fundamental part of care that requires staff to be well trained, clear about their roles and open to innovative ideas.

Implementing nurse-led discharge.

Many hospitals have for years tried to introduce nurse-led discharge but the evidence suggests this has not been entirely successful. Projects have failed due to lack of engagement from staff, failure to monitor outcomes and lack of sustainability. This article describes the early stages of the introduction of nurse/midwife-led discharge at the Heart of England Foundation Trust, which attempted to address these issues.

Promoting single sex acute units.

This article discusses an audit to explore patients' experiences of being nursed in mixed sex accommodation on an acute medicine unit. It outlines achievements resulting from the audit, which include staff awareness of the effect of mixed sex areas on patients and changing the culture in the unit to embrace single sex bays.

A practitioner's guide to service development.

Service development and service improvement are complex concepts, but this should not prevent practitioners engaging in, or initiating, them. There is no set blueprint for service development so this article examines the process, describes the skills required, lists some change management tools and offers a guide to the stages involved. The article aims to demystify service development for those considering embarking on the process for the first time.

Improving the quality of nursing documentation on an acute medicine unit.

BACKGROUND: An action research project was undertaken to explore issues underpinning poor quality documentation and how improvement in assessment can be achieved and sustained. AIM: To improve nursing documentation, as well as the quality of nursing assessments and evaluation in an acute medicine unit using anaction research approach. METHOD: Nurses from an acute medicine unit helped develop a new process for assessment documentation. Five pieces of documentation were radically changed and three new pieces developed. During testing, four cycles of action research w ere completed; as a result, focused interventions were made to the documentation and assessment process to promote improvement in the areas that demonstrated poor completion or compliance. The new documentation was evaluated for degree of completion and compliance with the new process. RESULTS DOCUMENTATION: the quality of entries recorded, and compliance improved. Documentation was also more up to date. Staff commitment helped unravel issues underpinning poor completion/compliance to the original documentation and assessment process. CONCLUSION: Care planning must be taught in pre-registration training as a fundamental principle of care. Understanding issues pertinent to a busy area and designing a process that makes completion of documentation easier means changes can be sustained long after the active stages of action research have been completed.

Exploring the principles of best practice discharge to ensure patient involvement.

Recent guidance features 10 practical steps to improve the process of patient discharge and transfer- one of the eight high impact actions for nursing and midwifery. This article examines the current policy context surrounding discharge in the health service, and gives practical advice on implementing the 10 steps. For each step the Lean methodology has been used. According to the NHS Institute for Innovation and Improvement, Lean is an improvement approach to improve flow and eliminate waste, developed by Toyota. The principles discussed in this article should help hospital trusts to apply a systematic approach to the discharge planning process and prevent readmissions while improving the quality of patient discharge.

Venous thromboembolism risk assessments in acute care.

This article is aimed at nurses and other health professionals working in clinical practice and involved in venous thromboembolism (VTE) risk assessments. The article adds to the body of published literature relating to patient risk assessment for VTE by exploring practical clinical perspectives of introducing a sustainable risk assessment process. It reports on a series of small scale changes carried out during a project in an acute medicine unit at the Heart of England NHS Foundation Trust in Birmingham, which aimed to improve the level of compliance with carrying out VTE risk assessments and administering prophylaxis. The results of two audits conducted over a seven-month period at the beginning and end of the project illustrate an improvement in compliance from 6.25% to 62.5%. The article concludes that leadership from medical consultants acting as clinical champions is imperative and that nurses and healthcare assistants also have a pivotal role in promoting patient assessments, and in maintaining the momentum and sustainability of VTE risk assessments in clinical areas.

Developing discharge practice through education: module development, delivery and outcomes.

In England (UK) the discharge of patients from hospital is a source of constant scrutiny from primary care trusts in order to reduce the patient length of stay in Hospital. To support nurses in practice a part time, post registration discharge practice education module was developed entitled Facilitating Timely Patient Discharge. It was the first of its kind to be accredited at degree level (level 6) during 2006. University evaluation of the module involved an academic assignment based on a 3000 word case study. Projects in practice were integrated to enable the students to apply theories to clinical practice. This aspect was driven by an organisational impetus to demonstrate learning back in practice to the benefit of Heart of England Foundation Trust (HEFT). Students self assessed their individual ability pre and post the discharge module using questionnaires citing 17 areas of discharge practice analysing knowledge and ability. They demonstrated an increase in knowledge and ability in key areas such as; 'understanding complex discharge' and 'teaching discharge practice to peers'. Although these were not formally included in the outcomes or evaluations they may inform future module development and design of delivery. The questionnaires were designed and developed with support for projects in practice from the Foundation of Nursing Studies in London.

Implementing a patient assessment framework in acute care.

This article describes the secondment of a critical care practitioner to an acute medicine unit. The aim was to develop the acute assessment skills of the unit's nurses and to implement a new assessment framework. The secondment took place over four months from December 2007 to March 2008 at the Heart of England NHS Foundation Trust, Birmingham. There were several stages to the project, commencing with exploration of existing practice and culminating with evaluation of the project's effect on practice. A review of the multi-professional patient records was conducted six months after the conclusion of the secondment. This revealed that the assessment framework continued to be used in practice. The secondment demonstrated that supporting nurses to embrace new skills resulted in a change in practice. However, a permanent change cannot be assured unless practice is revisited and supported on a continual basis.

Auditing the nursing standard for weighing patients on an acute medical unit.

This article describes an audit of a standard for observations and assessments introduced on an acute medical unit (AMU), one element of which was patient weight. It showed that only 50% of nurses routinely weighed patients as part of the admission process and/or as part of nutritional screening. Revisions were made to the existing nursing standard.