Policy for the Discharge and Transfer of Children and

Young People from Child Health

V4.0
January 2014

Table of Contents
1.

Introduction ......................................................................................................................... 3

2.

Purpose of this Policy/Procedure...................................................................................... 3

3.

Scope ................................................................................................................................... 4

4.

Definitions / Glossary ......................................................................................................... 4

5.

Ownership and Responsibilities........................................................................................ 4

5.3.

Role of the Consultant Medical Staff & Medical team .............................................. 4

5.6.

Role of Nursing Staff ................................................................................................... 5

5.7.

Role of Paediatric Discharge Liaison ......................................................................... 6

6.

Standards and Practice ...................................................................................................... 7

6.1.

Discharge of Children/Young People without continuing healthcare need............ 7

6.3. Discharge of Children/Young people with Complex and Ongoing Healthcare

Requirements ......................................................................................................................... 7
6.9.

Discharge of Children and Young People in Special Circumstances ..................... 8

6.14.

Discharge of Infants from the Neonatal Unit (NNU) .............................................. 9

6.15.

Discharge of Children and Young people with Mental Health Issues ................. 9

6.16.

Discharge from the Emergency Department ......................................................... 9

6.22.

Transfer of Children and Young People ............................................................... 10

6.23.

Discharge involving Children and Young People from The Isles of Scilly ....... 10

7.

Dissemination and Implementation................................................................................. 10

8.

Monitoring compliance and effectiveness ...................................................................... 11

9.

Updating and Review ........................................................................................................ 11

10.

Equality and Diversity ................................................................................................... 11

10.2.

Equality Impact Assessment................................................................................. 11

Appendix 1. Governance Information .................................................................................... 12

Appendix 2. Initial Equality Impact Assessment Form ......................................................... 15
Appendix 3. Discharge Plan and Checklist ........................................................................... 17
Appendix 3a.Discharge Plan and Parent Skills sheet-Neonatal Unit ..19
Appendix 4. Vulnerability Criteria......21
Appendix 5. Discharge Pathway.22
Appendix 6. Referral Pathway for CCN and Diana Nurses..23
Appendix 7. Children's Community Nurses/Diana Nurses
Referral.... 25
Appendix 8. Transfer Document.29
Appendix 9. Paediatric Discharge Liason Coordinator Pathway..35

Policy for the discharge and transfer of children and young people from child health

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1. Introduction
1.1. This policy has been developed to support Trust Staff in the discharge and transfer of
children and young people. It is a requirement of the NSF for Children Young People &
Maternity Services to have in place a policy that meets the specific needs of this group.
This policy for discharge and transfer must be adhered to when discharging or transferring
children and young people.
1.2. This policy states the responsibilities of the multidisciplinary team when discharging
or transferring children/young people from services. It conforms to guidelines for discharge
from hospital laid down in the following documents:

DH: Working Together to Safeguard Children 2013

DH NSF For children young people and maternity services (2004)
DH: Framework for Assessment of Children in Need and Their Families 2001
Children Act 2004
DH: Discharge from Hospital, Pathway, Process and Practice 2003

1.3. This version supersedes any previous versions of this document.

2. Purpose of this Policy/Procedure

2.1. The purpose of this document is to outline the Trust policy for the Discharge and
Transfer of children and young people and contains the responsibilities, procedures and
the documentation required to carry out the process. The policy becomes effective from
the date of ratification
2.2. To ensure that consideration is given to appropriate and timely discharge or transfer
arrangements. Carers, children and young people are entitled to expect to be fully involved
in the planning of these arrangements including an explanation of the process. The
decision to transfer a child or young person is a clinical one but planning should involve
children/young people and their families.
2.3. To ensure that any information collected from the children/young people and carer
follows a standardised format, which is agreed by the multidisciplinary team. Discharge
planning should commence at the time of admission.
2.4. To ensure that the responsibility for the co-ordination of assessment and discharge
or transfer plan for all children/young people with continuing health and/or social care
needs is undertaken by the multi-disciplinary team. Children/young people who require
continuing support from other health or social care agencies should not be discharged in
the evenings, at weekends or during a bank holiday without prior consultation with involved
agencies, if a need or potential need for intervention is perceived prior to the next working
day. Children/young people may be discharged at these times at the discretion of the
Consultant, provided agreement has been reached that the family are able to provide
adequate support. This must be documented in the nursing and medical records. In the
case of transfer of this group of children and young people from our services, this should
be carried out in consultation with them and their families, ensuring that, whenever
possible, the multi agency team involved in the care of this group are in full agreement with
any transfer arrangements.

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3. Scope
3.1. This policy applies to all staff members, and their Line Managers, who are involved
with the discharge or transfer for children or young people.

4. Definitions / Glossary

Clinical Review - This may be an assessment of how the patient is doing in regard to
the reason for admission and current clinical problems; it may be undertaken by a
responsible practitioner, e.g. Consultant or other experienced doctor or nurse. The
review will enable progress to be assessed when planning for discharge.

Discharge - When the policy talks about discharge this should apply to any transfer
of a patient from the acute setting to home/place of residence.

Transfer This refers to the transfer of children/young people from child health to
another hospital or other health or social care facility

Foundation Doctor (F1 & F2) - A doctor who is on a structured training programme,
usually in the first 1-2 years of their qualification.

PAS patient administration system real time bed management system which all
patients are admitted onto.

5. Ownership and Responsibilities

5.1. Staff involved with the discharge or transfer planning of children and young people
are required to follow this policy and be clear with regard to their individual roles and
responsibilities within the process. The Policy will be available on the Document Library
with a link on the Child Health Intranet site.
5.2. All staff have shared responsibility for the completion of the Discharge Plan and
Checklist Appendix 3.

5.3. Role of the Consultant Medical Staff & Medical team

The consultant staff and those to whom they delegate duties:

Must discuss with the parents and children/young people, the reason for their
admission to hospital/contact with the service, the treatment involved and likely
outcome, including discharge and expected length of stay/length of treatment and
intervention plans and whenever possible any necessary transfer arrangements.

Will be responsible, in consultation with other members of the multidisciplinary team,

for deciding which professionals and agencies need to be involved in the assessment
of the discharge or transfer plan for the patient.

Have a responsibility to seek and record the views of children/young people and their
carers where relevant.

Will ensure that an electronic discharge summary will be emailed to the

children/young peoples General Practitioner (GP). This should be within 24 hours of
discharge. If available parents can be given a copy prior to them departing the ward.

Policy for the discharge and transfer of children and young people from child health

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Must inform the GP at the earliest opportunity of any child/young person whose carer
takes his or her discharge against medical advice.

5.4. The Consultant along with other relevant team members will be notified if a parent
takes home a child/young person against medical advice and will advise as to whether the
child/young person would be classed as at risk of significant harm.
5.5. When necessary Social Services and the Police can be contacted to enable the
child/young person to be returned to hospital. Please refer to Appendix 5 for the SelfDischarge Pathway.

Must ensure, that, whenever possible, discharge prescriptions are completed in

advance, to allow adequate time for the dispensing of medicines and the provision of
information to the child/young person and carer.

Must liaise with relevant other providers when a transfer is required to ensure
acceptance of the transfer and to agree any necessary arrangements.

When a decision has been made to transfer, the consultant or senior doctor will
ensure that the receiving service has a full written account of care delivered within
RCHT stating clearly the reasons for transfer. This must be discussed fully with the
parents/carers and whenever possible with the child or young person.

5.6. Role of Nursing Staff

Nursing Staff involved in the discharge/transfer of children or young people:

Should collect and clearly document accurate information relating to the child/young
persons individual social circumstances as soon as possible following
admission/service contact. This information will form the basis of their discharge
planning arrangements and will be included in any transfer documentation.

Should discuss all babies under a year of age with the health visitor /midwife with
reference to the vulnerability criteria (Appendix 4) as applicable, and ensure this
discussion is documented. The Paediatric Discharge/Liaison Co-Ordinator can be
contacted for further advice and support.

Should assess children/young people against the vulnerability criteria (Appendix 4),
and where a child/young person is identified as vulnerable discuss them with the
Health Visitor/School Nurse and ensure this discussion is documented. The
Paediatric Discharge/Liaison Co-Ordinator can be contacted for further advice and
support.

Identify any specialist medical equipment or support required along with the multi
disciplinary team and inform Community Nurse, Midwife, Health Visitor or School
Nurse to allow for equipment to be in place at time of discharge.

Will provide written information concerning discharge in the form of the Paediatric
Discharge Leaflet Going Home Preparing for your Childs Discharge from
Hospital.

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Will ensure that a discharge summary is sent to the children/young peoples health
visitor/ school nurse. This should be within 24 hours of discharge. Parents can be
given a copy, if available, prior to them leaving the ward.

Have a responsibility, in consultation with medical staff for co-ordinating which

multidisciplinary team members and agencies need to be involved in the assessment
and discharge/transfer plan for the children/young people. If the child has nursing
needs, the Childrens Community Nurses should be notified as soon as possible
following admission via a Paediatric Community Nursing referral form (Appendix 6 &
7). All members of the multidisciplinary team involved in the child or young persons
care must also be made aware of any transfer.

Have a responsibility for ensuring that the relevant community nurse/health

visitor/school nurse is invited to attend any multidisciplinary meetings regarding
discharge or transfer. Adequate notice of such meeting must be given whenever
possible. The Paediatric Discharge/Liaison Co-Ordinator can be contacted for further
advice and support.

Will ensure that transfers of children/young people to other provider units from acute
paediatric services use the same standards as discharges, and that the transfer
documentation (appendix 8) is completed, transport is arranged and personal
property and the relevant medical records are transferred with the child/young
person.

Will co-ordinate transport arrangements at the earliest opportunity to ensure that the
timing takes account of the care arrangements made for the day of discharge. When
transport is required for transfer this will also be arranged by the nursing staff who
must at all times liaise with Patient Transport Services (PTS) ensuring a risk
assessment is carried out when considering mode of transport

Should ensure that the children/young peoples carers are involved in assessments
and discharge or transfer plans. Their views should be sought, recorded and
communicated with other members of the multidisciplinary team.

Will ensure that, if necessary, the community nursing services have full written details
of nursing requirements, equipment and disposable supplies required for discharge
and continuing care at home by helping them to complete their nursing assessment
documentation. This may be part of the agreed discharge plan or a copy of the
discharge summary.

Should ensure that children/young people and carers are given relevant information,
verbally and in writing, regarding medication, follow up services, health education
and where to get help if needed. The guidance for Open Access to the Paediatric
Wards (Child Health Website -May 2009) should be followed for those who may
require this facility.

Should ensure child/young person is discharged from PAS

5.7. Role of Paediatric Discharge Liaison

5.8. Whilst responsibility for managing discharge remains with the ward, the Paediatric
Discharge/Liaison Co-Ordinator will provide assistance/support, where appropriate, in
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relation to communication between hospital and community services. The Paediatric

Discharge/Liaison Co-Ordinator pathways are detailed in Appendix 9.

6. Standards and Practice

6.1. Discharge of Children/Young People without continuing healthcare
need
6.2. When the hospital admission has been straightforward, discharge planning
need not be elaborate, but must include:

Written information to the GP and Health Visitor/Midwife (under 5s) and School
Nurse (over 5s). All parents and carers must be informed of this sharing of
information and they must be given the opportunity to let us know if they do not wish
this to happen. This information must be copied to the parents and/or young person
Enter record of admission in parent held record including height and weight.
Appropriate information, in writing, where available for the parents/young person
about any likely after effects and follow on treatment
Provision of written information to parents/carers about medication, including safe
storage and side effects. The instructions/advice on the discharge summary is
acceptable, as are patient information leaflets.
What to do should their child/young persons condition deteriorate.
Written point of contact in case of difficulty.
Written arrangements for follow up.
Written and verbal health promotion/illness prevention advice.
Whenever there is information sharing or verbal consent, details should be
documented in the health record
Discharge Plan and Checklist (Appendix 3) is completed and filed in the childs
notes.
Discharge from PAS

6.3. Discharge of Children/Young people with Complex and On-going

Healthcare Requirements
6.4. Where there is a more complex hospital episode and/or the child has ongoing
healthcare needs (e.g. long term illness, disability or life limiting conditions) discharge or
transfer planning must include all of the above and, appropriate consideration must be
given to:

Medical information being sought from the previous NHS Trust(s) before discharge
where a child is admitted to hospital with an ongoing medical problem. (To include
information about any social or child protection concerns).
Social Services contact and follow up arrangements.
Primary Care contact and follow up arrangements.
Community Childrens Nursing / Allied Health Professional contact and follow up
arrangements - the ward needs to be aware of the roles of these groups, their referral
processes and the information they will require, prior to discharge, to support children
who are discharged with additional needs.
Community Paediatric contact details and follow up
On-going hospital contact and follow up arrangements
Equipment needs.
Parent/Carers proficiency in managing their childs condition and associated needs

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6.5. A discharge planning meeting should be provisionally booked within 24-48 hours of
admission for those children with complex needs whose discharge may not be
straightforward.
6.6. It is the responsibility of the hospital nursing staff in consultation with the medical
staff to coordinate which multi-agency teams need to be involved in the assessment and
discharge or transfer of children and young people. Due to the complexity of some of these
discharge or transfer arrangements there must be a named person, known to the child and
family, who will co-ordinate ongoing care. This person will act as the single point of contact
should the family experience difficulty with ongoing care arrangements. This person can
be identified via the common assessment framework process.
6.7. The Paediatric Discharge/Liaison Co-Ordinator can be contacted for further advice
and support with this process.
6.8. Ward staff should ensure that parents/carers are adequately trained in the care of
their child before discharge. This applies to the administration of medicine, in addition to
the management of any equipment.

6.9. Discharge of Children and Young People in Special Circumstances

Child Protection Concerns

Where there are concerns about possible child protection issues, there must
be a multi-agency action plan agreed and recorded before the child leaves hospital.
Any legal orders arising from the admission should be recorded (with copies filed if
available)
The child must be registered with a GP before discharge
No child can be discharged or transferred from hospital, where there are child
protection concerns without the permission of the responsible Consultant
Paediatrician. This can only be given once a clear, agreed action plan is in place and
confirmation that the child is being discharged/transferred to a place of safety.
So far as possible, all investigations should be completed before discharge/transfer,
even if the child is deemed medically fit, with clearly documented plans in place for
any remaining/follow up investigations.
Medical information should be sought from the previous NHS Trust(s) before
discharge where a child admitted to hospital with an ongoing medical problem, or is
recognized as at risk of harm, has already been treated at another hospital.
All follow-up plans, for all agencies, must be clearly documented and confirmed.
If the child is discharged to an address other than their home address and/or into the
care of someone other than their parent, this must be clearly recorded in the health
record, taking care with regard to confidentiality
Whenever possible the child, parents/carers should be informed of all arrangements
made, whilst taking care with regard to confidentiality.
The Named Nurse for child protection, can be contacted for further advice via RCHT
switchboard in working hours.
The Multi Agency Referral Unit (MARU) can be contacted in office hours on 0300
1231116

6.10. If there are urgent concerns out of office hours, either contact the duty doctor for child
protection (via RCHT switchboard) or the on call social worker (via 01208 251300)
6.11. Transition to Adult Services
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When a young person has ongoing care needs, and is reaching the age where adult
services will be assuming responsibility for this, the transition of care should be recorded in
the notes. A named person known to the young person and their family should be
identified where possible for contact in case of difficulty.
6.12. Children who have remained in hospital for 3 months or longer
These children will be subject to Section 85 of the Children Act 2004. The Trust has a
responsibility to notify social services in these circumstances and when the child is
discharged or transferred to another health provider. Please refer to multi agency guidance
re children who are in hospital for more than three months as directed by named
professionals for child protection.
6.13. Palliative care needs
Children who have palliative care needs must have an identified key-worker to co-ordinate
an appropriate support network within the home setting. They require a written plan of
treatment and intervention, details of which have been agreed with the family and shared
with the community teams prior to discharge.

6.14. Discharge of Infants from the Neonatal Unit (NNU)

The previous standards all apply to infants being discharged from NNU who may also
have a co-ordinated programme of follow up, with special arrangements for vision,
hearing, developmental progress and ongoing support. All of this should be recorded in the
childs notes. The principles of children with continuing healthcare need outlined above is
likely to apply to this group of patients.

6.15. Discharge of Children and Young people with Mental Health

Issues
Where a child has an identified mental health need, arrangements must be made in the
discharge or transfer plan for follow up from the Child and Adolescent Mental Health
Service (CAMHS). Where this is not thought to be necessary the reason(s) for this
decision need to be agreed with the child/young persons consultant and documented in
the health record.

6.16. Discharge from the Emergency Department

6.17. Many children will be seen and assessed in the Emergency Department and deemed
medically fit for discharge during the working day, evenings, weekends or bank holidays.
For most children this can occur safely and without concern for the social circumstances.
6.18. The clinical staff discharging the patient must ensure that, in addition to a full medical
assessment, they make & document an assessment of the social circumstances and
consider if the child and their accompanying carers can safely return home. If there is any
concern that the child may not be able to return home safely and in a timely way,
consideration should be made of provision of hospital transport or admission to child
health until such time that public transport is easily accessible.
6.19. Where a child and their parent/carer have arrived by ambulance and are deemed
medically fit for discharge, it is the parent/carers responsibility to arrange transport home.
If the discharge is to occur during unsocial hours parents/carers should still try and arrange
transport home. In exceptional circumstances where this may not be possible and
parents/carers have exhausted all avenues, further advice can be sought from Child
Policy for the discharge and transfer of children and young people from child health

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Health, specifically in relation to the availability of the Macdonald Suite Family

accommodation.
6.20. A discharge summary should be sent to the GP.
6.21. The Health Visitor/Midwife (under 5s) and School nurse (over 5s) should be notified
of the attendance.

6.22. Transfer of Children and Young People

When children/young people are being transferred within the hospital details of the
transfer should be documented in the health record.
When children/young people are transferred to another provider the transfer
document (appendix 8) should be completed and the Patients Transport Service
(PTS) at RCHT should be consulted to book appropriate transport.
Out of hours transfers should be minimal and based on risk assessment of the
clinical situation as outlined in RCHT Guideline for Critical Care Transfers.
Arrangements for this type of transfer will be made with SWAST directly and the
RCHT site co-ordinator notified.
The personnel who accompany the child /young person will be decided by senior
clinical staff based on clinical need and staff availability this will be documented in
the health record or on the transfer document. Clinical assessment should be done in
line with RCHT Policy for Observation and Monitoring in Child Health and recorded
on the patient records for intra hospital transfers and on the transfer document if
being transferred to another provider.

6.23. Discharge involving Children and Young People from The Isles of
Scilly (IoS)

When planning a discharge/transfer to the IoS due regard must be given to the
additional time needed to reach the Islands because of the limited transport services
available, particularly at weekends. In addition consideration should also be given to
transfer times involved if onward transport by boat from St. Marys is required when
the child/young person lives on an off-island.
It will need to be confirmed that the child/young person is medically fit to travel to the
airport, and onward by air.
If the family have a return ticket nursing staff will provide assistance/advice, if
necessary, about how to book a flight.
If the family do not have a return ticket it will be necessary for them to contact the
Patient Transport Service Office (PTS) on 01872 252211 to request a travel warrant
to return to the Isles of Scilly and to arrange a flight.
Nursing staff will provide families with information regarding transport to the airport.
Where a child and their parent/carer have arrived by ambulance and are deemed
medically fit for discharge, it is the parent/carers responsibility to arrange transport
home. If the discharge is to occur during unsocial hours further advice can be sought
from Child Health, specifically in relation to the availability of the Macdonald Suite
Family accommodation.

7. Dissemination and Implementation

7.1. Ward and Department Managers are responsible for ensuring adequate
dissemination and implementation of the policy within their own areas.
Policy for the discharge and transfer of children and young people from child health

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7.2. All managers will be aware of the contents of this policy and will ensure that their
staff have read and understood the procedures and processes relating to the discharge
and transfer of patients. New versions of the policy will be circulated to all managers for
dissemination to their staff with a summary of all amendments made to the updated
version.

8. Monitoring compliance and effectiveness

Element to be
monitored

Completion of a discharge plan

Documentation of liaison with other professionals and agencies
Timeliness of documentation to other professionals
Completion of a transfer document
Documentation of details of transfer in patient notes
Lead
Senior Matron Child Health
Tool
An agreed audit tool developed by the Directorate and registered
with clinical effectiveness as part of the annual records audit, to
include the elements to be monitored described above
Monthly quality audits will monitor the completion of discharge plans
Annually for the whole policy through audit of records
Frequency
Monthly for ward quality audits on discharge plans
Reporting
Audits will be reported via the Divisional Audit and Guidelines
arrangements
meeting in the Directorate. Action plans, incidents and complaints
related to discharge and transfer will be brought back to the
Directorate via Clinical Governance meetings.
Reports should be discussed at the appropriate Operational Board
Acting on
Reports should be discussed at the appropriate Operational Board and
recommendations any high risk areas highlighted and action plans developed to address
and Lead(s)
any gaps identified.
Change in
Lessons will be shared with all the relevant stakeholders by
practice and
presentation at Child Health audit and guidelines meetings and via the
lessons to be
Child Health risk management newsletter. Following liaison with
shared
relevant stakeholders, any required changes to practice will be
discussed at Directorate Clinical Governance meetings, prior to being
reflected in this policy and implemented clinically.

9. Updating and Review

The policy author is responsible for ensuring the policy is kept up to date, with reviews being
carried out at least once every 3 years, reflecting changes in legislation where necessary.
The author must also ensure the policy has been screened to establish if it requires a full
Impact Assessment against the Race Relations Amendment Act to ensure no minority group
is discriminated against within the document.

10. Equality and Diversity

10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service
Equality and Diversity statement.

10.2. Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

Policy for the discharge and transfer of children and young people from child health

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Appendix 1. Governance Information

Document Title

Policy for the Discharge and Transfer of Children

and Young People from Child Health

Date Issued/Approved:

January 2014

Date Valid From:

January 2014

Date Valid To:

January 2017

Directorate / Department responsible

(author/owner):

Mary Baulch, Matron Child Health

Caroline Amukasana Paediatric discharge liaison
nurse

Contact details:

01872 252636

Brief summary of contents

This policy states the responsibilities of the

multidisciplinary team when discharging or
transferring children/young people from child health.
Paediatrics, Children, Young People, Neonates,
Discharge, Transfer.
RCHT
PCH
CFT
KCCG

Suggested Keywords:
Target Audience
Executive Director responsible for
Policy:

Medical Director

Date revised:

January 2014

This document replaces (exact title of

previous version):

Policy for the Discharge and Transfer of Children

and Young People from Child Health version 3.0
Child Health Senior Nurses, Consultant
Paediatricians Child Health, RCHT Site
management

Approval route (names of

committees)/consultation:
Divisional Manager confirming
approval processes

Sheena Wallace, Divisional General Manager

Women & Childrens

Name and Post Title of additional

signatories

none

Signature of Executive Director giving

approval
Publication Location (refer to Policy
on Policies Approvals and
Ratification):
Document Library Folder/Sub Folder
Links to key external standards

Related Documents:

{Original Copy Signed}

Internet & Intranet

Intranet Only

Paediatrics
Care Quality Commission Outcomes
1,2,4,6,7,9,14, and 21
NHSLA Risk Management Standards 4.9 and 4.10
Multi Agency Safeguarding Children Policies
RCHT Adult Discharge Policy
RCHT Policy on Clinical Record Keeping

Policy for the discharge and transfer of children and young people from child health

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Guideline for Open Access to the Paediatric

Wards (Child Health website)
Policy for Children who are in Hospital for
more than three months
RCHT Policy for patient observation and
monitoring in Child Health
Clinical policy for safe transfer of patients
between care areas or between hospitals
DH: Working Together to Safeguard Children
2013
DH NSF For children young people and
maternity services (2004)
DH: Framework for Assessment of Children in
Need and Their Families 2001
Children Act 2004
DH: Discharge from Hospital, Pathway,
Process and Practice 2003
Reder P. et al (1993) Beyond Blame Routledge
LONDON
Reder P. & Duncan S. (1999) Lost Innocence
Routledge LONDON
Browne K. (1995) in The Child Protection
Handbook edited by Wilson & James Balliere
Tindall LONDON
CEMACH (2004) Why Mothers Die(20002002) Report on confidential enquiries into
maternal deaths in the United Kingdom,
RCOG Press LONDON
Appendix 7- original document from Cornwall
Foundation trust
Appendix 8- Original document from regional
critical care group.
Training Need Identified?

No

Policy for the discharge and transfer of children and young people from child health

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Version Control Table

Version
No

Date

Summary of Changes

Changes Made by
(Name and Job Title)

May 09

V1.0

Final amendments approved;

EIA Completed; document
published

May 11

V2.0

Full review & consultation

Mary Baulch
Senior Matron Child Health

Dec 11

V3.0

Rewording of transfer element to

clarify process

Mary Baulch
Matron Child Health

Full review & consultation

Caroline Amukusana
Paediatric Liaison/Discharge
Co-Ordinator
Tabitha Fergus Deputy ward
manger- re format

Jan 14

V4.0

Mary Baulch
Senior Matron Child Health

All or part of this document can be released under the Freedom of Information Act
2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy on Document Production. It should not be altered in any way without the express
permission of the author or their Line Manager.

Policy for the discharge and transfer of children and young people from child health

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Appendix 2. Initial Equality Impact Assessment Form

Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to
as policy) (Provide brief description): Policy for the Discharge and Transfer of Children and
Young People from Child Health
Directorate and service area:
Is this a new or existing Policy?
Child Health
Existing
Name of individual completing
Telephone: 01872 252636
assessment: Mary Baulch
This policy has been developed to support Trust Staff in the
1. Policy Aim*
discharge and transfer of children and young people. It is a
Who is the strategy /
requirement of the NSF for Children, Young people and Maternity
policy / proposal /
Services to have in place a policy that meets the specific needs of
service function
this group.
aimed at?
2. Policy Objectives*

To ensure safe and effective discharge and transfer of children and

young people from the Child Health Directorate

3. Policy intended
Outcomes*

Safe and timely discharge and transfer of patients

4. *How will you

measure the
outcome?
5. Who is intended to
benefit from the
policy?
6a) Is consultation
required with the
workforce, equality
groups, local interest
groups etc. around
this policy?

Annual audit of discharge documentation

b) If yes, have these

*groups been
consulted?

RCHT Staff and Patients

No

N/A

C). Please list any

groups who have
been consulted about
this procedure.
7. The Impact
Please complete the following table.
Are there concerns that the policy could have differential impact on:
Equality Strands:
Age

Yes

No

Rationale for Assessment / Existing Evidence

Policy for the discharge and transfer of children and young people from child health

Page 15 of 38

Sex (male, female, trans-

gender / gender
reassignment)

Race / Ethnic
communities /groups

Disability -

learning
disability, physical
disability, sensory
impairment and
mental health
problems

Religion /
other beliefs

Marriage and civil

partnership

Pregnancy and maternity

Sexual Orientation,

Bisexual, Gay, heterosexual,

Lesbian

You will need to continue to a full Equality Impact Assessment if the following have been
highlighted:
You have ticked Yes in any column above and
No consultation or evidence of there being consultation- this excludes any policies
which have been identified as not requiring consultation. or
Major service redesign or development
No
8. Please indicate if a full equality analysis is recommended.
Yes
9. If you are not recommending a Full Impact assessment please explain why. No areas
relevant

Signature of policy developer / lead manager / director

M.Baulch. C.Amukasana
Names and signatures of
members carrying out the
Screening Assessment

Date of completion and submission

28/11/13

1.
2.

Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa,
Truro, Cornwall, TR1 3HD
A summary of the results will be published on the Trusts web site.
Signed _____M.Baulch, C.Amukasana__________
Date _____15/01/14___________

Policy for the discharge and transfer of children and young people from child health

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Appendix 3. Discharge Plan and Checklist- Sample only CHA2690 V4

Policy for the discharge and transfer of children and young people from child health

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Sample only CHA2690 V4

Policy for the discharge and transfer of children and young people from child health

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Appendix 3a. Discharge Checklist and Parent Skills-Neonatal Unit. Sample Only CHA3060

Policy for the discharge and transfer of children and young people from child health

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Policy for the discharge and transfer of children and young people from child health

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Appendix 4. Vulnerability Criteria

1. Poor parenting affecting childs health or development.
2. One or both parents under 21 years.
3. Step-parent/co-habitee member of household
4. Violence within the family (includes animals and domestic abuse)
5. History of cruelty- includes child protection categories 1,2,3,4.
6. Parents abused/neglected
7. Drug/alcohol abuse of main carers
8. Frequent incidents/injuries
9. Behavioural/ emotional vulnerability of child
10. Unreal expectations of child
11. Failure to thrive
12. Mental illness of main carers
13. Mother suffering with post natal depression
14. Any other factor which makes professionals instinctively uneasy
15. Family closing down to outsiders
16. Parents with learning disabilities
17. History of criminality
18. Family isolated within the community
19. Homelessness
20. Late ante natal booking
21. Lack of engagement with service
22. Poor living conditions
23. Poor attendance at appointments
24. Chaotic lifestyle
25. Frequent contact with the service

NB. THE NUMBER OF TICKS NEED NOT INDICATE THE LEVEL OF CONCERN I.E. ONE TICK MAY BE AS
SERIOUS AS FOUR.

Policy for the discharge and transfer of children and young people from child health

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Appendix 5. Self Discharge Pathway

If a parent chooses to take the discharge of their child against medical advice, staff should
discuss this with the parents, establishing their reasons and explaining the risks this could have
on their childs health.

All discussion should be clearly documented in the childs health record.

If the parent still requests discharge, the appropriate doctor must be contacted immediately in
order to review the child and further inform and explain any associated risks to the parent.

If these interventions fail to deter the parent, the impact on the childs welfare must be assessed
by nursing and medical staff, and safeguarding procedures should be followed if leaving the
hospital would place the child at significant risk of harm.
Safeguarding procedures should also be followed if the child is subject to a protection plan or is
a child in Care.

If the child is removed against medical advice, and there are significant safeguarding concerns,
the Trust security department should be contacted to assist, and an immediate referral to
Childrens Social Care must be made.
Staff should not place themselves at risk in trying to prevent the parent leaving with the child.

If there are no safeguarding concerns, and the child will not be at significant risk of harm
following discharge, the parent should be asked to sign a Discharge Against Medical Advice
form.
If the parent refuses to sign, this must be fully documented in the childs health record.
The parent should be advised to contact their G.P. practice for ongoing care.
If possible normal discharge procedures should be followed with regard to giving advice,
arranging for medication etc.
Whenever clinically indicated, appropriate outpatient follow-up arrangements should still be
offered/made when a child/parent discharges against medical advice

A young person assessed as having capacity to understand the consequences of taking their
own discharge against medical advice may wish to take their own discharge. In this case staff
should try to dissuade the patient from doing so.
If this is unsuccessful the young persons parents must be notified and the patient should be
asked to sign a Discharge Against Medical Advice form. They should be advised that other
relevant professionals (e.g. G.P., Social Worker, School Nurse) will be informed of their
decision.

Without exception, the childs GP and Health Visitor/School Nurse and any other key
professionals involved in the childs care must be informed at the earliest opportunity, preferably
within 24 hours, that the child has left/been removed from the ward.

If a parent expresses that they wish to discharge their child due to a complaint or concern about
care, every effort must be made to address and resolve the complaint/concern with reference to
the Trust Complaints Policy, to enable care to continue

Policy for the discharge and transfer of children and young people from child health

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Appendix 6 - Referral Pathway for Childrens Community Nurses

(CCN) or Diana Nurses (October 2013)
Referrals are made to the Childrens Community Nurses (CCN) or Diana
Nurses via the CCN/Diana referral form

The referral should be completed electronically on the correct referral form, identifying
the specific input required from the CCN/Diana Nursing Service.
If the referral form is not completed correctly it will not be accepted and will be returned
to the referrer. (The CCN/Diana team can be contacted prior to referral to discuss)

Referral should be emailed to

Childrens.services@cornwall.nhs.uk
The CCN/Diana Team may contact referrer to discuss referral and to confirm
details (action time - non-urgent 10 working days Urgent 3 working
days)
Referral will be discussed by the team and a nurse will be allocated if the
referral is accepted
Referrer will be notified if referral is not accepted, with reasons why it is not
accepted
If referral is accepted, CCN/Diana Team will contact the family to arrange to
visit Action time - non-urgent 10 working days Urgent 3 working days

Initial visit will be a 2 person visit

To identify any potential risks for future visits
To give 2 perspectives when formulating a plan of care
To ensure that the family are not reliant on a single person for future
visits, advice, etc
Follow up will be according to individual need
Discharge Criteria If there is no assessed nursing need, or the child or
young person has had no contact or support for a period of six months

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Additional Information for initial visit

Information that could be given and obtained during the initial visit if appropriate;
What is the family expectation of the Diana Team, what information have they been
given?
The Diana Team do not provide long term direct/ hands on care
Supporting and empowering family to provide care for their child
Identify training needs
Discuss supplies; set up PLUSS, Vygon as necessary.
Explain to parents that we will help them to manage their supplies but it is not our
responsibility to know when they are running out and/or to deliver more at short notice.
Help families to understand the services they are accessing and sign post families to
other services as necessary
Multi disciplinary liaison;
In the first instance the Diana nurse will speak to other professionals, there after it will be
up to the parents to contact professionals as necessary. This will be different during End
of Life!
Discuss psychology involvement if appropriate Amanda could act as the second person
Complete nursing assessment and care plans, wishes document if appropriateDiscuss care packages if necessary
Equipment; what have they got, where did it come from, what do they need, asset
numbers, servicing
Obtain consent consider age and mental capacity
Provide service leaflets

Remember some families will be able to absorb more information than others, a second
assessment visit may be necessary.

Policy for the discharge and transfer of children and young people from child health

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Appendix 7 Childrens Community Nurses/Diana Nurses referral

form. Sample only. Forms available from paediatric HDU
Community Childrens Nursing Team and Diana Nursing Team
Referral Form
Paediatric Community Services
C/O Childrens Services Care Management Centre
Truro Health Park
Infirmary Hill
Truro
TR1 2JA
Tel:
Tel: 01872 221400
Fax: 01872 246938

Out of County Patient? Y / N?

Financial agreement from referring trust? Y / N?
NHS No:
Name of Child:

ICS No:
Hosp No:

Known as:
D.O.B.:

Gender:

Parent/Guardian:
Address:

Telephone numbers - Home:

Address for visit:

Mobile:

Directions to visit address:

Policy for the discharge and transfer of children and young people from child health

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G.P. name / address / telephone number:

Diagnosis:

Reason for visit:

Current Medication:

Policy for the discharge and transfer of children and young people from child health

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Date first visit requested:

Date Visiting County (if applicable):

Consultant:

Other Professionals involved with Family:

Additional information:

Policy for the discharge and transfer of children and young people from child health

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Referrals must be emailed to the Care Management Centre:

Childrens.services@cornwall.nhs.uk
Normally the team will need forty eight hours for an acute referral and five working days for
other referrals. We will always be pleased to discuss the possibility of short notice referrals and
will respond if we can.
Supplies to be provided by referrer:

Supplies/equipment requested for CCNs to provide:

Name of referrer:

Date of Referral:

Date referral sent:

Contact Details:

Policy for the discharge and transfer of children and young people from child health

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Appendix 8-TRANSFER DOCUMENT

Sample only. Forms available from paediatric HDU

PLEASE AFFIX
PATIENT'S ADDRESSOGRAPH

Patient's Weight

Date:

Time: .

1.

Discussion with receiving unit / Name of Staff Member

..

2.

Handover provided
....

3. Departure time
Mode of Transport:
Ambulance
Hospital Transport
...

Para-Medic Ambulance

Own Transport

Other

Destination: .
Receiving Doctor: Tel. No: ...
Receiving Nurse: .. Tel. No: ...

Accompanying Staff / Family:

Dr: ..
Nurse: .
Parent / Carer / Other:
Contact Details of Parent / Carer / Other: .

Current Care Issues:

1.
2.
3.

Principle reason for transfer:

Policy for the discharge and transfer of children and young people from child health

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OBSERVATIONS
TIME
39

T
E

37

M
P

35

33

31

29

200

P
180

mm
Hg

160

140

120

100

80

E
S

60

P
S

40

20

V
P

10

mm
Hg

0
CRT
Sp02

Blood Sugar
Fi02/02
Mode
Ventilator
Rate
Pressures

NEURO
OBS:
Eyes
Open

C
O
M
A

Best
Motor
Response

S
C
A
L
E

PUPILS

Best
Verbal
Response

Right

Left

Childrens Coma
Scale (< 4 yrs)

Glasgow Coma
Scale (4-15 yrs)

TIME

Spontaneously

Spontaneously

To Speech

To Speech

To Pain

To Pain

No Response

No Response

Obeys verbal commands

Obeys verbal commands

Localises pain

Localises pain

Flexion to pain

Withdraws in response

Abnormal flexion

Abnormal flexion

Extension to pain

Abnormal extension

No Response

No Response

Orientated & converses

Disorientated & converse

Smiles, orientated to sounds,

follows objects, interacts
Crying
Interacts
Consolable
Inappropriate

Inappropriate words

Moaning

Incomprehensible sounds

Inconsistently
Consolable
Inconsolable

Irritable

No Response

No Response

No Response

Size

Size

Reaction

Reaction

Size

Size

Reaction

Reaction

Eyes closed by
swelling
=C

Usually the
best arm
response

Endotracheal
tube or
tracheostomy
=T

+ reacts
- no reaction
c eyes closed

FLUIDS
TIME
I
N
T
A
K
E
O
U
T
P
U
T

TOTAL
Urine

TOTAL
BALANCE

TRANSFER EVALUATION FORM

Airway / C-Spine

Environment

Breathing

Family

Circulation

Glucose
Disability

Other Comments

....

Policy for the Discharge and Transfer of Children and Young People from Child Health

Page 31 of 38
Signed: .. Date:
.

TRANSFER CHECK LIST

SELF-INFLATING AMBU BAG - INF / PAED / ADULT
OXYGEN / AIR CYLINDERS
X 2 / X 3 E SIZE ( X 1 WITH VENT VALVE )
PORTABLE CYLINDER FROM BEDSPACE
PORTABLE SUCTION
APPROPRIATE SUCTION CATHETERS

SYRINGES
50ML
10ML / 5ML LEURLOCK
NORMAL SYRINGES
10ML / 5ML / 2ML / 1ML
INSULIN SYRINGES

ECG MONITOR
POWER PACK AND LEAD
ETCO2 MONITOR APPROPRIATE CABLES

GLUCOSE MONITOR

THERMOMETER

3 WAY TAPS / T-PIECE

FACE MASKS
NEO / INFANT / CHILD / SML & LGE ADULT

SPACE BLANKET

IV EXTENSION LINES

DRUG LABELS
GREEN TUBING
SCISSORS / FORCEPS
NEBULISER SET + TUBING
NG TUBE & LITMUS PAPER
STETHOSCOPE
GLOVES 6.0 - 8.5
YANKERS X 2
GAUZE X 2
GUEDAL AIRWAYS SIZES (x1 of each):
4 / 3 / 2 / 1 / 0 / 00 / 000

SURGISILK 3/0 / SURGICAL BLADES /

SUTCHER CUTTER

ELASTOPLAST / ASSORTED TAPE /

PLASTERS

GAMGEE / BUBBLE WRAP

SYRINGE PUMPS

BATTERIES (Appropriate for equipment)

VOLUMETRIC PUMP

FAMILY - INFORMED / CONSENT / DIRECTIONS

DRUG BAG
INOTROPES / RESUS DRUGS
SEDATION
MISCELLANEOUS

COPIES OF NOTES / X-RAYS / REF. LETTER

RESTRAINT IN TRANSPORT
ACCEPTING HOSPITAL AWARE OF DEPART.

INTRA-OSSEOUS NEEDLE
STAFF - FOOD & DRINK / MONEY / PHONE
IV CANNULAS (e.g. Neoflon, Medicut, etc.)
ARRANGEMENT FOR RETURNING STAFF
ASSORTED IV BUNGS / STERETS

FOR INTUBATED CHILDREN

VENTILATOR

LARYNGOSCOPE HANDLES X 2

ETT 2.5 - 8.5 UNCUFFED / CUFFED

FLEXIBLE CATHETER MOUNT

STYLET SIZES
12 X 2
2.2 X 1

ANGLE PIECE

LARYNGOSCOPE BULBS X 2 SPARE

LARYNGOSCOPE BLADES:
1 X SHORT STRAIGHT
1 X LONG STRAIGHT
1 X SHORT CURVED
1 X LONG CURVED

AQUAGEL X 2

OTHER: .

MAGILLS:
1 SMALL
1 LARGE

OTHER: .

ENDOTRACHEAL TAPE

Policy for the Discharge and Transfer of Children and Young People from Child Health

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NURSING REFERRAL FORM - TRANSFER OF PATIENTS

Home
From

To:

Ward
Ward Tel. No.
Hospital

Hosp. No:

Surname:

Age:

Forenames:

D.O.B.

Religion:

Discharge Address:

Home Address:

Tel. No:

Consultant:

Next of Kin:

Social Worker:

Address:

General Practitioner:

Relationship:

Address:

Tel. No:

Health Visitor (HV):

HV Informed of Transfer:

Yes

No

Other:

Date of Admission:

Relatives notified of Transfer:

Yes

No

Date of Transfer:

Diagnosis and Brief Summary of Patient's condition

Other Comments (e.g. Allergies, Special Disabilities, Pre-existent Conditions, to include infectious status etc.)

Policy for the Discharge and Transfer of Children and Young People from Child Health

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Nursing Requirements (Including special diets, feeding and dressings)

Drugs and Medicines

Family Information

Follow-up treatments and appointments

Date

1.

Time

Place

Date

2.

Time

Place

What arrangements have been made for transport? ......

Please photocopy and keep

1 copy in notes

Signature
Designation .
Date .

Policy for the Discharge and Transfer of Children and Young People from Child Health

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Appendix 9 Paediatric Discharge Liaison Co-Ordinator Pathway

Community professionals include
Health Visitors, School Nurses,
Community Therapies, Community
nurses and community
Paediatricians and any other
community services involved.

PATHWAY FOR CHILDRENS WARDS (HDU, POLKERRIS, HARLYN, FISTRAL)

Attend wards to gather information regarding any new admissions and on-going cases
Consider priority/complexity of presenting cases

ROUTINE PRESENTATION

COMPLEX PRESENTATION

e.g non-complex planned admissions,

minor infections/injuries, children who will not need
additional support after discharge

e.g long term illness, disability, life limiting conditions, or children

who will require additional support after discharge

Re-assess on regular visits to ward

and review in the event of any
change
Where there is no change
and the presentation remains
routine, discharge should be
straightforward and
completed without the
additional need for support
from the Paediatric
Discharge/Liaison CoOrdinator

In the event of
changes to
presentation, follow
pathway for Complex
Presentation

Health Visitors and School Nurses

may not be informed of routine, noncomplex admissions unless they
specifically request to be informed

Work with the wards to ensure any relevant community professionals

have been informed and this has been documented in ward notes (and
by Discharge/Liaison Co-Ordinator on Electronic Records when available
and where appropriate, * for community notes ensure that any call is
followed up with email to add to patient community notes.)
* Responsibility for contacting relevant professionals remains with
the ward, and community professionals maintain responsibility for
communication with the ward, unless there are specific, significant
complications that would benefit from intervention by the Paediatric
Discharge/Liaison Co-Ordinator

Safeguarding
concerns identified
should be shared by
the wards with the
Named Nurse for
Safeguarding, and
relevant policies and
procedures followed

Children meeting the Criteria

for Outreach will be
supported by Outreach
Nurses e.g. Respiratory,
Oncology, Diabetes, etc.
These discharges are likely to
proceed without additional
need for support

It remains the responsibility of community professionals to attend relevant

meetings in the event of significant difficulties attending meetings the
Paediatric Discharge/Liaison Co-Ordinator can attend and provide feedback
to the community
After involvement in Discharge Planning Meeting, where appropriate,
discharge may be followed with a call to the family to ensure that the
discharge plan is being followed and to ensure that the family have the
relevant contact details for the community teams/professionals.
A follow up meeting in the community may also take place if appropriate.

If a child is identified as a Looked After Child it is the ward/departments responsibility to inform Child in Care Team of admission/discharge. Paediatric Discharge/Liaison CoOrdinator
can from
assist
with
this and will double check that information has been shared
Policy for the Discharge and Transfer of Children and
Young People
Child
Health

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LIAISON WITH SERVICES OUT OF COUNTY (in development)

Out of county service to be provided with Paediatric Discharge/Liaison Co-Ordinator contact details.
Paediatric Discharge/Liaison Co-Ordinator to attend Childrens Community Nurse Team meetings on a regular basis
and remain updated from the wards in order to ensure awareness of any children that are receiving treatment out of
county
In the first instance, it is the responsibility of the ward transferring/receiving the patient from out-of county to inform the
relevant community service, and responsibility for maintaining communication with the ward remains with the
community staff involved.

Paediatric Discharge/Liaison Co-Ordinator role is to liaise with community services (and RCHT wards where
necessary) regarding any discharge/transfer plans he/she has been informed of (ensuring community staff have been
informed of any transfers out of and into Cornwall where appropriate), and to intervene as appropriate where specific,
significant complications arise in the discharge process.

Document in ward notes and on Electronic Records when available.

* For community notes ensure that any call is followed up with email to add to patient community notes where
electronic recording is not available.

If a child is identified as a Looked After Child it is

the ward/departments responsibility to inform
Child in Care Team of
admission/discharge/transfer. Paediatric
Discharge/Liaison Co-Ordinator can assist with
this and will double check that information has
been shared

Any Safeguarding concerns identified should be

shared with the Named Nurse for Safeguarding,
and relevant policies and procedures followed

**Childrens Community Nurses, for the purpose of this pathway, includes the Diana Nurses

Policy for the Discharge and Transfer of Children and Young People from Child Health

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NEONATAL
Attend ward regularly to gather information regarding any new and on-going cases.
Attend weekly Baby in the Family meetings

Infants meeting the Neonatal Outreach Criteria

will have discharges co-ordinated by the
Neonatal Unit Team.
These discharges are likely to proceed without
the additional need for support from the
Paediatric Discharge/Liaison Co-Ordinator.

Infants who will not require complex support after

discharge may not meet the criteria for the Outreach
Nurses Paediatric Discharge/Liaison Co-Ordinator to
provide any appropriate additional support for these
infants as required by the ward i.e. Additional Liaison
with Health Visitors or any other relevant professional

Liaise with Outreach Nurses, community Nurses and the ward where infants are transferred from
Neonatal to Polkerris. Following transfer, refer to pathway for Childrens Wards

If a child becomes identified as a

Looked After Child it is the
ward/departments responsibility to
inform Child in Care Team.
Paediatric Discharge/Liaison CoOrdinator can assist with this and can
double check that information has
been shared

Safeguarding concerns
identified should be shared
with the Named Nurse for
Safeguarding, and relevant
policies and procedures
followed

Policy for the Discharge and Transfer of Children and Young People from Child Health

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EMERGENCY DEPARTMENT (AND MINOR INJURY)

Paediatric Discharge/Liaison Co-Ordinator to attend Emergency Department (ED) on a regular basis to
address any communication issues they may have. Also maintain a level of communication with the
Trusts Minor Injury Units (MIU)
Identify any issues that require follow up in the community - via communication folder in ED

If a child is identified as a
Looked After Child it is the
departments responsibility
to inform Child in Care
Team of
admission/discharge.
Paediatric
Discharge/Liaison CoOrdinator can assist with
this if required

Safeguarding
concerns will be
identified by ED and a
referral made to
Named Nurse for
Safeguarding

This is a Pathway under

Development and will be subject to
regular review.

Straightforward
attendances that do
not require community
follow up, should not
need additional
support from the
Paediatric
Discharge/Liaison CoOrdinator

Facilitate referral to the relevant

community service for those children
who require follow up treatment in the
community but do not fall under
Safeguarding a communication folder
is in place in ED for this purpose.

Explore links with community services, in

particular the Childrens Community
Nurses, and encourage ED and MIU to
refer to community services in order to
accurately highlight the level of need for
community follow up.

Explore links with community

staff such as Health
Visitors, School Nurses, and
Childrens Community Nurses
to identify communication
concerns

** Childrens Community Nurses, for the purpose of this pathway, includes the Diana Nurses

Policy for the Discharge and Transfer of Children and Young People from Child Health

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