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Nurse-initiated discharge underway at Christchurch Hospital.

Ensuring nurses use their competency, skills and unique body of knowledge to positively influence patient care and reduce unnecessary delays to patient discharge, was the impetus behind the introduction of the nurse-initiated discharge project at Christchurch Hospital.

Director of nursing services Sue Hayward said the idea of the project emerged from a nursing services discharge audit which revealed unnecessary delays to discharge, as well as emergency department overcrowding, which could lead to gridlock throughout the hospital. Patients who were well enough to be discharged were sometimes waiting up to eight to ten hours to leave the hospital because of systems problems. Nurses had identified the project as necessary and it had been driven by nurses, Hayward said. "Obviously we have linked in with our medical and allied health colleagues and acknowledge the importance we each have in the discharge process." Project facilitator Sarah Brophy said during the three-month pilot project last year, weekend discharge rates had increased by 40 percent and there had been no significant increase in readmissions. Implementation of nurse-initiated discharge was now underway across Christchurch Hospital. Implementation involved three stages: full consultation to establish suitable patient groups and criteria, which took the most time; multidisciplinary staff training and education; and then roll out in medical and surgical wards.

The patient groups that can be discharged by nurses are those on the lower end of the care continuum--"those with a predictable outcome and an uneventful recovery," Brophy said. In medical wards this includes those with cellulitis, urinary tract infections, gastroenteritis, heart failure, and patients with an exacerbation of their asthma and chronic obstructive pulmonan disease symptoms. In neuroscience wards the patient group includes discectomies, and in cardiology those having elective procedures such as cardiac catheterisation or permanent pacemaker implants, as well as acute chest pain where a cardiac cause is excluded.

Nurses must complete two half-hour education sessions before they can initiate discharge. Brophy said the model worked very well in short-stay, high turnover areas and after hours. Nurse-initiated discharge formalised, with defined pathways and criteria, the discharge planning competencies of nurses "It empowers nurses to overcome unnecessary blocks and delays to discharge. They can anticipate a patient's discharge within known parameters and do all the necessary discharge preparation. This reduces nurses and patients' frustrations and can make the difference between gridlock throughout the hospital or not," she said.
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Title Annotation:NEWS AND EVENTS
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:1USA
Date:May 1, 2006
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