Establishing a Successful Establishing a Successful Discharge Discharge Readiness Program in the Readiness Program in the NICUNICU

Presented by: Michelle Clements, RNWakeMed Intensive Care NurseryNovember 11, 2009

GoalGoal

Discharge planning should begin early in the hospital course. The goal of the

discharge plan is to ensure successful transition to

home care.

Patient and

Family

Nursing

Medical Team

DevelopmentalTeam

LactationConsultant

Family Educator

Social Work

Audiology

Speech

Radiology

Respiratory Therapy

NICU Family Care Coordination

D/C Planner

Case Worker

Family Advisor

Parent SurveyParent SurveyDischarge ExperienceDischarge ExperienceMajority 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 Discharge Teaching Begins on AdmissionBegins on AdmissionDischarge plan should be individualizedAddresses both parent and infant needsFocus on what parent needs versus nurse Individualized BinderCase Manager: Can be clinical nurse

specialist, discharge planner, or nurse practitioner. Oversees all teaching and coordination of multi-disciplinary approach

Discharge Plan Discharge Plan continued…..continued…..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 Discharge Planning MeetingMeetingTwo Key Considerations:

1.The need for parents to receive accurate information about medical and long-term developmental outcomes2.The need for parents to be meaningfully involved in decision making – including the discharge planning meetings

Family-Centered Family-Centered ApproachApproachIncreasingly 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

Family-Centered Family-Centered Approach cont…..Approach cont…..Families collaborate with staff to

determine prioritiesFamily advisors assist in developing

and evaluating documentation formsFamilies and staff document

progressFamilies participate with

multidisciplinary teamFamilies participate in goal planning

Parent Participation in Parent Participation in CaregivingCaregiving

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 EducationParental Education

Involve parents in whatever way possibleRequest return demonstrationsAvoid overstating infant’s fragility Identify 2 responsible caregivers for

educationEstablish a written checklist or outline of

tasks to be mastered Identify family strengths

Core Components of Core Components of Discharge TeachingDischarge TeachingFeeding (breast, bottle, including

formula preparation)Basic infant care, including bathing;

skin, cord, and genital care; temperature measurement; dressing; and comforting

Infant CPR and emergency interventionSigns and symptoms of illness as well

as signs and symptoms specific to infant’s condition

Core Components of Core Components of Discharge Teaching Discharge Teaching cont…..cont…..Infant safety precautions,

including safe sleep and proper use of car seats

Special safety precautions (feeding tubes, equipment, etc)

Administration of medications

Earlier Discharge Earlier Discharge PlanningPlanningGoal: 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

EvaluationEvaluation•Parent Questionnaire: How’s Your Baby?

•Follow-up Phone call within first week of discharge

ReferencesReferencesAmerican 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