You are here

Grantham and District Hospital Good

All reports

Inspection report

Date of Inspection: 24, 25 February 2014
Date of Publication: 2 April 2014
Inspection Report published 02 April 2014 PDF | 94.14 KB

People should get safe and coordinated care when they move between different services (outcome 6)

Meeting this standard

We checked that people who use this service

  • Receive safe and coordinated care, treatment and support where more than one provider is involved, or they are moved between services.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 24 February 2014 and 25 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Reasons for our judgement

The hospital has a visual hospital scheme and the bed manager and wards had boards which showed when a patient was fit for discharge or had past their discharge time. A meetings occurred every morning between Monday and Friday which was attended by the discharge liaison nurse, bed manager, assertive in reach team, social workers and other health professionals. The reason for the meeting was to discuss all those patients who were medically fit to be discharged and what processes needed to be put in place to ensure the discharge happened. They also reviewed the patients who were in-patients for more than five days,this was to commence a possible discharge plan for each patient.

Times of discharges were monitored. Discharges after 8pm were allowed from the emergency admissions unit and accident and emergency only.

Staff told us discharges into community care establishments were sometimes a problem as there was little availability locally. Staff told us dealing with social care services outside the county was often a problem and could delay a discharge. One patient's discharge had been delayed because they had an infectious disease and could not be readmitted back to their care home. Late discharges sometimes meant patients could not be treated on the correct ward. During our visit the Day Ward was oversubscribed as it could only take 12 patients and 19 had been booked in or moved from another ward. Another ward was helping them take patients so their treatment was not delayed.

One staff member told us the complexities of discharging outside the United Kingdom (UK). They had recently had to discharge a person back to Lithuania. They had been in touch with the Lithuanian Embassy and accessed translation services. Other staff told us how they repatriate patients to other hospitals within the UK if their care can be completed nearer their home. One staff member said, "There is a pathway to follow and we have goal setting meetings, then when appropriate have a meeting re discharge." The stroke unit was particularly well set up in planning meetings from point of arrival. One staff member said, "We plan from day one."

It is the responsibility of the ward staff to arrange the discharges but the discharge liaison nurse helped them to make referrals to other agencies, arrange complex case conferences and complete health assessments both prior and during the patients stay.

Patients told us they had been involved in their discharge arrangements. One patient said, "My cousin is coming to pick me up, he arranged a suitable time with the staff." However another patient told us, "I keep asking them when I am going home. They have said this weekend, if it doesn't happen I am thinking of discharging myself, especially when I see people worse than me going home. The social workers have not been to see me in here."

We looked at three sets of patients' notes specifically around their discharge arrangements. In each case the discharge checklist had been commenced. in one case the patient told us the physiotherapist had involved them in discussions about the equipment they would need at home. The notes confirmed this. An electronic discharge letter is sent to the patient's GP when the patient leaves the hospital and a copy faxed to the community nurses if needed.

In two sets of patients notes we saw each person had been referred to the social services department two days after admission, so planning could commence.

Where required staff told us they liaised with outside agencies as part of the discharge planning process. In two sets of notes this had involved care staff for home care and the use of different equipment. Staff told us they gave patients leaflets on how to look after themselves. One nurse told us she was in the process of giving a person a leaflet about falls prevention.

Staff told us about one patient who was being discharged back to a care home and required an air mattress. The ward staff had asked the care home to confirm wi