Policy for Transfer of Adult Patients

(Excluding Maternity)

Date
Jan 11

Page
All

Amendments Comments
Full document review

Approved by
Chairmans actions for NMC

Compiled by: Ratified by: Date: Date Issued: Next review date: Target Audience: Impact Assessment Carried Out by: Policy Owner:

D Hallett & Claire OBrien Chairmans action by S Rankin for NMC January 2011 January 2011 December 2013 All staff D Hallett Equality & Diversity Champion D Hallett

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CONTENTS 1. INTRODUCTION .3 2. PURPOSE . 3 3. KEY PRINCIPLES 3 4. DUTIES . 4 5. MINIMUM REQUIREMENTS FOR ALL PATIENT TRANSFERS 6 6. TRANSFER FOR SPECIFIC PATIENT GROUPS WITHIN THE ORGANISATION ............................... 7

7. TRANSFER OF PATIENTS BETWEEN HOSPITALS .... 8

8. TRANSFER OF INFECTIOUS PATIENTS 10

9. TRANSFER OUT OF HOURS .. .10 10. DISSEMINATION AND IMPLEMENTATION 10 11. MONITORING ... 11 12. ARCHIVING 11 13. REFERENCES 11 14. ACKNOWLEDGEMENTS .12 APPENDICES Appendix 1: Equality Impact Assessment 13

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ASHFORD AND ST PETERS HOSPITALS NHS TRUST

POLICY FOR TRANSFER OF ADULT PATIENTS

See also: Guidelines for Transfer of Acutely ill patients from Ashford hospital to St Peters Hospital (See Trust net) Infection Control Manual Bed management Policy 1.0 INTRODUCTION

This policy sets out for staff across the Trust what is required to ensure a safe and effective transfer for any adult patient who requires transfer to another ward or department within or outside of Ashford and St Peters Hospitals. It includes an outline of the roles and responsibilities of trust staff, key principles fundamental to transfer, and the range of factors that need to be considered with patients and their carers before and during transfer. The standards outlined in this policy should be adhered to by all trust staff regardless of the type of transfer or the time of day in which the transfer is taking place. 2.0 PURPOSE

The aim of this policy is to ensure that there is a clear and consistent process in place for dealing with patient transfers at Ashford and St Peters Hospitals. This will ensure continuity of care for the patient with no detrimental effects attributable to the transfer. It will also ensure the patient receives optimal care during transfer while maintaining privacy and dignity at all times. Furthermore it will ensure that the Trust meets all its legal responsibilities and conforms to the relevant NHSLA Risk Management standards. 3.0 KEY PRINCIPLES

Five key principles underpin this policy and should be adhered to by individual members of staff and multiagency teams during patient transfer: 1. The potential benefits of transfer must be balanced against the risk: It must be established that the transfer is in the best interests of the patient and that the treatment or investigation is actually required. 2. The safety of the remaining patients must be taken into consideration: It is important to ensure that the safety of existing patients is maintained 3. Transfer must be timely: Wherever possible, patients should be transferred before 22:00 hrs. However due to changes in patients conditions and increased patient throughput, some transfers will have to take place outside of these hours.

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4. Effective communication (between staff, patient and carer) and accurate documentation regarding patient condition and their care needs is of paramount importance to patient safety. 5. The type of staff support required during transfer will be proportionate to the level of care needs. The following table defines the level of care of adult patients and will be used as reference within the policy:Patients whose needs can be met on a normal ward in an acute hospital. Patients at risk of deterioration, or those relocated from higher levels of care, whose needs can be met on an acute ward with additional advice and support from higher levels of care. Patients requiring more detailed observation or intervention including support for single organ failure or postoperative care and those stepping down from higher levels of care. Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least 2 organ systems. This level includes all critically ill patients requiring support for multi-organ failure

Level 0

Level 1

Level 2

Level 3

(Intensive Care Society 2009) 4.0 4.1 DUTIES Chief Nurse, Executive Lead To advise the Trust Board of any significant incident arising from patient transfer. 4.2 Heads of Nursing, Matrons and Ward Managers/Registered Nurse Responsible for ensuring the safe transfer of patients within their own area. To ensure that staff are made aware of the trust guidelines for transfer of patients. To act upon incidents arising from patient transfer. To ensure suitably competent staff are assembled as required for the transfer. To ensure all staff using specialist equipment have received appropriate training in accordance with Trust and NHSLA requirements. To provide the necessary equipment and resources for transfer Ensure that IPL is updated to reflect infection status Ensure transfer form is completed (see Trustnet Discharge framework) To book appropriate transport, including porters for transfer 4.3 Clinical Governance To identify patient safety issues arising from patient transfer To ensure appropriate investigations are undertaken of all incidents

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To support analysis of any negative impact in patient safety or experience 4.4 Practice Development and Clinical Practice Educators To work with the CSNPS to present the findings of the audit to the Heads of Nursing, Clinical effectiveness and audit committee and Clinical Risk committee. To ensure adequate provision for training and education in patient transfer

4.5

Infection Control Nurse Specialist/On Call Medical Microbiologist To advise staff as required regarding all transfers of infected patients. To prioritise side-room usage for infectious conditions

4.6

Critical Care Nurse A team of Critical Care Nurses, known as the Outreach Team, is used to support patients with high level needs during transfer, and in particular: To provide advice on the safe transfer of level 2 and 3 patients within the Trust and provide escort when deemed necessary by the Critical Care nurse between 08:00 and 20:15 Including Level 1 medium risk (NICE 50 2010) to a higher level of care To advise on the level of monitoring required during transfer In conjunction with ODPs, provide transport monitoring equipment as required

4.7

Clinical Site Nurse Practitioner (CSNP) To assist in the management of the safe transfer of Level 2 & Level 3 patients within the trust at night To undertake regular audit of patient transfer to monitor compliance with the minimum requirements of the policy. To support and communicate transfer of emergency and elective patients including inter ward transfers To identify appropriate patients for internal transfer as outlying patients

4.8

Anaesthetist To manage the safe transfer of level 3 patients within the trust or those at risk of airway compromise

4.9

Discharge Co-ordinator To ensure the appropriate patients are safely transferred to the community hospital for rehabilitation To monitor any incidents or trends related to the community transfers and provide an annual report.

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4.10

All Qualified Staff Must not compromise safety To ensure that the transfer policy is adhered to when transferring a patient. To report clinical incidents to their manager regarding incidents relating to patient transfer Must ensure privacy and dignity at all times To identify appropriate patients for internal transfer Porters To ensure that the request form for transfer is signed by the ward To maintain safety privacy and dignity at all times

4.11

5.0

MINIMUM REQUIREMENTS FOR ALL PATIENT TRANSFERS

In conjunction with the Medical Staff the nurse in charge will assess escort requirements and mode of transport necessary for the transfer of patients (i.e. trolley, wheelchair, bed). Clear instructions must be given when booking a porter regarding infection precautions, additional equipment e.g. portable oxygen and escort status. It is recognised that the nurse in charge of the patient must ultimately decide on the level of escort for patient leaving his/her area of responsibility. The following guidance should be used in conjunction with other patient related information at the time. Level 0 patients can be transferred with a porter / health care professional. The nurse in charge must be made aware of the transfer and notified when the patient is ready to leave the ward. Level 1 patients must be transferred with a porter and qualified staff member. Staff must assess the area prior to the transfer and ensure care of the existing patients will not be compromised while the transfer occurs. Level 2 - patients must be escorted from the ward environment to a higher level of care by a member of the outreach team if required or if out of normal hours the CSNP when possible.. Patients transferred from A&E to Cath Lab/Coronary Care Unit (CCU) and Medical High Dependency Unit (MHDU) must be accompanied by an A/E Nurse. Level 3 - patients must be escorted from the ward environment to Intensive Care by a member of the outreach team / senior intensive care nurse or if out of normal hours the CSNP. An anaesthetist must also be present during the transfer. 5.1 Documentation Patients will be transferred with the following: Medical Notes Drug Chart Nursing Documentation Transfer Letter/forms as appropriate Property as appropriate

The IPL should be updated to reflect the most recent status of the patient

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6.0 6.1.

TRANSFER FOR SPECIFIC PATIENT GROUPS WITHIN THE ORGANISATION Ward to Ward Patients who require transfer from ward to another ward will be escorted by a porter and Registered Nurse or Care Support Worker. Prior to transfer staff will comply with section 5, Minimum requirements for all patient transfers . The In-Patient List (IPL) must be updated and can be found on the Intranet at http://trustnet/docsdata/index.html .

6.2.

Medical assessment unit (MAU) to the ward All patients who are assessed and require admission to a ward from MAU will be escorted to the ward area by a porter and Registered Nurse or Care Support Worker Prior to transfer, MAU will comply with section 5,Minimum requirements for all patient transfers and the IPL updated which can be found on the Intranet at http://trustnet/docsdata/index.html .

6.3

Intensive Care Unit to Ward (Decreased level of care) Intensive care staff will liaise with Clinical Site Nurse Practitioner to facilitate transfer of any patient whose level of dependency has reduced and who is identified as suitable for transfer to a ward environment. The patient will be escorted by a porter and a Registered Nurse Prior to transfer intensive care staff will comply with section 5, Minimum requirements for all patient transfers and complete the critical care transfer document, (see Trustnet, Clinical information/Bed management) The IPL must be updated.

6.4

Transfer to theatre Where a patient needs to be transferred to theatre, prior to transfer staff will comply with section 5, Minimum requirements for all patient transfers and complete the theatre ICP . (see Trustnet, Clinical information/Bed management)

6.5.

Transfer to endoscopy Where a patient needs to be transferred to endoscopy, prior to transfer staff will comply with section 5 , Minimum requirements for all patient transfers and complete the endoscopy ICP. (See Trustnet, Clinical information/Bed management) Accident and Emergency (A&E) to ward All patients who are assessed and require admission to hospital will be transferred from A&E to the ward and be escorted to the ward area by a porter and Registered

6.6

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Nurse or Care Support Worker ,( following assessment) prior to transfer staff will comply with section 5 Minimum requirements for all patient transfers update the IPL and photocopy casualty card. 6.7 A&E / Ward to Intensive Care Unit (Increase level of care to 2- 3) Patients who have become acutely unwell and their level of dependency has increased, on transfer: Level 2 patients must be escorted from the ward environment to Intensive Care by a member of the outreach team / senior intensive care nurse /CSNP (if available OOH) and Registered Nurse from AE/Ward Level 3 patients must be escorted from the ward environment to Intensive Care by a member of the outreach team / senior intensive care nurse/CSNP (if available OOH) and Registered Nurse from AE/Ward . An anaesthetist must also be present on the transfer. A verbal handover will be given to the receiving unit. Documentation of the change in condition will be recorded in the patients medical notes and the IPL updated. Comply with Section 5, Minimum requirements for all patient transfers . 6.8 Transfer to Outpatient Department (OPD) All in-patients who have been assessed as still requiring an outpatient appointment booked prior to admission should receive an appropriate level of escort depending on their level of care. In particular: Any patient assessed as at risk of falling, wandering, or confusion, and who needs to attend OPD from a ward must be accompanied by a member of the ward staff. OPD staff must be made aware of all patients attending OPD clinics from wards. If patient is judged as not needing a nurse escort, but needing the appointment the patient must be handed over to the OPD staff. Patients who have routine OPD appointments and are in-patients are, where possible, to have appointments re-booked unless appointment part of Two Weeks Review (TWR) or breeching schedule. Ward staff to liaise with OPD staff before patient appointment to ensure minimum wait, to check if appointment is still necessary or if the patient can be seen on the ward. Comply with Section 5, Minimum requirements for all patient transfers .

6.9.

Transfer to other departments (i.e. X-ray) Where a patient needs to be transferred to another department within the trust, prior to transfer staff will confirm that the department is ready to accept and will ensure a patient manual handling glide sheet is sent with the patient. Comply with Section 5, Minimum requirements for all patient transfers

7.0

TRANSFER OF PATIENTS BETWEEN HOSPITALS

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7.1

Transfer between Ashford and St Peters Hospitals Ensure the patient is aware of the transfer. Notify the nominated next of kin of the transfer. Check with the receiving area that they are ready to accept the patient. Check that the receiving team are aware Notify area of infection status Notify area of any equipment required on transfer. Collate the medical notes and clinical records. Provide verbal handover to ward on arrival with patient. Record a Modified Early Warning Score (MEWS) For level 2 3 patients all transfers will be led by the Clinical Site Nurse Practitioner out of hours and may require an anaesthetist in attendance and be appropriately monitored during the transfer. (See Guidelines for transfer of Acutely Ill Patients from Ashford Hospital to St Peters Hospital, Clinical Information system, bed management and transfer. Comply with Section 5, Minimum requirements for all patient transfers

7.2

Transfer to a Rehabilitation Hospital All transfers of patients to Rehabilitation (Woking, Walton, Ashford Hospitals) will be co-ordinated by the Discharge team (Bleep 5469) to ensure they meet relevant admission criteria. Transfer must be discussed with patients, relatives and carers and the patients medical condition must be stable on transfer. Transport will be provided by the hospitals own transportation service. Patients should be transferred prior to 8pm. NB: Medical notes need to be coded prior to transfer and the following must accompany the patient: Patients property Medications A copy of the hospital discharge letter and medication prescription sheet Details of any new diagnosis of infection (such as MRSA and C.difficile) should be included in the GP letter (DH 2008 & 2006) and comply with section 5, Minimum requirements for all patient transfers

7.3

Transfer to another acute NHS trust for specialist treatment All transfer of patients to a tertiary hospital will be co-ordinated by the nurse in charge of the transfer ward and patients Consultant. Patients must have been accepted for transfer by a Consultant at the receiving hospital. The receiving hospitals bed manager and ward sister should be contacted to ensure a bed is available. The patient and their relative or carer will need to consent to the transfer. All transport will be booked via hospital ambulance service and a Registered Nurse escort as required.

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The nurse in charge must seek advice as to whether an Anaesthetic or other Medical Staffing escort is required. A photocopy of the following documents should accompany the patient: Medical notes, recent admission documentation and reason for transfer Drug Chart Nursing documentation Blood results Doctors letter Transfer form Acute/critical care transfer document SWCCN1 (held in ICU) X-ray / Scan reports Property Form Details of any new diagnosis of infection (such as MRSA and C.difficile) should be included in the GP letter (DH 2008 & 2006). Comply with section 5, Minimum requirements for all patient transfers 8. 0 TRANSFER OF INFECTIOUS PATIENTS

Refer to the Transfer of Infectious Patients Section of the Infection Control Manual. See Trust net For such patients: ensure the move is clinically appropriate; a patient isolated in a single room for infection control reasons should only be transferred between wards (excluding A&E) based on that individuals clinical need and on the advice of the on-call medical microbiologist (contact via switchboard). Ensure that the CSNP and receiving ward/department is informed of the individuals infection control status and related care/treatment needs An infected patient will be recorded on the IPL. Comply with section 5, Minimum requirements for all patient transfers

9.0

TRANSFER OUT OF HOURS

Wherever possible, patients should be transferred before 22:00 hrs. However due to changes in patients conditions and increased patient throughput, some transfers will have to take place outside of office hours. Patients transferred out of ICU after this time should have an incident form completed, held in each ward area. Clear communication and documentation regarding the patients condition and their care needs is especially important out of hours for all transfers to maintain patient safety. Comply with section 5, Minimum requirements for all patient transfers 10.0 DISSEMINATION AND IMPLEMENTATION OF THIS POLICY

This policy will be disseminated to and implemented by all Trust staff via Aspire Global email and the Trustnet.
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11.0

MONITORING OF THIS POLICY

In order to ensure that the policy works in practice and for the purpose of continuous monitoring, the effectiveness of this policy will be monitored by a quarterly trust wide audit to be undertaken by the CSNP/Outreach team. The audit will monitor the following transfers: o o o o o o o o o o Ward to Ward Mau to Ward ICU to ward Transfer to theatre Transfer to endoscopy A&E to ward A&E to ICU Ward to ICU Transfer to another acute NHS trust. Out of hours transfer

As part of the audit report, an annual report will be produced by the Clinical Governance Team.

The audit will be presented at the Nursing and Midwifery Committee. Where deficiencies are identified, areas of improvement will be highlighted and action plans will be developed in discussion with the Divisional Lead Nurses and Matrons. 12.0 ARCHIVING OF THIS POLICY

Archiving will be managed by the quality department who can be contacted to request master/archived copies. 13.0 EQUALITY IMPACT ASSESSMENT

This policy has been subject to an equality impact assessment and is not anticipated to have an adverse impact on any group. See Appendix 1 14.0 REFERENCES The Intensive Care Society standard. Levels of Critical care for Adult patients (2009). ICS. The Nursing, Midwifery Council Code of professional conduct: standards for conduct, performance and ethics for Nurses and midwives (2008) NMC. Care Quality Commission, Sept 2009. Working together to prevent and control: a study of the arrangements for infection prevention & control between hospitals and acre homes. Care Quality Commission, London. Department of health, Dec 2008. The Health & Social Care Act: Code of practice for the Prevention and Control of Health Care Associated Infections. Department of health, London.
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15.0

ACKNOWLEDGEMENTS

Special thanks for their contribution to this document: Infection Control Team Outreach Team CSNPs Clinical Risk and Administration Manager

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Appendix 1

Equality Impact Assessment Summary

Name of Author: DA Hallett Equality & Diversity Champion Policy/Service: Policy for Transfer of Adult patients (Excluding Maternity) Background. The aim of this policy is to guide on the correct process for transfer of adult patients within the Trust and to some external agencies. The policy is intended for all staff involved in the transfer of patients. The author as an Equality and Diversity champion in the trust, together with the Capacity manager and Risk manager assessed the impact on equality.

Methodology A brief account of how the likely effects of the policy was assessed (to include race and ethnic origin, disability, gender, culture, religion or belief, sexual orientation, age) The data sources and any other information used The consultation that was carried out (who, why and how?) The policy is relevant to all patient and staff groups and is not considered to be a disadvantage to any of the minority groups as it is generic in nature.

Key Findings Describe the results of the assessment Identify if there is adverse or a potentially adverse impacts for any equalities groups There have been no identified adverse impacts on any of the minority groups.

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Conclusion Provide a summary of the overall conclusions The policy is designed to be fully inclusive of all patient and staff groups in the Trust and represents an equal and diverse approach to all minority groups.

Recommendations State recommended changes to the proposed policy as a result of the impact assessment Where it has not been possible to amend the policy, provide the detail of any actions that have been identified Describe the plans for reviewing the assessment Nil changes to be made. Suggested reviewing of the assessment is three yearly by members of the Equality and Diversity steering group.

Guidance on Equalities Groups Race and Ethnic origin (includes gypsies and travellers) (consider communication, access to information on services and employment, and ease of access to services and employment) Disability (consider communication issues, access to employment and services, whether individual care needs are being met and whether the policy promotes the
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Religion or belief (include dress, individual care needs, family relationships, dietary requirements and spiritual needs for consideration)

Sexual orientation including lesbian, gay and bisexual people (consider whether the policy/service promotes a culture of openness and takes account of individual
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involvement of disabled people)

needs

Gender (consider care needs and Age (consider any barriers to accessing employment issues, identify and remove or services or employment, identify and justify terms which are gender specific) remove or justify terms which could be ageist, for example, using titles of senior or junior) Culture (consider dietary requirements, Social class (consider ability to access family relationships and individual care services and information, for example, is needs) information provided in plain English?)

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