Policy for the Discharge and transfer of children and young people ...

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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 beengiven?The Diana Team do not provide long term direct/ hands on careSupporting and empowering family to provide care for their childIdentify training needsDiscuss supplies; set up PLUSS, Vygon as necessary.Explain to parents that we will help them to manage their supplies but it is not ourresponsibility 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 toother services as necessaryMulti – disciplinary liaison;In the first instance the Diana nurse will speak to other professionals, there after it will beup to the parents to contact professionals as necessary. This will be different during Endof Life!Discuss psychology involvement – if appropriate Amanda could act as the second personComplete nursing assessment and care plans, wishes document if appropriate-Discuss care packages if necessaryEquipment; what have they got, where did it come from, what do they need, assetnumbers, servicingObtain consent – consider age and mental capacityProvide service leafletsRemember some families will be able to absorb more information than others, a secondassessment visit may be necessary.Policy for the discharge and transfer of children and young people from child healthPage 24 of 38
Appendix 7 – Children’s Community Nurses/Diana Nurses referralform. Sample only. Forms available from paediatric HDUCommunity Children’s Nursing Team and Diana Nursing TeamReferral FormPaediatric Community ServicesC/O Children’s Services Care Management CentreTruro Health ParkInfirmary HillTruroTR1 2JAOut of County Patient? Y / N?Tel:Tel: 01872 221400Fax: 01872 246938Financial agreement from referring trust? Y / N?Name of Child:Known as:D.O.B.:NHS No:ICS No:Hosp No:Gender:Parent/Guardian:Address:Address for visit:Telephone numbers - Home:Mobile:Directions to visit address:Policy for the discharge and transfer of children and young people from child healthPage 25 of 38
Page 5 and 6: • Must inform the GP at the earli
Page 7 and 8: elation to communication between ho
Page 9 and 10: When a young person has ongoing car
Page 11 and 12: 7.2. All managers will be aware of
Page 13 and 14: Training Need Identified?Guideline
Page 15 and 16: Appendix 2. Initial Equality Impact
Page 17 and 18: Appendix 3. - Discharge Plan and Ch
Page 19 and 20: Appendix 3a. Discharge Checklist an
Page 21 and 22: Appendix 4. Vulnerability Criteria1
Page 23: Appendix 6 - Referral Pathway for C
Page 27 and 28: Date first visit requested:Date Vis
Page 29 and 30: Appendix 8-TRANSFER DOCUMENTSample
Page 31 and 32: PUPILSNEUROOBS:COMASCALEEyesOpenBes
Page 33 and 34: NURSING REFERRAL FORM - TRANSFER OF
Page 35 and 36: Appendix 9 - Paediatric Discharge L
Page 37 and 38: NEONATALAttend ward regularly to ga

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