Establishing a Successful Discharge Readiness Program in the NICU

1. Establishing a Successful Discharge Readiness Program in the NICU Presented by: Michelle Clements, RN WakeMed Intensive Care Nursery November 11, 2009

2. Goal Discharge planning should begin early in the hospital course. The goal of the discharge plan is to ensure successful transition to home care.

3. Family Care Coordination NICU Medical Team D/C Planner Radiology Lactation Consultant Social Work Patient and Family Audiology Case Worker Family Educator Speech Nursing Respiratory Therapy Developmental Team Family Advisor

4. Parent SurveyDischarge Experience Majority 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

5. Discharge Teaching Begins on Admission • Discharge plan should be individualized • Addresses both parent and infant needs • Focus on what parent needs versus nurse • Individualized Binder • Case Manager: Can be clinical nurse specialist, discharge planner, or nurse practitioner. Oversees all teaching and coordination of multi-disciplinary approach

6. Discharge Plan 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

7. Discharge Planning Meeting • Two Key Considerations: • The need for parents to receive accurate information about medical and long-term developmental outcomes • The need for parents to be meaningfully involved in decision making – including the discharge planning meetings

8. Family-Centered Approach • Increasingly 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

9. Family-Centered Approach cont….. • Families collaborate with staff to determine priorities • Family advisors assist in developing and evaluating documentation forms • Families and staff document progress • Families participate with multidisciplinary team • Families participate in goal planning

10. Parent Participation in Caregiving • 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

11. Parental Education • Involve parents in whatever way possible • Request return demonstrations • Avoid overstating infant’s fragility • Identify 2 responsible caregivers for education • Establish a written checklist or outline of tasks to be mastered • Identify family strengths

12. Core Components of Discharge Teaching • Feeding (breast, bottle, including formula preparation) • Basic infant care, including bathing; skin, cord, and genital care; temperature measurement; dressing; and comforting • Infant CPR and emergency intervention • Signs and symptoms of illness as well as signs and symptoms specific to infant’s condition

13. Core Components of Discharge Teaching cont….. • Infant safety precautions, including safe sleep and proper use of car seats • Special safety precautions (feeding tubes, equipment, etc) • Administration of medications

14. Earlier Discharge Planning • Goal: 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

15. Evaluation • Parent Questionnaire: How’s Your Baby? • Follow-up Phone call within first week of discharge

16. References • American 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