The following is discharge and transfer placement advice from Jennifer, a children’s nursing student:

‘As a third year nursing student I have now had experience of discharging patients in both acute and community settings with the assistance of my mentor. I have found that discharge planning can be a daunting and difficult process, just as every patient is different, their discharge needs will be too.  

I have learned that it is necessary to take an individualised patient-centred approach where the needs of the child and family must be considered holistically. It is important that you get to know the child and the family, as discharge planning is most effective when it is done in collaboration with your patient and their family.  Using a family-centred approach will help you to determine what matters to them and determine what their circumstances are at home. 

My experience in acute settings has taught me that it is crucial that discharge planning should begin on admission as you can begin to identify areas of concern that could possibly prolong the discharge. My experience with community teams has made me realise that community professions need to be involved in the discharge process as soon as possible and require as much information as possible.

As a nurse, your job role will be key in facilitating effective discharge planning; therefore as a student it is essential that you engage fully with this process and get as much experience as possible discharging children and families. The procedures used to implement discharge planning can vary depending on a number of factors. Discharging from an acute or a community setting, if the patient has simple or complex health care needs and if the patient is considered a short- or long-term patient.  However, there are a few common approaches to be used when planning discharge in any of these circumstances.’

Some top tips for learning opportunities in discharge planning:

• As a nursing student you are supernumerary, use this time to ask questions! Show an interest and get involved in every opportunity you can before you qualify. 
• Pre-placement it is important to research your new placement and get to know the patient group.  What are the common conditions that this area cares for and how quick is their turn over?
• On arrival at your placement determine the discharge planning protocols and procedures.
• Get familiar with the discharge documentation used.
• Does your placement use patient’s estimated length of stay (ELOS)?
• If so with your mentor work out the patient’s ELOS. Reflect on how this can improve the discharge planning process.
• Participate in the development of an individualised discharge plan with your mentor and if appropriate with the multidisciplinary team.
• Consider the home environment of the child and family – will this impact on the discharge process?  Children with complex needs may need home adaptions before discharge.
• Attend discharge planning meetings.
• Consider the role of multidisciplinary and multiagency teams in discharge planning.
• Explore how the various professionals work as a team. If possible spend time with team members exploring how they can assist the child and family in discharge planning.
• Some professionals you will work alongside are identified as follows:

1. Medical staff
2. Nursing team
3. Discharge co-ordinator
4. Community services discharge liaison officer
5. Dietician
6. Speech & language therapist
7. Physiotherapist
8. Occupational therapist
9. Social worker
10. Community nursing teams
11. Pharmacists
12. Social worker
13. Health visitor
14. CCN
15. Discharge planning coordinator
16. Specialist nurse 
17. Play therapist

• Explore communication within the multidisciplinary team.  How do they communicate effectively?
• Look at how the multidisciplinary team ensures partnership with the child and family and helps them engage fully in the discharge process.
• Follow a patient’s journey from admission to discharge and reflect on what went well and what could have gone better in order to improve your future practice.  

•  With your mentor explore and participate in teaching and education that the child, family and carers may require before discharge.   Is there a review or refresher plan documented for education and training needs of staff, carers, family?

‘When you have a stay in hospital with your child, the best news you can get is “I think you can go home in the morning”. However, actually being discharged is another matter. It's a waiting game. Waiting for the doctors to do their rounds, waiting for the discharge notes to be completed and waiting for a prescription to be collected from the ward and then dispensed from the pharmacy and brought back to the ward. This all takes time. So, when all you want to do is go home, it turns into a long, frustrating day. Actually I would rather I wasn't told about going home until everything was done and we could just walk out that would be much less stressful’.  

Louisa, Parent