Leading change

The Modern Matron and Ward Manager at Harplands Hospital (Ward 6), North Staffordshire Combined Healthcare NHS Trust enhanced the discharge planning skills and training for assistant practitioners (APs) to address unwarranted variation on the ward. The development has led to improved outcomes, experiences and use of resources locally.

Where to look

At North Staffordshire Combined Healthcare NHS Trust, seven trainee assistant practitioners began working on the wards at the Harplands Hospital. Their role was designed to support registered nurses delivering care and treatment of in-patients, building on their skills as a healthcare support worker, and carrying out duties such as venepuncture, performing Electrocardiograms (ECGs) and discharge planning.

The modern matron and ward manager identified unwarranted variation in the knowledge and skills of APs and registered nurses regarding discharge planning and discharge coordination. An opportunity was identified to develop the AP skillset to lead on facilitating discharge processes and supporting the team to deliver high quality patient care.

What to change

North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands. Ward 6 at Harplands Hospital is a 15-bed assessment unit for older people with dementia. The ward provides assessment, treatment and discharge for older people with organic type illnesses, under the coordinated care of the ward staff and the support of a wider multi-disciplinary team.

The ward manager identified that practice amongst APs and registered nursing staff regarding discharge processes varied. Staff were spending long periods completing paperwork to aid the discharge and funding process. There was unwarranted variation in the knowledge and training of staff in discharge processes which was informing the understanding patients and relatives had of the process too. For instance, sometimes, information gathered wasn’t always facilitating an effective discharge and the information wasn’t standardised. This could result in longer MDT meetings or ward reviews. There was an opportunity to implement additional training on discharge planning to improve this process.

How to change

Assistant Practitioners with experience of discharge processes could support the improvements needed in discharge planning. The Matron consulted with Ward Managers and put together key responsibilities in supporting discharge that the APs would need to be able to lead on.

The Matron worked alongside Staffordshire University to devise a training programme that would support the APs to be upskilled in supporting this discharge pathway. Each AP was assigned a registered staff nurse to be their mentor during the training. Additional support was also offered by the Matron in the form of group supervision. As well as the training they received from Staffordshire University, additional training around discharge processes was provided by local continuing healthcare providers.

The Assistant Practitioners are now the first point of contact for social care personnel, nursing homes, the wider health community, and for patients, their families and carers. Under registered nurse supervision, the APs complete discharge paperwork, which allows staff nurses to spend more time with their patients and complete other clinical duties.

Adding value

Better outcomes – With supporting the skills of APs for discharge planning, this has streamlined the process for patients, staff and families alike. They have become a point of contact for discharge on the ward and the improved knowledge means they can work to make the process as smooth as possible for all involved. This is expediting the process. Assistant Practitioners attend ward reviews and participate in multi-disciplinary meetings to keep fully abreast of each patient’s discharge plan. This collaborative working and open lines of communication is supporting a reduction in length of stay and the discharge planning is happening earlier in the patient’s hospital stay which is advocated.

Better experience – Relatives have recognized the improvements in discharge planning:

• “Being able to contact the ward anytime and know that I can ask what’s going on with mum’s discharge is fantastic. This is such a worrying time but I know I can call in anytime and find out which allays my fears a little”.
• “Having one person I can ask for and talk to is brilliant. I know if I ask for something to be done or ask for information it is there without having to keep on requesting it!! “

Staff have also responded positively to the change in process:

• “Being able to spend the time with families, social workers and outside agencies has been fantastic. This is something nurses don’t always have enough time to do for as long as they would like to.”
• “The assistant practitioner provides a high level of consistency to the role and is skilled and experienced in communicating with patients and relatives”

Better use of resources – This focus on discharge planning is supporting a trend towards reducing delayed discharges and length of stay which will have positive financial implications for the directorate, as well as the clear benefits for patients. Since taking on additional discharge responsibilities, the APs have also worked to streamline the existing discharge process in the directorate which is supporting effective and efficient practice across the multidisciplinary team.

Challenges and lessons learnt for implementation

A change in practice can pose challenges initially while new processes are developed, but the team embraced this new way of working.

The enhanced training and upskilling opportunity for Assistant Practitioners also has the potential benefit of being a developmental pathway towards registered nurse training.

For more information contact

Michelle Lewis
Ward Manager
Ward 6 Harplands
North Staffordshire Combined Healthcare NHS Trust
MichelleL.Lewis@combined.nhs.uk

Julie Anne Murray
Deputy Director of Nursing, AHP and Quality
North Staffordshire Combined Healthcare NHS Trust
JulieAnne.Murray@combined.nhs.uk