document type: unique identifier: procedure corp/proc/444

Document Type: PROCEDURE

Unique Identifier: CORP/PROC/444

Title: Transfer (Adults)

Version Number: 4 Status: Ratified

Scope: Trust Wide

Classification: Organisational

Author/Originator and title: John Quinn, Unscheduled Care Directorate Manager Barbara Becker, Assurance and Compliance Manager

Responsibility: Emergency and Access Directorate

Replaces: Version 3 Transfer (Adults) CORP/PROC/444

Description of amendments: Amendments throughout

Name Of: Divisional/Directorate/Working Group:

Date of Meeting:

Risk Assessment: Not Applicable Financial Implications Not Applicable

Validated by: M Aubrey, Deputy Director of Corporate Affairs and Governance

Validation Date: 10/01/2013

Which Principles of the NHS Constitution Apply? Principle 3

Ratified by: Quality Governance Committee

Ratified Date: 10/01/2013

Issue Date: 10/01/2013

Review dates may alter if any significant changes are made Review Date: 01/01/2016

Does this document meet the requirements of the Equality Act 2010 in relation to Race, Religion and Belief, Age, Disability, Gender, Sexual Orientation, Gender Identity, Pregnancy & Maternity, Marriage and Civil Partnership, Carers, Human Rights and Social Economic Deprivation discrimination? Initial Assessment

Blackpool Teaching Hospitals NHS Foundation Trust ID No. Corp/Proc/444

Title: Transfer (Adults) Revision No: 4 Next Review Date: 01/01/2016 Do you have the up to date version? See the intranet for the latest version

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1. PURPOSE To ensure that all handover requirements for adult patients who require transfer of their care to another area within the Trust (including transfers between the Acute site and Community hospitals, and transfers between wards/healthcare professionals on one site), or transfer to another Trust will be undertaken safely and in an appropriate and timely manner 2. SCOPE This procedure will be used by any persons working within Blackpool Teaching Hospitals NHS Foundation Trust involved in the management of the transfer and clinical handover of patients. 3. PROCEDURE 3.1 Definition Of All Patient Groups This procedure applies to the transfer of Adult patients in Surgery; Medicine including Community Hospitals; Cardiac; Nurse-Led Therapy Unit; A&E and Critical Care excluding maternity (adult patients) and CITU (adult patients) as a separate procedure is available for these adult patient groups (See section 7).

3.2 Duties For All Wards And Departments It is the duty of any member of staff involved in the management of the transfer and clinical handover of patients to ensure that this procedure is followed.

3.3 Transfer Requirements (Including handover of care between care settings and the giving, receiving and recording of information) 3.3.1 Nursing Team Handover of Care As a minimum a nursing team handover will take place at each shift change, i.e. early shift, late shift and night shift. The nurse in charge / primary nurse will hand over the episode of care for each patient present on the ward at the time of the shift change. Nursing staff will update the nursing notes / care plan for each patient in their care in order to inform the next shift of the plan of care.

3.3.2 Medical Team Handover of Care As a minimum a medical team handover will take place at each shift change, i.e. early shift and night shift. The medical team on duty at that time will hand over the episode of care for each patient who has had medical intervention or whose medical condition has changed requiring medical intervention during that shift. The medical team will update the medical case notes for each patient who has had an intervention or whose plan of care has changed.

3.3.3 Transfer Requirements/Handover of Care for Medicine; Surgery; Consultant led Community Hospitals; Cardiac; Nurse Led Unit; A&E and Critical Care A clear management plan on the relevant Handover Checklist Patient Transfer Form (SBAR) or Patient Transfer Form is completed by the nurse and filed in the patient’s case notes in section 3 prior to the transfer for the following areas: • Handover Checklist Patient Transfer Form (SBAR) Scheduled Care (Appendix 1) • Handover Checklist Patient Transfer Form (SBAR) Unscheduled Care including



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Consultant Led Community Hospitals (Appendix 2) • Cardiac Treat and Transfer Form (Appendix 3) • Transfer checklist form used for Nurse-Led Therapy Unit (Appendix 4) • Electronic Transfer form used for A&E (Appendix 5) • Critical Care Discharge Summary (Appendix 6) • Critical Care Transfer Form (Appendix 7)

A transfer plan must be fully documented on the relevant Handover Checklist Patient Transfer Form used in the appropriate area as identified below: • Handover Checklist Patient Transfer Form (SBAR) Scheduled Care (Appendix 1) • Handover Checklist Patient Transfer Form (SBAR) Unscheduled Care including

Consultant Led Community Hospitals (Appendix 2) • Cardiac Treat and Transfer Form (Appendix 3) • Transfer checklist form used for Nurse-Led Therapy Unit (Appendix 4) • Electronic Transfer form used for A&E (Appendix 5) • Critical Care Discharge Summary (Appendix 6) • Critical Care Transfer Form (Appendix 7)

Other approved transfer forms may be used for other patient groups where appropriate and these can be found in the relevant procedures as identified below: • Maternal Transfer / Discharge Guidance for maternity adult patients.

(Obs/Gynae/Guide/053)

• Transfer of Critically Ill Patients from the Cardiac Intensive Care Unit (CITU) to Another Trust Hospital (Card/Prot/016)

• Transfer of Critically Ill Patients from the Cardiac Intensive Care Unit (CITU) to the

Computed Tomography Scan (CT) (Card/Prot/017) • Clinical Handover of Care of Patients (CHS/Proc/027)

• A verbal Health Professional to Health Professional, Nurse to Nurse and / or Doctor to

Doctor handover (where appropriate) must take place prior to transfer.

• The nurse will document the transfer details in the nursing notes and on the relevant Handover Checklist Patient Transfer Form (SBAR).

• The Doctor will have documented fit for transfer in the patient’s case notes. • All of the patients case notes including the patients nursing notes accompanying the

correct patient being transferred is done so safely, by the nurse checking the patients identification

• The patient’s case notes including the patients nursing notes must be transferred in a

sealed case note transport envelope in line with the Transfer of Notes Procedure Corp/Proc/467.

• The patient and the next of kin/carer are informed by the transferring nurse of the

reason for transfer, day of transfer, likely length of stay and any proposed discharge plan in progress. This may include relevant written information.



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• The transferring nurse must ensure that any prescribed medications are transferred with the patient

• The transferring nurse must inform Pharmacy of any change in patient location for

internal transfers. • The transferring nurse must ensure that any catering arrangements have been

considered, and suitable arrangements made for appropriate meals to continue on the receiving hospital ward.

• The transfer out is entered on the Admissions / Discharge / Transfer (ADT) system. by

the transferring nurse at the time of transfer. • A verbal nurse to nurse handover will take place on the transferring ward/department.

and this will be recorded on the Handover Checklist Patient Transfer Form (SBAR form) and signed by the Transferring Nurse and the Receiving Nurse. The SBAR form will be filed in the nursing notes by the receiving Nurse.

• Any equipment accompanying the patient (for example monitors, syringe drivers) must

be clearly documented, transported in appropriate carriers and returned to the department owner when no longer in use.

3.3.4 Documentation to accompany the patient for Surgery; Medicine including Consultant led Community Hospitals; Cardiac; Nurse Led Unit; A&E; and Critical Care • All of the patients case notes including the patients nursing notes accompanying the

correct patient being transferred is done so safely, by the nurse checking the patients identification

• The patient’s casenotes including the patients nursing notes must be transferred in a

sealed casenote transport envelope in line with the Transfer of Notes Procedure Corp/Proc/467.

• The completed Handover Checklist Patient Transfer Form (See Appendix 1 – 7) must

accompany the patient when being transferred and must be filed in the patient’s case notes in section 3.

3.3.5 Transfer/Handover Requirements Critical Care – Ward/Department • The Internal transfer of level 1 patients to a ward will be documented by the Consultant

in the patient’s medical case notes. • A plan will be identified on the Critical Care Summary form (Appendix 6) for the

receiving ward/department to follow in the first 48 hours?

• The patient must be accepted by the receiving Medical Consultant and this must be recorded in the patient’s case notes by the transferring Doctor?

• A verbal nurse to nurse handover must take place prior to transfer and this must be recorded in the nursing notes by the transferring Nurse?



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• The nurse must document the transfer details in the nursing notes. • The Doctor must document the transfer details in the patient’s case notes.

• All of the patient’s case notes including nursing notes must accompany the correct

patient being transferred and done so safely, by the nurse checking the patient’s identification.

• The patient and the next of kin/carer must be informed by the transferring nurse of the reason for transfer and the day of transfer.

• The transferring nurse must ensure that any prescribed medications are transferred with the patient

• The transferring nurse must inform Pharmacy of any change in the patient location for

internal transfers

• The transfer out must be entered on the Admissions / Discharge / Transfer (ADT) system by the transferring nurse at the time of transfer.

• A verbal nurse to nurse handover must take place on the transferring ward/department. and this must be recorded in the nursing notes and on the Critical Care Summary form which will signed by both the transferring nurse and the receiving nurse.

• The patient must be followed up from Critical Care up by an Outreach Team member within 36 hours of transfer.

3.3.6 Documentation To Accompany The Patient When Being Transferred (Internal Transfer) Critical Care - Ward/Department

• All of the patients casenotes including nursing notes must accompany the correct

patient being transferred and done so safely, by the nurse checking the patients identification

• The completed Critical Care Summary Form (See Appendix 6) must accompany the

patient when being transferred from Critical Care to the Ward/Department and this must be filed in the patient’s case notes in Section 4.

3.3.7 Transfer Requirements Critical Care – CT Scan Department

• The Internal transfer of level 2 and 3 patients to CT Scan will be requested by the

Consultant and documented in the patient’s medical case notes.

• The nurse MUST document the transfer from Critical Care to the CT Scan Department in the nursing notes.

• All of the patients case notes including nursing notes must accompany the correct


• The Critical Care Nurse and Critical Care Doctor must stay with the patient throughout

the CT scan and ensure the patient is monitored throughout the procedure.



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• The Critical Care nurse must record in the nursing notes that the patient has transferred

safely to the CT Scan Department? 3.3.8 Documentation To Accompany The Patient When Being Transferred - Internal Transfer Critical Care - CT Scan Department • All of the patients case notes including nursing notes must accompanying the correct


3.3.9 Transfer CT Scan – Critical Care • The nurse must document the transfer from CT Scan Department to Critical Care in

the nursing notes • All of the patients case notes including nursing notes must accompany the correct


• The Critical Care Nurse / Doctor must continue to ensure the patient is monitored

throughout the procedure. • The Critical Care nurse must record in the nursing notes that the patient has

transferred safely from the CT Scan department to Critical Care. 3.3.10 Documentation To Accompany The Patient When Being Transferred Internal Transfer – CT Scan Department – Critical Care

• All of the patients case notes including nursing notes must accompany the correct


3.3.11 Transfer Requirements Critical Care - Theatre - Internal Transfer • The nurse must document the transfer to theatre from Critical Care in the nursing notes • All of the patients case notes including nursing notes must accompany the correct


• The Critical Care Nurse and Critical Care Doctor must transfer the patient to theatre

with the portable ITU ventilator and during the transfer must ensure the patient is monitored throughout the transfer.

• The Critical Care nurse must record in the nursing notes that the patient has been

transferred to Critical Care from Theatre and Nurse – Nurse and Doctor to Doctor handover has been given.

3.3.12 Documentation To Accompany The Patient When Being Transferred (Internal Transfer Critical Care – Theatre



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• All of the patients case notes including nursing notes must accompany the correct patient being transferred and done so safely, by the nurse checking the patients identification

3.3.13 Transfer Requirements Theatre - Critical Care – Internal Transfer

• The nurse must document in the nursing notes that the patient is being transferred to

Critical Care from Theatre • Were all of the patients case notes including nursing notes accompanying the correct

patient being transferred done so safely, by the nurse checking the patients identification

• The Critical Care Doctor must ensure the patient is monitored throughout the

procedure. • The Critical Care nurse must record in the nursing notes that the patient has been

transferred safely Critical Care from Theatre?

3.3.14 Documentation Internal Transfer – Theatre – Critical Care

• All of the patients case notes including nursing notes must accompany the correct patient being transferred and done so safely, by the nurse checking the patients identification

3.3.15 Transfer Requirements Critical Care – Other Hospital - External transfer

• The External Critical Care Transfer form (Appendix 7) must be completed by the nurse

and escorting Doctor and filed in the patient’s case notes prior to transfer in section 3. • A copy of the completed External Critical Care Transfer form must be returned to

ICIBIS, Manchester, M8 5RB and recorded in the patient’s case notes that this has been actioned.

• The External Critical Care Transfer form must be completed by the nurse and escorting

Doctor and must be filed in the patient’s case notes prior to transfer in section 3 • The patient must be accepted by the receiving Consultant and this must be recorded in

the patients case notes • A patient verbal history must be given by the Consultant to the receiving Consultant

and this must be recorded in the patients case notes • All of the patients case notes including nursing notes must be photocopied and

accompany the correct patient being transferred and done so safely, by the nurse checking the patients identification

• The patient’s case notes including nursing notes must be transferred in a sealed case

note transport envelope in line with the Transfer of Notes Procedure Corp/Proc/467. • The patient and the next of kin/carer must be informed by the transferring nurse of the

reason for transfer and the day of transfer.



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• The transfer out must be entered on the Admissions / Discharge / Transfer (ADT)

system by the transferring nurse at the time of transfer. • The nurse and anaesthetist must transfer the patient to the receiving hospital • The Anaesthetist must take ensure the patient is monitored throughout the transfer and

record these observations on the relevant section of the Critical Care Transfer Form • A verbal Doctor-to-Doctor handover must take place on the receiving ward. and this

must be recorded on the Critical Care Transfer Form by the transfer Doctor • A verbal nurse to nurse handover must take place on the receiving ward. and this must

be recorded on the Critical Care Transfer Form by the transferring Nurse • The receiving Doctor must record comments on the Critical Care Transfer Form and

this must be signed by the receiving Doctor. • The transferring nurse must have undertaken transferring training and they must have

been assessed as competent on the use of the medical devices equipment (Portable ITU Ventilator etc)

3.3.16 Documentation To Accompany The Patient When Being Transferred (External Transfer Critical Care - Other Hospital

• All of the patients photocopied case notes including nursing notes must accompany

the correct patient being transferred and done so safely, by the nurse checking the patients identification

• The patient’s photocopied case notes including the nursing notes must be transferred

in a sealed case note transport envelope in line with the Transfer of Notes Procedure Corp/Proc/467.

• The completed transfer form must accompany the patient when being transferred and

a copy must be filed in the patients case notes of the recipient hospital , a copy must be filed in the transferring hospital patients case notes in section 3; and a copy must be returned to ICBIS, Manchester, M8 5RB and this must be recorded in the patients case notes

3.3.17 Transfer Requirements CITU – Other Hospital – External Transfer The process for the transfer of critically ill patients from the Cardiac Intensive Care Unit (CITU) to another Trust Hospital is outlined in Card/Prot/016 (See Section 7).

3.3.18 Transfer Requirements CITU – Computed Tomography Scan (CT) The process for the transfer of critically ill patients from the Cardiac Intensive Care Unit (CITU) to Computed Tomography Scan is outlined in Card/Prot/017 (See Section 7).

3.3.19 Transfer Requirements Ward 8 – Isolation Ward The process for the transfer of patients with confirmed Clostridium difficile toxin (CDT) positive diarrhoea to Ward 8 is outlined in Corp/Pol/055 (See Section 7).



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3.3.20 Transfer Requirements Medical Escalation Patients – Ward 39 In the event of the medical patients requiring transfer from other areas of the hospital to Ward 39 the Ward 39 Transfer Checklist (Appendix 8) must be completed in addition to the SBAR form (Appendix 1 and 2).

3.3.21 Transfer Requirements AMU – Other Areas All patients on AMU should be clerked and a post take review by Consultant or Senior Physician be undertaken prior to transfer. If in the absence of a senior review a patient transfer is to be recorded as an incident and will only be considered at times of significant patient flow pressure or where the patient need demands such a transfer. Patients transferred in these circumstances can be sent where a next day senior review can be facilitated.

3.3.22 Transfer Requirements Acute Ward – Acute Ward All patients transferred from an Acute Ward to another Acute Ward must have a senior review prior to transfer.

3.4 Process For Transfers Out Of Hours • The discharge or movement of patients into other beds on other wards, including

Community Hospitals, will be avoided after 2300 hours where possible with the exception of the Assessment Units in line with the Bed Management Policy (Corp/Pol/139).

• In the event of a patient needing to be transferred out of hours, all of the above transfer

requirements and documentation process must be followed.

3.5 Infection Status When transferring patients/ clients to and from care settings, it is vital that the receiving ward or unit is notified in advance if the patient has a suspected or confirmed infection. Prompt identification is vital to ensure that patients presenting with an infection or who acquire an infection during care are identified promptly and receive appropriate management and treatment to reduce the risk of transmission. A ‘confirmed risk’ patient is one who has been confirmed as being colonised or infected with organisms such as Methicillin-resistant Staphylococcus Aureus (MRSA, glycopeptides-resistant enterococci, pulmonary tuberculosis and enteric infections including Clostridium difficile. Suspected risks include those awaiting laboratory tests to identify infections, or organisms, or those patients / clients presenting with diarrhoeal illness or vomiting, and those known to have been in contact with other infected clients / patients.

3.6 Process For Monitoring Compliance • The process for monitoring compliance with this policy it outlined in Appendix 9. 4. ATTACHMENTS Appendix Number Title

Appendix 1 Handover Checklist Patient Transfer Form (SBAR) Scheduled Care Appendix 2 Handover Checklist Patient Transfer Form (SBAR) Unscheduled

Care including Consultant Led Community Hospitals Appendix 3 Cardiac Treat and Return Transfer Form



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4. ATTACHMENTS Appendix Number Title

Appendix 4 Nurse-Led Therapy Unit Transfer Checklist Form Appendix 5 A&E Transfer / Discharge Arrangements Appendix 6 Critical care Discharge Summary Form Appendix 7 Critical Care Transfer Form Appendix 8 Ward 39 Transfer Checklist Appendix 9 Process for Monitoring Compliance

Appendix 10 Equality Impact Assessment Tool

5. ELECTRONIC AND MANUAL RECORDING OF INFORMATION Electronic Database for Procedural Documents Held by Policy Co-ordinators/Archive Office 6. LOCATIONS THIS DOCUMENT ISSUED TO Copy No Location Date Issued 1 Intranet 10/01/2013 2 Wards and Departments 10/01/2013 7. OTHER RELEVANT/ASSOCIATED DOCUMENTS Unique Identifier Title and web links from the document library Corp/Pol/054 Health And Corporate Records Management

http://fcsharepoint/trustdocuments/Documents/CORP-POL-054.doc

Corp/Pol/065 Information Governance http://fcsharepoint/trustdocuments/Documents/CORP-POL-065.doc

Corp/Proc/467 Transportation of Records Procedure http://fcsharepoint/trustdocuments/Documents/CORP-PROC-467.doc

Corp/Proc/185 Patient Identification Wristband Procedure http://fcsharepoint/trustdocuments/Documents/CORP-PROC-185.doc

Obs/Gynae/Guide/002 High Dependency Care – Including the Criteria for Transfer to HDU/ITU http://fcsharepoint/trustdocuments/Documents/OBS-GYNAE-GUID-002.doc

Obs/Gynae/Guide/053 Maternal Transfer/Discharge http://fcsharepoint/trustdocuments/Documents/OBS-GYNAE-GUID-053.doc

Corp/Pol/055 Ward 8 – Isolation Ward Operational Policy http://fcsharepoint/trustdocuments/Documents/CORP-POL-055.doc

Corp/Pol/139 Bed Management Policy http://fcsharepoint/trustdocuments/Documents/corp-pol-139.doc

CORP/PROC/497 Emergency Transfer of Patients With an Intra Aortic Balloon Pump (IABP) From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network http://fcsharepoint/trustdocuments/Documents/CORP-PROC-497.docx





http://fcsharepoint/trustdocuments/Documents/CORP-PROC-467.doc




http://fcsharepoint/trustdocuments/Documents/OBS-GYNAE-GUID-002.doc






http://fcsharepoint/trustdocuments/Documents/corp-pol-139.doc

http://fcsharepoint/trustdocuments/Documents/CORP-PROC-497.docx

http://fcsharepoint/trustdocuments/Documents/CORP-PROC-497.docx



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7. OTHER RELEVANT/ASSOCIATED DOCUMENTS Unique Identifier Title and web links from the document library Card/Prot/016 Transfer of Critically Ill Patients from the Cardiac Intensive Care

Unit (CITU) to Another Trust Hospital http://fcsharepoint/trustdocuments/Documents/CARD-PROT-016.doc

Card/Prot/017 Transfer of Critically Ill Patients from the Cardiac Intensive Care Unit (CITU) to the Computed Tomography Scan (CT) http://fcsharepoint/trustdocuments/Documents/CARD-PROT-017.doc

CHS/Proc/027 Clinical Handover of Care of Patients http://fcsharepoint/trustdocuments/Documents/CHS-PROC-027.docx

8. SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS

References In Full Department of Health (2002) Comprehensive critical care: a review of adult critical care services http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf Drager Medical (2009) Drager Oxylog 3000 Instructions for use. Drager Medizintechnik GmbH, Lubeck,Germany. http://www.draeger.com/media/10/03/17/10031789/oxylog3000_pi_9051995_us.pdf Driscoll P (2006) Safe Transfer and Retrieval: the practical approach 2nd Edition. BMJ books Blackwell Publishing London The Association of Anaesthetists of Great Britain and Ireland (2009) Safety Guideline Interhospital Transfer. http://www.aagbi.org/publications/guidelines/docs/interhospital09.pdf The Intensive Care Society (2002) Standards and Guidelines for the Transport of the Critically Ill Adult. http://www.ics.ac.uk/intensive_care_professional/standards_and_guidelines/transport_of_the_critically_ill_2002 Watson D (2006) Planning to ensure the safe transfer of hospital patients. Nursing Times 102 (09) pg21. 9. CONSULTATION WITH STAFF AND PATIENTS Name Designation Barbara Becker Compliance and Assurance manager Jayne Robinson Vascular Nurse Jacqui Fish Clinical Change Facilitator Stephen Mellars Clinical Nurse Manager Sara Sloan Clinical Lead 10. DEFINITIONS/GLOSSARY OF TERMS A&E Accident and Emergency ADT Admissions/Discharge/Transfer system CAMHS Child and Adolescent Mental Health Service GP General Practitioner MRSA Methicillin-resistant Staphylococcus Aureus

http://fcsharepoint/trustdocuments/Documents/CARD-PROT-016.doc




http://fcsharepoint/trustdocuments/Documents/CHS-PROC-027.docx

http://fcsharepoint/trustdocuments/Documents/CHS-PROC-027.docx

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082872.pdf

http://www.draeger.com/media/10/03/17/10031789/oxylog3000_pi_9051995_us.pdf

http://www.aagbi.org/publications/guidelines/docs/interhospital09.pdf



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11. AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL Issued By John Quinn Checked By Mary Aubrey Job Title U/C Directorate

Manager Job Title Deputy Director of

Corporate Affairs & Governance

Date January 2013 Date January 2013



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Appendix 1: Handover Checklist Patient Transfer Form (SBAR Form) Scheduled Care



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Appendix 2: Handover Checklist Patient Transfer Form (SBAR Form) Unscheduled Care including Consultant Led Community Hospitals



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Appendix 3: Cardiac Treat and Return Transfer Form

FILE IN SECTION 3

Lancashire and South Cumbria Cardiac Network

From: Cardiac Day Case Unit, Lancashire Cardiac Centre To: …………………………………………………………….. (Referring Hospital)

Wound at LCC Wound at Referring Hospital Location:

Status of wound: (e.g. bruising/bleeding)

Status of wound: (e.g. bruising/bleeding)

Actions taken:

Actions taken:

TR Band/Femstop (i.e. how much air removed etc)

TR Band/Femstop (i.e. how much air removed etc)

Complications whilst on Day Case Unit Observations prior to transfer Medications Blood Pressure

Aspirin

Pulse

Clopidogrel

Respiratory Rate

Reopro: Time infusion commenced: Rate: Time stopped for transfer: Amount infused prior to transfer: Rate to be re-started:

Oxygen Saturation

Other

Temperature

Any changes

Blood Tests Full blood count No Yes - Time:

Diabetic No Yes – Blood glucose:

ECG No Yes – Comments: Documents to be photocopied prior to transfer:

Done (X) Done (X)

History Sheet/Anaesthetic Record Care Plan Observation Chart ECG (if applicable) Prescription Chart Have you checked patient Identification

against notes on transfer

Patients documents to be transferred in sealed casenote transfer envelope

Patient transferred out on ADT system

Plan/Special Instructions to Referring Hospital: Approved by Health Records Committee Chairman’s Action given 09.12.10

Write patient details or affix Identification label

Hospital Number: Name: Address: Date of Birth: NHS Number:

CARDIAC TREAT & RETURN TRANSFER FORM

List of Abbreviations LCC - Lancashire Cardiac Centre ADT System - Admissions/Discharge/ Transfer System



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Appendix 4: Nurse-Led Therapy Unit Transfer Checklist Form FILE IN SECTION 3

Action Yes No Comments Is it written in the patient’s notes that they have been discharged from consultant care?

If the patient has DO Not Resuscitate status, is the next date for review noted in the medical notes?

Has a new prescription sheet been written, including prn medication>

Has a discharge General Practitioner (GP) letter including regular and prn medication been completed?

Has a new prescription sheet, GP letter and old prescription sheet taken by hand to pharmacy

Were the patients medications transferred with the patient?

Does the patient require any follow up appointments?

State date and time

Does the patient use any walking aids? Please book on transport Is patient on anticoagulants? If yes, has the need for anticoagulant been reviewed?

Please prescribe for at least one day

Does the patient have any would dressings? Please send with patient a 3 day supply Has the next of kin been informed of transfer? On the day of transfer, is it written in the patient’s notes that they are medically stable and are fit for transfer?

Have you checked patient identification against notes on transfer

Were patients notes transferred in a sealed casenote transfer envelope

Was the transfer out entered on the ADT system Signature ……………………………………........... (Of person completing the form) Print Name ………………………………………… Designation ………………………………………… Ward ……………………………………………….. Date ………………………………………………… Approved by Health Records Committee Chairman’s Action 09.12.2010

NURSE-LED THERAPY UNIT TRANSFER CHECKLIST FORM



List of Abbreviations ADT System – Admission/Discharge/Transfer System

Appendix 5: A&E Transfer / Discharge Arrangements

Appendix 6: Critical Care Discharge Summary Form

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/444


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Appendix 7: Critical Care Transfer Form

Appendix 8 FILE IN SECTION 3

Consultant: ……………………………….

Referring Ward: …………………………..

Diagnosis:……………………………………………

Signature: Print name: Designation: Date:

Name of person receiving information.

Statement/Question Tick/comment

Patients temperature (record) White cell count (record) Productive cough? Exclude infection Rash, infection excluded MRSA status Date of MRSA screen PCR test performed today Result of PCR test Wounds: signs of infection excluded. Cellulitis, extent? Any vomiting within last 48 hours Any diarrhoea within the last 48 hours Is the Patient confused? Is the Patient at high risk from falls?

Abbreviations used in this document to be listed here with the full description: PCR- Polymerase Chain Reaction MRSA_ Methicillin-Resistant Staphylococcus aureus.



Ward 39 Transfer Checklist:

Appendix 9: Process for Monitoring Compliance

Minimum requirement to be monitored

Process for monitoring e.g. audit

Responsible individual/ group/ committee

Frequency of monitoring

Responsible individual/ group/ committee for review of results

Responsible individual/ group/ committee for development of action plan

Responsible individual/group/ committee for monitoring of action plan and Implementation

a) Handover requirements between all care settings, to include both giving and receiving of information

Audit Discharge Team Annual Discharge Team Discharge Team Discharge Team/Clinical Improvement Committee

b) How handover is recorded


c) Out of hours handover process


Appendix 10: Equality Impact Assessment Form Department Organisation Wide Service or Policy Procedure Date Completed: January 2013 GROUPS TO BE CONSIDERED Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider community, offenders. EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and socio economic/deprivation.

QUESTION RESPONSE IMPACT Issue Action Positive Negative

What is the service, leaflet or policy development? What are its aims, who are the target audience?

The Procedural Document is to ensure that all members of staff have clear guidance on processes to be followed. The target audience is all staff across the Organisation who undertakes this process.

Raise awareness of the Organisations format and processes involved in relation to the procedural document.

Yes – Clear processes identified

Does the service, leaflet or policy/ development impact on community safety • Crime • Community cohesion

Not applicable to community safety or crime N/A N/A

Is there any evidence that groups who should benefit do not? i.e. equal opportunity monitoring of service users and/or staff. If none/insufficient local or national data available consider what information you need.

No N/A N/A

Does the service, leaflet or development/ policy have a negative impact on any geographical or sub group of the population?

No N/A N/A

How does the service, leaflet or policy/ development promote equality and diversity?

Ensures a cohesive approach across the Organisation in relation to the procedural document.

All policies and procedural documents include an EA to identify any positive or negative impacts.

Does the service, leaflet or policy/ development explicitly include a commitment to equality and diversity and meeting needs? How does it demonstrate its impact?

The Procedure includes a completed EA which provides the opportunity to highlight any potential for a negative / adverse impact.

Does the Organisation or service workforce reflect the local population? Do we employ people from disadvantaged groups

Our workforce is reflective of the local population.

Will the service, leaflet or policy/ development i. Improve economic social conditions in

deprived areas ii. Use brown field sites

. Improve public spaces including creation of green spaces?

N/A

Does the service, leaflet or policy/ development promote equity of lifelong learning?

N/A

Does the service, leaflet or policy/ development encourage healthy lifestyles and reduce risks to health?

N/A

Does the service, leaflet or policy/ development impact on transport? What are the implications of this?

N/A

Does the service, leaflet or policy/development impact on housing, housing needs, homelessness, or a person’s ability to remain at home?

N/A

Are there any groups for whom this policy/ service/leaflet would have an impact? Is it an adverse/negative impact? Does it or could it (or is the perception that it could exclude disadvantaged or marginalised groups?

None identified

ACTION: Please identify if you are now required to carry out a Full Equality Analysis No (Please delete as appropriate) Name of Author: Signature of Author:

Christine McCulloch Date Signed: January 2013

Name of Lead Person: Signature of Lead Person:

Date Signed:

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/444


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Name of Manager: Signature of Manager

Mary Aubrey Date Signed: January 2013