Practice Elements of NP Treat and Discharge
Hospital Nurse Practitioners (NPs) in Ontario both manage and provide care for both inpatient and outpatient populations while collaborating and consulting with physician colleagues and the inter-professional team as needed to address patient care needs. Since July 1, 2011, Ontario hospital NPs have been authorized to treat and discharge inpatients and today discharge planning is routinely performed by NPs in many Ontario hospitals. NPs view treatment and discharge planning, however, as one of several components within a comprehensive plan of care developed by NPs in consultation with the hospital inter-professional team.
A central part of the NP role is to actively involve patients and families in the process of developing a therapeutic plan of care and monitoring patients’ response of treatment progress towards specific goals. NPs assess patients’ and their readiness for discharge throughout the hospital stay and work with inter-professional care teams to ensure discharge arrangements align with a safe transfer of accountability to the primary (or other) care provider.
Maximizing Patient Access and Flow
NP accountabilities for treatment and discharge vary in different settings. Depending on both the complexity of coordinating the discharge or transition as well as the level of access to members of the inter-professional teams (that may or may not include discharge planners), treatment and discharge may include:
- Comprehensive care planning, treatment and assessment of readiness for discharge,
- Plan to transfer care to the right provider, at the right time, to the right place,
- Development and communication of the discharge plan with patients, families and the inter-professional team,
- Communication of transfer of accountability to another care setting / care provider or coordination of care services in the community,
- Writing the discharge order and completing the prescriptions and appropriate chart documentation (e.g., health record summary), and
- Medication reconciliation.
Improving Efficiency and Effectiveness
In the past, NPs were required to perform many of these functions through cumbersome 'work arounds', using medical directives to meet the legal requirements of providing routine patient care. Hospital adoption of NP treatment and discharge however eliminates the need for this inefficient layer of responsibility and enables NPs to focus on providing direct processes of care that improve the effectiveness and efficiency of discharge while ensuring full accountability during the discharge process.
Promoting Innovation and a Higher Quality of Care
Due to recent legislative and regulatory amendments hospitals now have an ideal opportunity to maximize the scope of NPs practice contributions and to explore innovative ways to improve inpatient processes within the inter-professional team.
When preparing to implement NP’s new authority to treat and discharge, organizations should examine current policies and existing practices to consider how maximizing NP utilization increases the efficiency and effectiveness of current care processes. At the same time, hospitals should examine the role and accountabilities of all healthcare team members and clearly identify the NP role and responsibilities within their own particular inter-professional teams.Key Questions for Hospitals to Consider when Implementing NP Admit, Treat and Discharge Authority, are provided within this toolkit (in progress – will be updated shortly). Similarly, Tools for NP Implementation, which facilitate inpatient care processes and include discharge check lists, care maps, and other forms of tracking tools, are also provided. These tools compare patient’s progress to established goals in their health record. Such leading practices keep the entire healthcare team aware of each patient’s readiness for transfer of care to another provider and discharge from the hospital setting.