DISCHARGE POLICY
Reference Number:
701 2010
Author & Title:
Sue Vost, Discharge Team Leader
Astrid Siddorn, Discharge Liaison Nurse
Responsible Directorate:
Clinical
Review Date:
October 2014
Ratified by (committee):
Operational Governance Committee
Date Ratified:
12 October 2011
Version:
6
Related Policies
•
•
•
•
•
Medicines Code: Discharge Medicines
Policy
RUH Patient Transport Policy and
Procedure
Safeguarding Adults policy & procedure
Mental Capacity Act
Consent policy
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 1 of 17
Index:
1.
Policy_______________________________________________________________ 3
2.
Standards, Responsibilities and Duties for Safe Discharge __________________ 3
3.
Discharge Categories _________________________________________________ 4
4.
Simple Discharge Process _____________________________________________ 4
5.
Complex Discharge Process____________________________________________ 7
6.
Rapid Discharge ______________________________________________________ 9
7.
Self Discharge ______________________________________________________ 10
8.
Out of Hours Discharge _______________________________________________ 10
9.
Prisoners___________________________________________________________ 11
10.
Patients admitted and discharged under the Mental Health Act (2005) ______ 11
11.
Discharge Medications _____________________________________________ 11
12.
The Emergency or Urgent Discharge of Adult Patients to other Acute
Healthcare Trusts________________________________________________________ 11
11.
Education ________________________________________________________ 12
14.
Monitoring Arrangements ___________________________________________ 13
APPENDIX 1
Consultation Schedule _____________________________________ 14
APPENDIX 2
Discharge Nursing Documentation ___________________________ 15
APPENDIX 3
Flow Chart for Patient Discharge _____________________________ 16
Ratification Check list ____________________________________________________ 17
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 2 of 17
1.
Policy
1.1
Introduction
This policy is designed to standardise and provide a coordinated approach to
the management of patient discharge. It is written in accordance with the NHS
and Community Care Act 1993/98, DoH Discharge from hospital: Pathways,
Process and Practice 2003, the Community Care Act (Delayed Discharge)
2003, National Framework for continuing healthcare and NHS- funded
Nursing Care 2007 & Achieving Simple Timely Discharge from Hospital 2004.
Patient discharge must be seen as an interdisciplinary / multidisciplinary
issue. This policy is therefore intended for use by all healthcare staff including
nurses, doctors, allied health professionals and managers.
This policy aims to ensure that unplanned re-admissions do not occur as a result of
poor discharge planning.
2.
Standards, Responsibilities and Duties for Safe Discharge
It is the responsibility of the ward or department manager to ensure all
ward/department staff understand and comply the Discharge Policy.
It is the responsibility of the Registered Nurse looking after the patient to coordinate the discharge plans.
It is the duty of the discharge liaison nurse to assist ward staff with discharge
pathways and support all complex discharges.
It is the responsibility of the discharge cluster group to review and monitor complex
discharges and change procedures as required. The cluster group should involve
members of the PCT, RUH and Local authorities. The meeting will be held monthly.
The consultant in charge of the patient’s medical care is responsible for the
decision to make the patient medically or surgically fit for discharge. It is also their
responsibility to ensure that their patients’ discharge summaries are completed in a
timely way.
The weekly delayed transfers of care (DTOC) meeting is responsible for ensuring
all patients that are deemed to be a DTOC are recorded in the appropriate way.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 3 of 17
3.
Discharge Categories
3.1
Simple discharge process
A simple discharge is one that:
• Will involve minimal disturbance to the patient’s activities of daily
living.
• Does not prevent or hamper a return to their usual place of
residence.
• Will not require a significant change in support offered to the patient
or their carer in the community.
3.2
Complex discharge process
The patient profile will identify the complex discharge needs of this group.
3.3
Rapid discharge and transfers to community hospitals and care homes.
These may be simple or complex and usually as a result of pressures to place
patients in appropriate care environments as a result of the escalation
process.
3.4
Self discharge
These relate to patients wishing to self discharge against medical advice.
3.5
Out of hours discharge
These are discharges that occur after 19:00 at night and before 08:00 in the morning.
3.6
Prisoners
The process for the admission and discharge of Prisoners.
3.7
Patients admitted and discharged under the mental health act (2005)
The processes to ensure patients are supported by the Site Manager
3.8
The emergency or urgent discharge of adult patients
The process for urgently discharging patients, due to clinical need or in the
event of a major incident.
4.
Simple Discharge Process
A simple discharge is one that:
• Will involve minimal disturbance to the patient’s activities of daily
living.
• Does not prevent or hamper a return to their usual place of
residence.
• Will not require a significant change in support offered to the patient
or their carer in the community.
On the day of discharge the discharging nurse must confirm all arrangements are in
place and the patient is fit to leave hospital
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 4 of 17
An initial assessment and plan must be completed by a Registered Health
Professional within 24 hours of admission, or directly from a pre–admissions clinic.
Issues that must be considered are:
• Previous care needs
• Changing medication needs including compliance aids
• Likely changes as a result of admission
• Transport needs
• Social needs
• Eligibility for Continuing Health Care
• Possible vulnerability of patients’ e.g. frail, elderly, terminally ill,
learning disability, mental health problems.
• Infection control issues and the possible need for consultation with the
infection control team
This information must be recorded within the RUH discharge proforma document,
including the home circumstances information. This information may now change the
patient from a simple to a complex discharge. Refer to section 5 for further complex
discharge planning
All patients must be given an estimated date of discharge (EDD) within 24 hours of
admission. This must be documented in the multi-disciplinary notes, the appropriate
IT system and the ward white board. This must be reviewed and updated on a
regular basis.
The matron responsible for each area must be involved with the provision of advice
and support for ward managers with simple discharges.
The patient and/ or carers must agree the discharge plan. This must be documented
in the multi-disciplinary notes.
If an existing care package needs to be restarted, the registered health professional
undertaking the assessment will need to contact the relevant Social Services
department to find out the most appropriate way to do this. Social services need 48
hours notice before a care package can be restarted.
On the day of discharge the patient must be handed over to, and transferred to the
Discharge Centre, prior to 10:00am.
Ensure the patient has been provided with medication to take away in line with the
Medicines Code: Discharge Medicines policy.
The discharging nurse, from the ward, must ensure that the patient and carer receive
instructions on care required after leaving hospital.
The discharging nurse, from the ward, must complete the discharge checklist which
is included in the nursing documentation.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 5 of 17
Transport arrangements for discharge must be considered at the earliest opportunity,
at least 24 hours prior to discharge. (RUH Patient Transport Policy and Procedure)
Ambulance transport must only be used in the event of clinical need.
If discharge arrangements change all members of the multidisciplinary team, the
patient and the patient’s carer must be informed as the changes occur. All changes
must be documented in the multidisciplinary notes.
The patient must be informed if an outpatient appointment is necessary, the time
scale in which the appointment is needed and how they will be notified of the
appointment date and time. First appointments must be made for INR checks for all
patients discharged on Warfarin with the appropriate clinic/GP surgery. Patients will
need to be informed of the time and date of appointment prior to discharge.
The patients GP and/or District Nurse must be involved prior to discharge if the
discharge is deemed complex by the multidisciplinary team.
The nurse coordinating the discharge must ensure all valuables held in the Patient
Affairs office are returned and signed for before the patient’s discharge.
The discharging nurse should ensure that the patient has a sufficient supply of
dressings and continence pads, if necessary.
The nurse discharging the patient should check how the patient will gain access to
the property and ensure any keys are sent with the patient.
The discharging nurse must ensure that the patient is fully clothed before discharge;
the patient must not be discharged in their night clothes. Unless the patient declines
the offer of clothes, or alternative clothing is not available.
If the RUH patient profile highlights complex planning discharge needs, please follow
Complex Discharge process.
4.18 Discharge documentation
The discharge summary must be completed at the point of discharge. Copies of the
discharge summary should be:
•
•
•
Given to the patient to take away;
Filed in the patient’s health records within 24 hours;
Sent to the patient’s GP, or other hospital/institution to which the
patient is discharged, within 24 hours.
Electronic templates for procedure or diagnosis specific discharge summaries must
be authorised by the Trust’s ratification panel.
If the patient is employed, they may require a sick certificate. A MED10 certificate
stating the patient has been an inpatient may be completed by the nursing staff
coordinating the discharge. The medical/surgical team will need to complete a MED3
certificate if the patient requires time off after their hospital admission.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 6 of 17
5.
Complex Discharge Process
If the patient profile indicates complex discharge needs, the health professional coordinating discharge must ensure all elements of the Simple Discharge process have
been considered and actioned.
The registered health professional who has undertaken the initial assessment of the
patient, must ensure the prompt referral to Social Services or to the appropriate
Primary Care Trust for Home Care, Placement or Intermediate Care, if need has
been identified. The referral must be commenced as soon as a requirement for care
has been recognised (Section 2 notification Community Care Act, Delayed
Discharges, health/rehab referral).
If a Section 2 notification has been sent, it is the ward/department manager’s
responsibility to ensure that Section 5 notification is sent as soon as the patient is
medically fit for discharge and all assessments are complete (Physiotherapy,
Occupational Therapy, Psychiatry, Nursing etc.)
If after the Section 5 notification has been sent the patient becomes unwell, the ward
is closed due to infection or the patient requires further assessment prior to
discharge it is the ward/department manager’s responsibility to ensure that social
services have been informed. On regaining health, the ward reopening or on
completion of assessment the ward must ensure that the Section 5 is resent with an
updated Estimated Date of Discharge entered.
5.1
Screening for continuing healthcare
All patients are entitled to screening for Continuing Health Care (CHC). Continuing
Health Care means care provided over an extended period of time, to a person aged
18 or over, to meet physical or mental health needs that have arisen as a result of
disability, accident or illness. It is the assessing health professionals’ responsibility
to ensure this is completed as appropriate. The relevant CHC training course must
be completed prior to screening.
Currently Wiltshire and BANES PCT, complete their CHC screening assessments
once the patient is established in their discharge destination. The RUH supports
Somerset PCT to process their CHC screening assessments while the patient is in
the acute hospital environment.
A CHC Fast Track Tool assessment should be completed for patients that have a
rapidly deteriorating condition and are entering a terminal phase. This tool is used
instead of the general CHC process to access urgent packages of care and support
for patients in their preferred place of care where possible. An appropriate clinician
should complete the assessment tool, i.e. consultant, ward doctor or registered
nurse.
5.2
Information on particular care needs
Staff must ensure that information about infections, and any particular care needs
related to those infections and their control, are communicated when a patient
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 7 of 17
moves from their care to the care of another person e.g. community nurse, GP,
nursing home or community hospital. This information should include:
• MRSA status and whether the patient is currently receiving
decolonisation treatment;
• The date of next MRSA screen;
• Contact with other patients with known or suspected infection;
• Whether the patient is being discharged from a ward that is closed
due to infection;
• Any history of diarrhoea and/or vomiting.
Communication with care providers must be documented in the patient’s health
records and the discharge summary must include any infection risks and associated
care needs.
The Discharge Team must be involved for the provision of expert advice to the
ward/department managers and staff to:
•
•
•
•
•
•
•
•
Assist ward staff in the identification of patients with on-going carer
needs;
Support ward staff in ongoing assessment of patient discharge
needs and assist ward staff in making alternative discharge plans
as appropriate;
Advise ward staff about suitability for and availability of Community
Hospital beds;
Advise ward staff about reimbursement process;
Advise ward staff about eligibility for CHC in conjunction with the
lead nurse for CHC;
Participate in multidisciplinary ward meetings/ward rounds with
physicians and medical staff as appropriate;
Assess whether patients are appropriate for accommodation within
the Discharge Centre;
Provide an ongoing programme of education for ward/department
staff.
The patient and home carer (including informal carers) must be central to the
Discharge Plan. They must be kept informed of progress on a regular basis by all
members of the multidisciplinary team (MDT). Where appropriate the patient and
carers will be invited to attend multidisciplinary meetings, discharge planning and
case conferences.
Any concerns regarding a possible vulnerable adult, must be advised to the senior
nurse on duty, following the procedure within the Safeguarding Adults policy.
If the patient has been deemed not to have capacity following a capacity assessment
(refer to the Mental Capacity Act 2005 or Consent policy) a referral to an Independent
Mental Capacity Advocate (IMCA) should be considered before making any discharge
plans.
5.3
Transferring to a community hospital/care home
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 8 of 17
When patients are transferred to a community hospital/ care home the discharging
nurse must ensure:
•
•
•
•
•
6.
All health records and X-rays are sent with the patient, if they are being
transferred to a Bath health community Hospital; or a photocopy of the
health records if they are being transferred to a hospital out of area.
Care homes should not receive the patient’s health records.
The Dr caring for the patient must complete a medical transfer letter
and document in the health records that the patient is fit for discharge.
The discharging nurse should complete and send a nursing transfer
letter.
The community hospital or care home must be contacted and be given
a full handover prior to discharge.
Transport is arranged at the earliest opportunity, with the aim that the
patient will arrive at their destination no later than 15:00.
Rapid Discharge
Rapid discharges should only occur when it is essential to discharge a patient
urgently to prevent bed crises and to achieve the emergency care standard. Please
refer to the Patient Access Operation policy for further information on managing the
related levels of escalation.
When rapid discharges are necessary, the discharging nurse must ensure a safe
discharge, by expediting all of the criteria for simple and/or complex discharge
process.
When it is necessary to rapidly discharge a patient to Intermediate Care or
placement e.g. Transitional Care bed, the discharging nurse must:
•
Establish the availability and suitability of a bed/placement;
•
Inform the patient and family;
•
Arrange transport;
•
Handover the patient to the receiving ward/placement;
•
Ensure that necessary medication, TTAs are sent with the patient;
•
Ensure that the health records are sent with the patient. A copy of the
current episode of care should be sent with the original drug chart;
•
Complete all health record and discharge documentation and send a
transfer letter with the patient;
•
Ensure that the District Nurse team are informed and a discharge letter
completed, if appropriate.
It is essential to promptly transfer the patient to the Discharge Centre to await
transport.
Unplanned re-admissions must not occur as a result of poor discharge planning.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 9 of 17
7.
Self Discharge
Patients may decide to discharge themselves from the hospital against clinical
advice.
If a patient wishes to self discharge:
•
Staff must advise the patient why it is in their best interest to remain in
hospital;
•
If the patient does not wish to take this advice they must be asked to
sign the appropriate ‘self discharge’ form;
•
•
The doctor on duty must be informed;
The doctor on duty must inform their consultant within 2 hours or
sooner if the patient is vulnerable;
Any medication required on discharge must be provided. If the patient
refuses to wait for their medication then all reasonable steps must be
taken to ensure that the patient receives it, e.g. using a courier service
to deliver the medications;
Relatives, carers and Social Services must be contacted, if relevant;
The patient’s GP must be contacted at the time the patient leaves the
hospital;
A discharge summary must be sent to the patient’s GP within 48 hours
of the patient leaving hospital.
•
•
•
•
All actions and discussions must be recorded, dated, timed and signed in the
patient’s health records.
Patients who leave the discharge centre without their medication are to be classed
as self discharge patients and therefore the actions outlined in point 7.1 should be
taken.
Patients must not be given permission to leave the hospital site prior to formal
discharge. This must be discussed and agreed with the clinical team involved in the
patients care.
8.
Out of Hours Discharge
Out of hours discharge is classed as a discharge that occurs after 7pm at night and
before 8am in the morning.
Out of hours discharges should only occur through patient choice or if there is no
other option.
Where possible, all agencies (including GP and District Nurse), relatives and carers
should be contacted during working hours to inform them of discharge plans. If this is
not possible then this should be completed as soon as normal hours resume. It is
the responsibility of the discharging nurse to ensure this occurs.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 10 of 17
9.
Prisoners
A prisoner admitted via the Emergency Department, or as an elective patient, will be
accompanied by a prison officer at all times. Using the simple discharge process,
the discharging ward will discuss medications, follow up appointments and further
care with both prisoner and prison officer.
10.
Patients admitted and discharged under the Mental Health Act (2005)
When a patient is admitted whilst under a section of the Mental Health Act, their
admission must be advised as soon as possible to the Site Manager. The
documents that record the details of the section should be copied and given to the
Site Manager.
At the time of discharge, the details of discharge should be advised to the Site
Manager. This is to ensure that the discharge plan is appropriate to that patient.
11.
Discharge Medications
1.1
All discharge medication requests should be sent to pharmacy at least 24
hours in advance.
1.2
If the patient requires a compliance aid because:
•
•
The patient previously had a compliance aid filled by a community
pharmacy and this needs to be restarted;
The patient is waiting to be discharged to a home which requires
medication in a compliance aid. then
then inform the ward pharmacist at the earliest opportunity and at least 48hrs before
the expected date of discharge. The pharmacist will ensure that arrangements have
been put in place for continuation of medicines after discharge.
1.3 Please note that compliance aids are not always appropriate for patients and they
may need to be assessed for suitability. Please consult with your pharmacist.
12.
The Emergency or Urgent Discharge of Adult Patients to other Acute
Healthcare Trusts
This excludes discharges from the Critical Care Services (ITU & HDU) and the
Emergency Department (ED).
The decision to transfer the care of a patient to another acute healthcare Trust will
be decided by the medical team caring for the patient.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 11 of 17
The decision must be discussed with the patient and family as appropriate. At all
times during the transfer process the patient and family must be fully updated on the
plan and discharge destination.
If appropriate, an ambulance should be called to enable the transfer. The category
required by the ambulance team should be advised by the medical team. This could
be an immediate transfer or within 1 to 2 hours. The ward nurse making this call
should ensure all relevant information regarding the patient’s clinical condition,
including infection status and actions that may be required by the paramedic team
during transfer.
If a nurse of doctor is required to escort the patient, accountability for care should be
discussed and agreed prior to leaving the hospital.
The return to the hospital base for the escort and any equipment should be arranged
prior to transfer. A taxi can be booked with the transport team during office hours
and via the Site Manager out of hours.
The ward nurse should ensure that only copies of the current episode of care from
the patient’s health records are sent to the receiving hospital. The original health
records should remain at the RUH. The patient’s possessions should be packed
using the patient’s bags, as appropriate and in a timely way, to ensure a smooth
ward handover to the ambulance team.
Once the ambulance team arrive on the ward, the ward nurse on medical team
should liaise with the paramedics regarding the patient’s condition and any
requirements for their safe transport.
11.
Education
Staff must refer to the Mandatory Training Matrix, available on the intranet at
http://webserver.ruhbath.swest.nhs.uk/development/mandatory/documents/matrix_roles.xlsi, to identify
what training in relation to patient discharge is relevant for their role. The Mandatory
Training Matrix identifies when training needs to be undertaken, the method of
delivery and frequency of the training.
The Mandatory Training policy identifies how training non-attendance will be followed
up and managed and is available on the intranet at http://webserver.ruhbath.swest.nhs.uk/staff_resources/governance/policies/documents/non_clinical_polic
ies/black_hr/HR_148_Mandatory_training_policy.pdf
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 12 of 17
14.
Monitoring Arrangements
The following arrangements have been put in place to monitor the effectiveness of
this policy:
Incidents and complaints regarding patient discharge will be reviewed by the
Discharge Team Manager, in order to identify immediate actions required to
increase patient safety and to identify trends and key risks for the safe discharge
of patients.
The findings of this analysis will be reported to the multiagency cluster group
on a quarterly basis in order to identify actions required to address issues of
non-compliance with the policy, share good practice and explore improved
discharge planning.
The audit of completion of the discharge documentation (appendix 2) will be
included in the clinical audit programme and undertaken annually. The results
of the audit will be reported to the Operational Governance Committee, as
part of the agreed exception reporting process. The Divisional Management
teams will also be provided with a copy of the audit findings, in order for any
areas of non-compliance to be addressed through the creation and
completion of an action plan.
The discharge multi agency cluster group will monitor complex discharges by
discussing selected cases monthly. These cases are agreed by consensus of
the participating members of the cluster group. This process will encourage
an educational learning environment and help inform future discharge
planning.
Delayed discharges will be monitored weekly through the Delayed Transfer of
Care (DTOC) meetings; these are then be submitted to the Department of
Health. Identified patients will be monitored and action taken to minimise the
delays appropriately.
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 13 of 17
APPENDIX 1
Consultation Schedule
Name & title of individual
Date consulted
Francesca Thompson, Director of Nursing
Sharon Bonson, Assistant Director of Nursing
Gareth Howells, Assistant Director of Nursing,
Medicine
Jan Lyn, Assistant Director of Nursing, Surgery
Jo Miller, Assistant Director of Nursing/DIPC
Matrons, Senior Sisters, Senior Nurses and Ward
Managers (all)
December 2009
Name of Committee/group
Policy Group
Operational Governance Committee
Date of meeting
27.09.11
12.10.11
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 14 of 17
APPENDIX 2
Discharge Nursing Documentation
Discharge Plan
Home 
Planned place of Discharge :
Nursing Home 
Care Package 
Residential Home 
Community Support Team 
Print name
Multidisciplinary team agreement for discharge
All equipment arrangements made
Social Work agreement to discharge date
Care package in place
Patient aware of proposed discharge date
Relatives aware of proposed discharge date
Community Services informed: or
Community Support Team arranged: Sutures removed / removal arranged
District nurse referral letter completed and given to patient
Person to receive patient arranged
House Keys available
Heating on / food available
Relatives able to transport patient home
Home from Hospital booked
Hospital Transport booked (circle type)
Car / ambulance / sitting / stretcher
Special requests e.g. Oxygen, zimmer frame
TTAs prescribed / ordered include medication appliances
GP surgery informed if required
Out patient appointment made / to follow by post
Day of Discharge
Discharging Nurse Print name
Ward
Discharge Centre
GP letter given to patient
TTAs dispensed and explained to patient
Dressings / pads supplied
Medical sick note supplied
Property returned including from safe
Pad/dressing checked
Check all cannulas removed
Relatives contacted and informed patient has left
Community hospital contacted and informed patient has left
Care home contacted and informed patient has left
jjj
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 15 of 17
APPENDIX 3
Flow Chart for Patient Discharge
Discharge planning starts at either preadmission clinic or on admission
Discharge assessment is completed
within 24 hours of admission
An estimated date of discharge is
agreed with the patient
On-going care needs identified
Yes
No
Refer to discharge team for support
with complex discharge planning
Refer to social services/
intermediate care
Screening for continuing health care is
completed for patients with complex needs
Refer to matron for support and
advice for simple discharge
On day of discharge
Confirm care is in
place/bed available
Patient is medically fit and safe
to transfer from the acute
sector
Patient and their family
are aware of and agree
with discharge
Discharge checklist is
completed
Patient is transferred to the discharge
centre to await TTAs /transport
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 16 of 17
Ratification Check list
Dear Chairman
Please would you review this document at your next meeting and agree final approval and
organisational ratification.
Title of meeting: Operational Governance Committee
Date of meeting: 12 October 2011
Name of document:
Discharge Policy (701)
Name of author:
Susan Vost, Discharge Liaison nurse
Yes No
Are there any elements of this policy which present operational
issues that require further discussion? If yes, please provide a
contact name for the author.
x
Does the document include a training plan?
x
Is the policy referenced?
x
Are up to date National Guidelines included?
x
N/A
If you are the appropriate forum, have the necessary resources
been agreed to implement this document?
x
Is there a plan for policy implementation?
x
Does your meeting recommend further consultation with groups or
staff other than listed at the front of the policy?
x
What are the cost implications of implementing this policy?
Equipment
Staffing (additional)
Training
Other
x
£
£
£
£
Document approved without further comment (Please circle):
Yes
Further amendments to document suggested (Please circle)?
No
Name of Chair: Carol Peden
Signature:
Date: 12.10.11
Document name: Discharge Policy
Issue date: November 2011
Ref.: 701
Status: Final
Page 17 of 17