Preparing for discharge
Aim to support families as they leave hospital and adjust to going home without their baby.
Families tell us leaving the baby in the hospital is difficult, they feel unsure who is caring for the baby and for themselves, and who will be providing contact and support.
What do we need to do?
- Give the family time to ask questions about who is caring for their baby, where their baby is being cared for, and who to contact when they have left the hospital.
- If appropriate psychological support is available, immediately and longer term, offer the opportunity to take the baby home or out of the hospital environment - a template form is available. Refer to local guidelines on taking a baby home, e.g. informing Police Scotland.
- Sensitively discuss the options for donating or suppressing milk.
- Offer to cancel the Baby Box delivery if it has already been requested, and the woman, partner or a family member wishes. The box can be cancelled by calling 0800 030 8003. The call can be made either by the parent, a family member or a nominated health professional. However there is no need to cancel if they prefer to have the box.
- Discuss the emotions the family may experience and let them know they are common. Make sure the family knows how to access emotional support, have information and offer to help make contact if they wish. Information includes:
- their key contact, ongoing plan of care, and follow up appointment
- how to contact the spiritual care/chaplaincy team, offer to contact on their behalf
- how to access emotional support available from NHS Boards and primary care team contacts for support organisations and how they can help
- offer to help make contact if they wish.
- Consider NICE guidance QS115 on antenatal/ postnatal mental health and SIGN guidance 127 on perinatal mood disorders.
- Check all primary and secondary healthcare staff, including referring units have been informed that the baby has died. This should be within 24 hours of the neonatal death.
- Make sure that staff have reported a neonatal death through the Board’s risk reporting system.
- Document final agreed arrangements in the baby’s medical record and communicate these to primary care colleagues.
- Make sure there is a clear handover from the paediatric team to primary care teams. This should be in written form and documented on the baby’s medical record.
- Make sure the family know whom to contact for their healthcare needs from this point onwards.
Feedback
- Explain to the family that feedback about their care helps the Board understand if they received the appropriate care and that staff will ask families about their experience at follow up appointments. Ensure any verbal feedback is recorded. Explain how anonymous feedback could be given, if preferred.
- If they are comfortable about being asked for feedback then let them know how and when they will be contacted. Document if a family are in agreement with this.
- Consider using Sands' Maternity Bereavement Experience Measure (MBEM) to capture parent feedback.
- Be clear with the family that feedback they give for this purpose is not part of a review of the baby’s death nor a complaints process.
The hardest part was leaving my baby in the hospital. There are no words to describe how difficult this was. He was my baby and every part of me wanted to stay with him. The nurse brought a beautiful Moses basket into the room and this allowed us to leave him looking like he was sleeping and with someone who we trusted. I left with a bundle of information and no signposting for community care. I felt very alone.
How will we know we have achieved our aim?
Families will tell us they felt well supported as they left hospital and knew who was responsible for their care once they were at home.
Staff will say they feel confident and competent supporting families as they leave hospital. Primary care staff will say they were given full information and were
informed in a timely way.