In some Canadian provinces and territories, hepatitis B vaccine is routinely given to all infants. Care providers should be sensitive to the interaction between infant, mother and family; it is important to identify concerns about the mother’s ability to care for her infant. The well-planned, comprehensive discharge of a medically stable infant helps to ensure a positive transition to home and safe, effective care after discharge. When hospital discharge is premature, however, use of resources after discharge from the hospital may increase. The American Academy of Pediatrics specifies that this assessment should take place 48 h to 72 h after discharge when a newborn has been discharged <48 h postdelivery [52][53]. Going home: Facilitating discharge of the preterm infant. Objective: The aim of this study is to achieve an international consensus on hospital discharge criteria for patients undergoing colorectal surgery. An abnormal transition period, characterized by problems such as respiratory distress, hypoglycemia, temperature instability, lethargy and septic risk factors, increases the likelihood of problems in the first few days of life that require prolonging hospitalization or readmission [14]. Nurs Womens Health 2014;18(4):333–9. Pediatrics 2004;114(3):708–13. During the hospital stay, the mother’s ability to care for her infant should be assessed, along with her level of confidence. Public Health Agency of Canada. Adv Neonatal Care 2007;7(2):69–75; quiz 76–7. Healthy term infants should be considered ready for discharge home when all criteria in Table 1 have been met. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Pan-Canadian inventory of public health early child home visiting: Key facts and glossary. Hearing and newborn screens have been scheduled (if they were not conducted in-hospital); appropriate follow-up for jaundice; vitamin D supplementation if breast-fed; other follow-up, as required. The checklist domains include (1) indication for hospitalization, (2) primary care, (3) medication safety, (4) follow‐up plans, (5) home‐care referral, (6) communication with outpatient providers, and (7) patient education.CONCLUSIONSThe Checklist of Safe Discharge Practices for Hospital Patients summarizes the sequence of events that need to be completed throughout a typical … Pediatrics 2004;114(1):297–316. Hospital discharge planning is a process that involves determining the appropriate post-hospital discharge destination for a patient; identifying what the patient requires for a smooth and safe CMS has revised guidelines for the discharge planning condition of participation in the State Operations Manual. Variations, taking into account individual circumstances, may be appropriate. <>/Metadata 340 0 R/ViewerPreferences 341 0 R>> Paediatr Child Health 2007;12(7):583–9. Grullon KE, Grimes DA. Prevention and management of neonatal herpes simplex virus infections. 1. At least 95% of healthy term newborn infants pass their first stool by 24 h of age. Acad Pediatr 2013;13(1):27–39. Examining the normal neonate. Guidelines need to be in place to help nurses in the A major study of 38,958 patients after ambulatory surgery found that the risk of dying … Delayed detection of cleft palate: An audit of newborn examination. Early weight loss nomograms for exclusively breastfed newborns. Can J Cardiol 2017;33(2):199–208. Common post-discharge complications include adverse drug events, hospital -acquired infections, and procedural complications. © 2020 Canadian Paediatric Society. When weight loss approaches or exceeds 10% of birth weight, adequacy of feeding must be assessed before discharge. The scope of the first postdischarge HCP review should always include assessment of weight loss, jaundice, hydration, general health, feeding, and any congenital malformation not seen at the initial examination in hospital. Discharge planning should start for any person not meeting the clinical criteria to reside in hospital. The infant’s health care provider should be chosen and noted. Understanding newborn infant readmission: Findings of the Ontario mother and infant survey. Urine and at least one stool have been passed. Jefferies A; Canadian Paediatric Society, Fetus and Newborn Committee. Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Most newborn care guidelines recommend a postdischarge assessment by an HCP within the first week of life. Gastrointestinal obstruction and hyperbilirubinemia requiring treatment are not always clinically apparent within 24 h of birth [14][15]. SAFE discharge for infants with highrisk home environments. Chichester, UK: Wiley-Blackwell, 2015. Use of a discharge readiness checklist (Table 1) can improve consistency and ensure thoroughness. Canadian Task Force on Preventive Health Care. Members: Heidi Budden MD (Board Representative), Mireille Guillot MD (Resident member), Leonora Hendson MD, Ann L. Jefferies MD (past Chair), Thierry Lacaze-Masmonteil MD (past Chair), Brigitte Lemyre MD, Michael Narvey MD (Chair), Leigh Anne Newhook MD (past Board Representative), Vibhuti Shah MD, Liaisons: Radha Chari MD, The Society of Obstetricians and Gynaecologists of Canada; James Cummings MD, Committee on Fetus and Newborn, American Academy of Pediatrics; William Ehman MD, College of Family Physicians of Canada; Roxanne Laforge RN, Canadian Perinatal Programs Coalition; Chantal Nelson PhD, Public Health Agency of Canada; Eugene H. Ng MD, CPS Neonatal-Perinatal Medicine Section; Doris Sawatzky-Dickson RN, Canadian Association of Neonatal Nurses; Kristi Watterberg MD, Committee on Fetus and Newborn, American Academy of Pediatrics (past representative), Principal authors: Brigitte Lemyre MD, Ann L. Jefferies MD, Pat O’Flaherty MEd, MN, RN-EC. Sword WA, Watt S, Krueger PD et al. Low educational level, poor socio-economic circumstances, young maternal age, language barriers, inadequate housing, inadequate prenatal care, use of illicit substances or alcohol, depression, isolation, lack of family support, and unstable parental relationships are circumstances which may place an infant at risk [35]. A shorter postpartum LOS highlights that low-risk birth is an event defined by ‘wellness’ rather than illness. Appropriate electronic resources, such as www.caringforkids.cps.ca or www.aboutkidshealth.ca should be recommended. Discharge from hospital should happen as soon after that as possible, normally within Paediatr Child Health 2014;19(1):3166. Table 1 should be customized for specific hospital and health region policies, because requirements and programs vary considerably by jurisdiction. J Hum Lact 2016;32(1):67–74. It is important that these plans and protocols be tailored to meet the individual needs of each mother–infant dyad and family. Many studies use hospital readmission as an outcome measure, which presupposes that readmission, including readmission for jaundice, indicates morbidity. Transfer from the ward should happen within one hour of that decision being made to a designated discharge area. Criteria for the safe discharge of patients from the recovery room AUTHOR Helen Reed, RGN, BA, is staff nurse, Freeman Hospital, Newcastle upon Tyne. Evaluation of the risks and benefits of early postpartum discharge – systematic review. 7. Godel JC; Canadian Paediatric Society, First Nations, Inuit and Metis Health Committee. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. Adequacy of breastfeeding can be assessed by direct observation of the feeding position, latch and swallow. Family-Centred Maternity and Newborn Care: National Guidelines. A dedicated discharge nurse position has been shown to enhance workflow and improve satisfaction levels among parents and nursing staff [51]. Patel H, Feldman M; Canadian Paediatric Society, Community Paediatrics Committee. Canada’s Family-Centred Maternity and Newborn Care: National Guidelines [1] outline the goals of care during this time: For this statement, the term ‘family’ is intended to reflect the diversity of families in Canada, including those with single parents and same-sex partners and adoptive families. Healthy mothers and infants should remain together and go home at the same time. Most cardiorespiratory issues related to transition present within the first 6 h to 12 h [10]. BMJ 1996;312(7023):71–2. Hepatitis B vaccine can be considered for infants born to mothers with hepatitis C infection [50]. Neonatal examination and screening trial (NEST): A randomised, controlled, switchback trial of alternative policies for low risk infants. The facts that bilirubin levels peak and weight loss reaches a nadir between days 3 and 5 [13][58] support an initial postdischarge assessment within 24 h to 72 h following an early discharge. Benitz WE; Committee on Fetus and Newborn, American Academy of Pediatrics. Ottawa: Minister of Public Works and Government Services Canada; 2000. Can J Public Health 2001;92(3):196–200. essential elements of a safe, comprehensive, and quality discharge from the ED. %���� ׅe�����/�dO H7C��'P����. Paediatr Child Health 2014;19(4):201–12. Because some newborn problems may not be apparent early on, it is prudent to re-examine infants assessed during the first 6 h of age. Vertical transmission of the hepatitis C virus: Current knowledge and issues. These include but are not limited to: Legible and complete antenatal records must be readily available for review by the infant’s HCP. Chen YJ, Chen WC, Chen CM. Surg Clin North Am 2012;92(3):685–711, ix–x. Arch Dis Child 2007;92(6):490–4. The guidelines have an e… The safety of early postpartum discharge: A review and critique. Complaints about hospital discharge difficulties are rising. Nursing Times; 99: 38, 22–24. Family psychosocial and environmental concerns should be assessed during the hospital stay and appropriate referrals or interventions arranged. Desmond MM, Franklin RR, Vallvona C et al. 10. A randomized trial of single home nursing visits vs office-based care after nursery/maternity discharge: The nurses for infants through teaching and assessment after the nursery (NITTANY) study. Johnson D, Jin Y, Truman C. Early discharge of Alberta mothers post-delivery and the relationship to potentially preventable newborn readmissions. Public Health Agency of Canada, Health Canada, Canadian Paediatric Society, Canadian Foundation for the Study of Infant Deaths, Canadian Institute of Health. This review emphasized the importance of appropriate metabolic screening, breastfeeding education, and postdischarge follow-up. Management of term infants at increased risk for early onset bacterial sepsis. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. Pediatrics 2001;108(3):719–27. Discharge criteria, inclusive of a post anesthetic recovery score system An abnormality is detected in approximately 8% to 10% of newborns [24][25]. Routine examination in the neonatal period. At time of discharge, infants must have an appropriate follow-up plan in place that includes: contact information for a primary health care provider; a scheduled follow-up visit 24 h to 72 h postdischarge—in hospital, clinic or at home—with a qualified health care provider. 8. Healthy term newborns should remain in hospital long enough to allow identification of major problems. Ideally, the examination should be performed in the mother’s room, with parents present, to minimize separation of mother and baby, facilitate parental questions, and provide confidentiality. National Collaborating Centre for Determinants of Health (NCCDH). Appendix. In Canada, approximately 98% of infants are born in a hospital [2]. J Perinatol 2010;30(Suppl):S6–15. W� ����"�܄}�-^���^������lA������I�Ѽٹ��kV+�H�lf!��S�]�b$��E �:^�E�� �[=�7a5�^�)hVS��xJ�Q���r&̏�p��E�3H���p� �c�qһ��h��EN6N�[��ޒ,�� B��te�R��Ǜ��"*���7@�d�.���y�ى�_ Antigonish, NS: St. Francis Xavier University, December 2009. http://nccdh.ca/images/uploads/TK_KeyFactsGlossaryJune25_v61.pdf (Accessed May 8, 2018). Pediatr Clin North Am 1966;13(3):651–68. Ongoing assessment of the infant and mother–infant dyad throughout the hospital stay helps ensure safe discharge. The purposes of the newborn assessment include ensuring successful transition from intrauterine life, identifying abnormal clinical findings, following-up problems detected antenatally, obtaining measurements of head circumference, length and weight, and confirming GA. Infant temperature is stable: in an open cot, with the newborn appropriately dressed. Safe Discharge from Hospital Always make sure at least one family member or friend is present when you review your specific discharge instructions with your doctor and nurse. Early postnatal hospital discharge: The consequences of reducing length of stay for women and newborns. Many mother–infant dyads are ready to go home 24 h after birth. <> Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. The authors concluded that same-day discharge is safe for patients with suspected or biopsy-proven MH after uncomplicated ambulatory surgery. Background: Standardized discharge criteria are considered valuable to reduce the risk of premature discharge and avoid unnecessary hospital stays. Under CLD the decision for discharge is made and documented by the senior medical clinician (e.g. Pediatr Surg Int 2010;26(11):1083–6. Paediatr Child Health 2008;13(6):529–34. Cochrane Database Syst Rev 2017;8:CD009326. Findings that may be missed include cleft palate and imperforate anus [27][28]. Martens PJ, Derksen S, Gupta S. Predictors of hospital readmission of Manitoba newborns within six weeks postbirth discharge: A population-based study. The development of the document was driven by the decision to provide written information that staff could use both in recovery and in theatre, to ensure consistency of care. Many mother–infant dyads will be ready to go home 24 h after birth. %PDF-1.7 Document first published: 19 March 2020 Page updated: 3 September 2020 Topic: Coronavirus, COVID-19 Publication type: Guidance. endobj 1 0 obj Similarly, ‘mother’ refers to any parent giving birth or, in the case of surrogacy, to the adult(s) adopting an infant. A complete physical examination of all newborns, performed during the first 24 h to 72 h of life before discharge, is standard practice in North America and elsewhere. Scientific World Journal 2003;3:1363–9. Paediatr Child Health 2010;15(10):655–60. A 2009 meta-analysis of 10 randomized trials comparing different hospital policies for newborn discharge reported that early discharge had no significant impact on readmission rates (RR 1.29, 95% CI 0.60 to 2.79), or on breastfeeding rates at 1 to 2 months after birth (RR 0.90, 95% CI 0.76 to 1.06) [8]. Not all diseases are detected reliably when the screening blood spot is collected before 24 h of age and, in these cases, a follow-up sample must be collected within the first week postbirth. There are few randomized trials and most studies focus on the nature of follow-up rather than timing. JAMA Pediatr 2014;168(4):361–70. Current Opin Pediatrics 2004;14(4):361–5. Safe discharge of the late preterm infant. The relative risk (RR) of newborn readmission following early discharge was 1.25 (95% confidence interval (CI) 0.97 to 1.61). Your newborn: Bringing baby home from the hospital, General appearance (activity, tone, colour), Promote the physical well-being of mother and infant, Support the relationship among mother, infant and family members, Facilitate development of infant feeding skills, Strengthen the mother’s knowledge and confidence, Maternal medical and mental health concerns, positive family history, Psychosocial and/or socio-economic stressors, domestic violence, Maternal medications, smoking, alcohol, or substance use, Abnormal prenatal screening and ultrasound findings, Maternal hepatitis B surface antigen, syphilis, HIV, or rubella status, Risk factors for infection, including maternal Group B streptococcal colonization status or intrapartum antibiotic prophylaxis, Apgar score, need for stabilization at birth, and/or low umbilical cord pH, Risk factors for early-onset neonatal jaundice, Infant feeding, including importance of breastfeeding, Recognition of early signs of illness, including jaundice and dehydration, and how to respond, Infant safety, including car seat use, safe sleep practices and other measures to decrease risk of sudden infant death syndrome, Mother provides routine infant care, including feeding, in a safe and confident manner, Mother demonstrates knowledge of how to recognize illness in her infant and when to seek help, Psychosocial and environmental risk-factors have been assessed, with an appropriate follow-up plan, Physical examination by health care provider, Birth weight, length and head circumference measurements obtained, Normal, stable temperature, heart rate and respiratory rate, Weight loss <10%; if approaching or >10%, a follow-up plan has been arranged, Antenatal and perinatal risk factors (e.g., sepsis) have been evaluated, If circumcision performed, no excessive bleeding at site, Newborn screen at 24 h (must be repeated within 7 days if administered before 24 h), Bilirubin screening – results reviewed and follow-up arranged, if required, Ophthalmia neonatorum prophylaxis, in accordance with regional guidelines, Immunizations, if needed (e.g., hepatitis B vaccine), Infant safety and injury prevention (including car seat safety, safe sleep practices, sudden infant death syndrome risk reduction), Care of circumcision site, if infant is circumcised, Infant’s community health care provider has been identified and recorded in chart, Follow-up visit scheduled for 24 h to 72 h after hospital discharge, Other investigations, referrals and appointments organized, as required, Community supportive resources have been offered. 3 0 obj Any parental questions should be answered. 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