Discharge planning and home IVN/PN
Considerations across the lifespan when discharging a patient on Home Intravenous Nutrition/Parenteral Nutrition; MDT planning; patient and whānau education
The provision of IVN/PN by its nature prolongs life; prior to commencing IVN/PN it is critical to define its use. To facilitate consent patient and whānau discussion should include:
Rationale for use and limitations
Side effects (including morbidity and mortality), symptom management and limitations
Requirement for active engagement with intestinal rehabilitation and MDT care provision (engagement with monitoring and review – consider formal agreement)
Anticipated duration (Home IVN/PN indicated if patient requires IVN/PN greater than 3 months)
End point for treatment (agreement)
Availability of patient/caregiver supports
Capacity for self-care assessed and mitigated
Consent for referral to psychology and social work
| Practice points for patients of all ages with intestinal failure |
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| Across the lifespan, each age and stage will have specific care needs, to ensure the safe provision of IVN/PN in the community |
| The ‘Minimum care requirements’ for home IVN/PN must be met prior to discharge, and maintained while the patient remains on IVN/PN in the community |
| The IVN/PN prescription is stable and not requiring adjustment more than once a week |
| Practice points for children and young people under 15 years of age with intestinal failure |
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| Each patient discharged on home IVN/PN will have a named care coordinator who will be responsible for personalised, emergency management and respite care planning - see Starship Clinical Guideline: Child health care coordination framework - https://www.starship.org.nz/guidelines/starship-nurse-specialist-care-co-ordination-framework |
| If the patient is school aged, it is possible that additional supports may be required to facilitate school attendance and engagement with education. Liaison with school based services health and education is indicated. Consideration for funding is via the On-going Resourcing Scheme ORS - https://www.education.govt.nz/school/student-support/special-education/ors/criteria-for-ors/. A further source of funding may be via the 'School High Health Needs Fund'(https://education.govt.nz/school/student-support/special-education/school-high-health-needs-fund/) |
| Practice points for young people over 15 years of age and adults with intestinal failure |
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| The ability to return to part or full-time employment is linked to patient dependence on IVN/PN (infusions per week) and patient desire to work. Intestinal rehabilitation planning should factor in grouping cares, and an infusion schedule which meets both nutritional requirements and causes minimum disruption to activities of daily living |
Key elements of patient and whānau education
Should incorporate principles of health literacy 3-Steps-Brochure-FA-web-v2.pdf
(hqsc.govt.nz)Is competency based, with completion documented within the clinical record
Recognition of the deteriorating patient, including sepsis & emergency management
CVAD cares including Aseptic Non-Touch Technique (ANTT), connection and disconnection of IVN/PN and administration of line locks if required
Safe storage of IVN/PN (refrigeration and deliveries)
Individualised rehabilitation/symptom management plan and monitoring protocol
Advance care planning
Emergency management planning (first response community and hospital)
If the patient is a young person aged over 14 years, consideration should be given to training them to promote self-care and increasing independence
Transition to adolescent and young adult (AYA) or adult services should be considered as developmentally appropriate and aligned with available service
Discharge planning checklist
See here for pdf discharge planning checklist
Training resources
Preparing to take your child home on IVN - a guide for whānau
Short Bowel Syndrome Family Guide (Nutrition for children with SBS)
Short Bowel Syndrome Family Guide (Nutrition for infants with SBS)
Information Booklet – Travelling with Parenteral Nutrition
Fluid input and output monitoring for oral diet
Fluid input and output monitoring for tube feed
Fluid input and output monitoring ileostomy output returned via distal stoma
Working with IVN providers
Industry partner role
Work with the hospital towards a specific discharge date to assist the patient with a smooth transition between hospital and home
Train caregivers/patient on IVN/PN connection and disconnection where requested by the DHB
Train based on the DHB’s IVN/PN protocol
Provide training on the home infusion pump
Provide IVN/PN deliveries to the designated delivery address as specified by the DHB
Liaise with the clinical team to achieve safe ANTT practice
Provide training in a timely manner
Provide out of hours support for IVN/PN delivery and pump troubleshooting
Provide the option for equipment to be hired as part of the home IVN service
Provide the option to the hospital to be the consumable provider. All consumables are ordered by patients/whānau on a monthly basis
Manufacture the IVN against the prescription provided and according the IVN/PN
DHB role
Assess the patient/family to determine if they are a suitable candidate to Home IVN/PN
Assess the patients home /social circumstance to determine if they are suitable for IVN/PN
Identify and assess the caregivers if they are suitable home IVN/PN caregivers
Liaise with the domicile DHB regarding the patients clinical care
Determine which industry partner they wish to engage with for home IVN/PN
Decide if they would like the patient/caregiver trained by DHB staff or the industry partner
Provide the industry partner with IVN protocol to base IVN/PN training on
Provide line access care training to the patient/caregiver
Give the industry partner reasonable notice for training
Determine if they would like the industry partner to provide consumables
Discuss and obtain written consent from the patient if they wish to utilize the remote monitoring system
Provide an up to date prescription with specified validity timeframe to the industry partner to manufacture against
Advise the industry partner when the patient arrives as an inpatient and if IVN/PN deliveries are to be changed