Appendix Q- Standardised Agenda and Reporting Template for Teleconference Appendix R A PATIENT TRANSFER TOOL TO EVALUATE THE LEVEL OF RISK FOR INPATIENT MOVES – TRUST STATUS: DATE: It is well documented that internal patient moves increases length of stay and has multiple risk factors associated with an elongated length of stay. To minimise against the potential risks to all parties involved in the transfer there must be a clear understanding of the need to move the patient using a systematic physical assessment, an assessment of the situation, confirm the routes of communication, documentation and identification of clinical equipment required to provide a safe transfer experience for patients and clinical staff. Name of Patient: DOB: Name of person Could be DHM requesting move: for escalation reasons Patient EWS Oxygen O2%: Other Requirements? Mask Type: Equipment O2 Flow: Required? Reason for Move: Please Detail: Clinical Please Detail: Clinical Requirement for Requirement for another Patient this Patient? Patient Condition: Yes No Comments: Elevated EWS with no management plan (CODE RED) Imminently dying/ Last few days of life / EOL pathway Dementia / cognitive impairment learning difficulties Patient under care of Safe guarding / DOLS/ MH Act Suspected / Known Infection Please detail the number of previous moves: Moves History: Risk Continue to move patient? Yes No Signed: Use score card overleaf to determine level of risk: Define main risk: Patient Communicated Yes No Signed: with? If the patient must be moved despite meeting any of the criteria above please provide explanation and detail risk mitigation below: Patient Medical Team Informed Yes No Time: Method: Who else was informed? Time: Method: e.g other staff / family / carer
Appendix Q- Standardised Agenda and Reporting Template for Teleconference Appendix R – A PATIENT TRANSFER TOOL TO EVALUATE THE LEVEL OF RISK FOR INPATIENT MOVES TRUST STATUS: DATE: It is well documented that internal patient moves increases length of stay and has multiple risk factors associated with an elongated length of stay. To minimise against the potential risks to all parties involved in the transfer there must be a clear understanding of the need to move the patient using a systematic physical assessment, an assessment of the situation, confirm the routes of communication, documentation and identification of clinical equipment required to provide a safe transfer experience for patients and clinical staff. Name of Patient: DOB: Name of person requesting move: Could be DHM for escalation reasons Patient EWS Oxygen Requirements? O2%: Mask Type: O2 Flow: Other Equipment Required? Reason for Move: Clinical Requirement for this Patient? Please Detail: Clinical Requirement for another Patient Please Detail: Patient Condition: Yes No Comments: Elevated EWS with no management plan (CODE RED) Imminently dying/ Last few days of life / EOL pathway Dementia / cognitive impairment learning difficulties Patient under care of Safe guarding / DOLS/ MH Act Suspected / Known Infection Please detail the number of previous moves: Moves History: Risk Use score card overleaf to determine level of risk: Continue to move patient? Yes No Signed: Define main risk: Patient Communicated with? Yes No Signed: If the patient must be moved despite meeting any of the criteria above please provide explanation and detail risk mitigation below: Patient Medical Team Informed Yes No Time: Method: Who else was informed? e.g other staff / family / carer Time: Method:
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