01 April 2015

Enhanced recovery programme relies on community nursing support

The Enhanced Recovery Programme has two aims; the first is to improve the quality of patient care, and the second is to reduce the length of stay in hospital. Its person-centred approach aims to put the individual fully in control of their care from the time of their referral through to the follow-up process and eventual discharge.

In this #NurChat, we wanted to discuss the community support aspect of the programme. Post-operative communication with the patient and support they receive in the home are both key to avoiding a hospital readmission, which would largely remove the benefits of the programme for all involved. The feedback from staff that had experience of patients on the programme seemed to be good, with positive results seen from using this programme.

@PUNC14CHolmes we use enhanced recovery in the Emergency Assessment Unit of my hospital with great success #nurchat #punc14

@thebestjoan If you empower patients they will stick to their decisions and recover quicker. A win win as you said #nurchat

However, there were some concerns raised that if communication with the patient is lacking, the individual could feel as they though they are being rushed out of hospital before they have sufficiently recovered. For some elderly patients in particular, they may have no one at home to go to, so without the knowledge of their support options, going home soon after surgery may not feel like a benefit.

@puncjean there is actually no place like home but for some elderly patients they have no one at home to go back too #NurChat

Starting the discharge planning process during admission is crucial for a smooth and continuous patient experience. It can help manage expectations about the patient’s length of stay in hospital as well as reinforce the role of the patient in their recovery. This includes nutrition planning, and food-to-go bags that contain essentials such as milk and bread, have been pioneered by two trusts in England to help with the initial return-home period.

@hospitalcaterer #Nurchat I am working with some trusts on take home packs of essentials ie milk, bread are these of real value?

The benefits to nursing and healthcare staff of adopting this programme are a reduced workload per patient, reduction in failed discharges and a more predictable bed availability. However, this can only be achieved if the community support is in place and works effectively managing the needs of the patient.

@rararougemakeup I think it's the future due to the reduction in beds and the shift to community, need more community rns to facilitate it #nurchat

@JuneinHE Will never happen while we have ‘community nurses’ and ‘hospital nurses’. Employment needs to cross boundaries. #nurchat

It has been well publicised that District Nurses are in decline, with the quoted reduction from 12,000 in 2003 to 7,500 in 2014. A reduced nursing workforce in the community is undoubtedly going to impact how effective programmes such as the Enhanced Recovery Programme can be. The tangible benefits on offer illustrate just how essential community nurses are and the multiple impacts they can have on both colleagues and patients to positively impact patient care.

Join us again on #NurChat on 14th April at 8pm UK time when we’ll be discussing Acute Kidney Injury.