Policy for the Discharge and transfer of children and young people ...

Appendix 5. Self Discharge PathwayIf a parent chooses to take the discharge of their child against medical advice, staff shoulddiscuss this with the parents, establishing their reasons and explaining the risks this could haveon their child’s health.All discussion should be clearly documented in the child’s health record.If the parent still requests discharge, the appropriate doctor must be contacted immediately inorder to review the child and further inform and explain any associated risks to the parent.If these interventions fail to deter the parent, the impact on the child’s welfare must be assessedby nursing and medical staff, and safeguarding procedures should be followed if leaving thehospital would place the child at significant risk of harm.Safeguarding procedures should also be followed if the child is subject to a protection plan or isa child in Care.If the child is removed against medical advice, and there are significant safeguarding concerns,the Trust security department should be contacted to assist, and an immediate referral toChildren’s Social Care must be made.Staff should not place themselves at risk in trying to prevent the parent leaving with the child.If there are no safeguarding concerns, and the child will not be at significant risk of harmfollowing discharge, the parent should be asked to sign a ‘Discharge Against Medical Advice’form.If the parent refuses to sign, this must be fully documented in the child’s health record.The parent should be advised to contact their G.P. practice for ongoing care.If possible normal discharge procedures should be followed with regard to giving advice,arranging for medication etc.Whenever clinically indicated, appropriate outpatient follow-up arrangements should still beoffered/made when a child/parent discharges against medical adviceA young person assessed as having capacity to understand the consequences of taking theirown discharge against medical advice may wish to take their own discharge. In this case staffshould try to dissuade the patient from doing so.If this is unsuccessful the young person’s parents must be notified and the patient should beasked to sign a ‘Discharge Against Medical Advice’ form. They should be advised that otherrelevant professionals (e.g. G.P., Social Worker, School Nurse) will be informed of theirdecision.Without exception, the child’s GP and Health Visitor/School Nurse and any other keyprofessionals involved in the child’s care must be informed at the earliest opportunity, preferablywithin 24 hours, that the child has left/been removed from the ward.If a parent expresses that they wish to discharge their child due to a complaint or concern aboutcare, every effort must be made to address and resolve the complaint/concern with reference tothe Trust Complaints’ Policy, to enable care to continuePolicy for the discharge and transfer of children and young people from child healthPage 22 of 38