• Only consultant or middle grade decide readiness for discharge

• Medical and nursing staff to agree discharge date with parents or persons with parental responsibility

• Nursing team/allocated discharge planner perform majority of discharge requirements

   

   

Where appropriate, the following must be achieved before discharge:

Parental competencies

• Administration of any medications when required  
  • give parents information on how to get repeat prescriptions and expected duration of medications/prescription formula
• Baby care (e.g. nappy changes, top and tailing, bathing etc.)
• Feeding (including how to make up formula if appropriate)
• Nasogastric tube feeding where necessary
• Stoma care 
• Home oxygen where necessary

Parental education

• In addition to above, it is best practice to offer parents education on:
  
  • basic neonatal resuscitation (practical demonstration or leaflet/DVD etc.)
  • common infectious illnesses (see https://www.bliss.org.uk/parents/about-your-baby/common-infectious-illnesses)
  • immunisations, if not already received (give national leaflet)
  • safer sleeping

Parental communication

• Check home and discharge addresses and confirm name of GP with parents 
• Complete Red Book (include immunisations given and dates) and give to parents
• Give parents copy of discharge summary and time to ask questions after they have read it
• Follow local policy for breast pump loan and/or return
• Ensure parents have information regarding local breastfeeding groups for ongoing support, and BLISS support group meeting
• Ensure parents have up-to-date safety information
• If transporting in a car, use suitable car seat
• If transferring to another unit, ensure parents understand reason for transfer. Provide information about receiving unit
• Ensure remaining mother’s breast milk in hospital fridge/freezer given to take home

Parental information

Local unit discharge pack

Procedures/investigations

• Newborn bloodspot (see Bloodspot screening guideline)
  
  • for babies <32 weeks’ gestation, repeat on day 28 or day of discharge if sooner 
• When immunisation (2, 3 and 4 month) not complete in preterm babies, inform GP and health visitor 
• Give (or arrange) BCG immunisation if required (see BCG immunisation guideline) and/or Hepatitis B (see Hepatitis B and C guideline)
• Complete audiology screening (see Hearing screening guideline)
• Where required, confirm ophthalmology appointment date [see Retinopathy of prematurity (ROP) screening guideline]
• If going home on oxygen, follow Oxygen on discharge guideline
• Cranial ultrasound scans completed before discharge or plan in place for outpatient appointment scan
• Arrange outpatient hip ultrasound scan, if indicated

Professional communication

• Complete admission book entries

• Inform:

  • health visitor of discharge

  • community midwife if baby aged <10 days 

  • if safeguarding concerns and baby aged <28 days, notify community midwife and social worker
    GP

  • community neonatal or paediatric team as required locally

Multidisciplinary (MDT) review/discharge planning meeting

• Babies with safeguarding concerns (to formulate child protection plan)

• Babies with complex needs (e.g. home oxygen therapy or nasogastric tube feeding)

• Babies with antenatal palliative care plans require MDT (obstetrics, neonatal and community paediatrics/palliative care) meeting/discharge planning before and soon after delivery considering parental wishes towards palliative care following birth

• Other babies as appropriate

Medical team

• Complete discharge summary by date of discharge
• Complete BadgerNet dataset by date of discharge (complete ‘final neonatal outcome’) 
• Answer parents’ questions after they have read discharge summary
• Ensure all follow-up appointments made (see Follow-up)
• Perform and record discharge examination

Appointments

• Parents to have single point of contact following discharge
• Ensure appointments are written on discharge summary and in Red Book. Likely appointments could include:
  
  • neonatal/paediatric consultant outpatient clinic
  • ophthalmology screening
  • audiology referral
  • cranial ultrasound
  • MRI scan
  • physiotherapy
  • hip or renal ultrasound
  • dietitian
  • community paediatrician
  • child development centre
  • palivizumab
  • planned future admission (e.g. for immunisations)
  • planned future review for blood taking, wound review
  • tertiary consultant outpatients
• Open access to children’s wards where available and appropriate
• See also Follow-up of babies discharged from the neonatal unit guideline