| Responsible Team Member |
Discharge Task |
| Medical Team |
- Ensure:
- Appropriate plan is in place for management of other comorbidities.
- Medications and refills are prescribed to provide adequate supply until subspecialist follow-up visits.
- Discharge feeding and medication regimen is feasible in a home setting (allows for appropriate infant monitoring and adequate rest for caregivers).
|
| Medical Team, CTA |
- Schedule PCP visit prior to discharge.
- Schedule visit with Pulmonary BPD team or outside pulmonologist as applicable.
- Schedule or submit Complex Scheduling Service request for other
subspecialty appointments.
|
- Medical Team, RD,
- SLP, and/or CTA
|
- Determine who will manage tube feedings and oral feeding
advancement outpatient.
- In general, PCPs will not provide long-term management of enteral tube feedings. However, inpatient medical team should provide warm handoff to PCP regarding details of feeding and nutrition plan.
- Feeding and Swallowing Outpatient Clinic follow-up (Feeding Team, made up of MD/RD/SLP/OT) is appropriate for most infants going home with a combination of oral and tube feedings.
- If Feeding and Swallowing Outpatient Clinic follow-up cannot be scheduled in the desired time frame, consider interim referral to Complex Enteral Nutrition Clinic (MD/RD) and Speech.
- If infants have significant GI issues, such as requiring medications for GERD or constipation, GI may manage tube feeds, but infant will still need Speech follow-up for oral feeding advancement.
- For infants who will not receive subspecialty care at CHOP, ensure follow-up for nutrition, enteral feed ordering provider, and feeding therapy as appropriate.
|
| Medical Team, CM |
- If the infant will be discharged receiving supplemental oxygen, ensure they have necessary supplies: pulse oximeter, oxygen tanks, nasal cannulas, adhesives to hold a nasal cannula in place, and pulse oximeter probes.
- Pulse oximeter parameters should include a SpO2 low of 90%. If the infant has pulmonary hypertension, discuss this parameter with the pulmonary hypertension team. HR range per primary team.
- The pulse oximeter should be used at all times for infants ≤ 6 mos of age. For infants > 6 mos of age, the pulse oximeter should be used continuously while asleep or unattended and spot checked while awake and attended to unless the clinical team decides otherwise.
|
| CM |
Ensure receipt of all necessary equipment. |
| Nurse |
Ensure caregiver training is complete, including independent care stay
if appropriate. |