Audit on discharging patients from community specialist palliative care nursing services

Discharging patients from community specialist palliative care services is a contentious issue. Although some specialist nursing teams discharge patients at the earliest opportunity and are open to re-referral, others retain patients as "pending", i.e. patients do not receive regular contact or intervention but remain on the caseload until a need arises. This anomaly is not surprising given the lack of evidence of good practice in the discharge of patients who no longer have specialist needs. This article describes an audit by a community specialist palliative care nursing team of patients discharged from their caseloads over a 6-month period from January to June 2002. The aims of the audit were to compare the reasons for discharge given by the nurse specialists with existing discharge criteria and to provide data for guidelines for good practice in discharging patients. The rate of re-referral for the discharged cohort was also measured. There were 199 patient discharges in the audit period with 23 being re-referred within 6 months of discharge. The reasons for discharge were generally broader than the discharge criteria and the nurses frequently emphasized to the patient, the family and primary carers that re-referral was welcomed as needs arise. The need for multicentre discharge audits was also highlighted.