BURAIDAH CENTRAL HOSPITAL

Department : NURSING SERVICE Policy Number: PP-BCH-NR/GNR-017-APP-E Title: DISCHARGING OF NEW BORN Applies to: All Nursing Staff New

B. C. H.

APP

Replace Number : XXXXX

Effective Date : 01-01-1432 H

Number of Pages: 3 Review Due : 01-12-1433 H

1. PURPOSE: 1.1 To ensure newborn infants are safely discharged.

2. DEFINITION: 2.1 Means the release of the new born from care and custody of a licensed health facility to the parents or into the community. 3. POLICY: 3.1 Before discharging the baby,they should meet basic criteria and have appropriate arrange ment for ongoing care. 3.2 The baby should be healthy in the clinical judgment of the physician and the mother should have demonstrated a reasonable ability to care for the child.

4. PROCEDURES: 4.1 Discharge Criteria : 4.1.1 Full-term infant ( 37- 42 weeks ) with size appropriate for gestational age. 4.1.2. Normal cardio - respiratory adaptation to extra uterine life. 4.1.3 No evidence of sepsis. 4.1.4.Temperature stable in cot ( axillary temperature of 36.1oC to 37oC ). 4.1.5. No apparent feeding problems ( at least two successful feedings documented ). 4.1.6. Physical examination of the baby by physician or other qualified health professional within 12 hours prior to discharge indicates no need for additional observation and /or therapy in hospital. 4.1.7.Baby has urinated. 4.1.8.No bleeding at least 2 hours after the circumcision, if this procedure has been performed . 4.1.9. Receipt of necessary medications and immunization (e.g. hepatitis B). 4.1.10.Metabolic screen completed (at >24 hours of age) or satisfactory arrangements made.

Prepared by: Ghada Falah Al- Harby Staff Nurse

Approved by: Ahmed Abdulla Al-Omar Hospital Director

Page Number: 1/3

Approval Stamp

Form Index: BCH-QM-009-E

4.1.11.Mother is able to provide routine infant care (e.g., of the cord) and recognizes signs of illness and other infant problems. 4.1.12 Arrangements are made for the mother and baby to be evaluated within 48 hours of discharge. 4.1.13.Physician responsible for continuing care is identified with arrangements made for follow-up within 1 week of discharge. 4.1.14.Only infants delivered at term of appropriate birth weight, and found to be normal on examination should be considered for discharge at less than 24 hours. A Nursery stay of at least 12 hours should be required. 4.1.15 All infants need to be examined by a qualified practitioner. The findings of the exami nation should be forwarded to the practitioner of record at time of discharge. 4.1.16. The infant should be able to maintain thermal homeostasis. 4.1.17.The infant should be able to feed normally, and parents should have access to lac tation consultation. Education as to normal newborn well-being should be given and should include feeding, passing stool, voiding, sleep position, and signs of acute illness.The education would be best acquired prenatally prior to the added stresses of new parenthood. 4.1.18 All state required newborn screening tests should be obtained. 4.1.19 Maternal testing for syphilis and hepatitis surface antigen, and any interventions should be documented. 4.1.20 Initial hepatitis B vaccine should be administered. 4.1.21 Cord blood of all type O positive mothers should be saved so that the mother- baby studies could be done quickly as needed. 4.1.22 A primary care practitioner trained in the care of newborn needs to be identified prior to discharge. 4.1.23 Follow-up care directed by said practitioner must be obtained no later than 72 hours post discharge. Agreement to seek such care should be documented. 4.1.24 The correct usage of an approved infant care seat must be documented. 4.2. Consideration For the Newborn and Family: 4.2.1.Planning for discharge should begin at time of admission. An infant in normal health is discharged from the hospital at the same time as the mother. 4.2.2 Instructions for parents ( teaching should be continuous ) : 4.2.2.1 Feeding schedule. 4.2.2.2 Bathing routine. 4.2.2.3 Home care needs. 4.2.2.4. Umbilical cord stump care. 4.2.2.5. Infant safety in the car. 4.2.3 Prior to discharge, a follow-up appointment date should be arranged for the newborn ( local policy determines the date-two, four, or six weeks ). 4.2.4 A final identification check of the mother and the infant must be performed before the infant can be allowed to leave the hospital. 4.2.5 The following systems particularly should be noted on physical examination ( By the time of discharge, a physician should examine the newborn 2 to 3 times or more ): 4.2.5.1 4.2.5.2 4.2.5.3 4.2.5.4 4.2.5.5 Head shape and signs of trauma (caput, cephalohematoma). Dysmorphic features. Eyes (red reflex). Palate morphology, presence of natal teeth, and shortened frenulum. Clavicles ( crepitus suggestive of fracture ).

Policy Number: PP-BCH-NR/GNR-017-APP-E

Title: DISCHARGING OF NEW BORN

Page Number: 2/3

Approval Stamp

Form Index: BCH-QM-009-E

4.2.5.6 Cardiac system ( murmurs ). 4.2.5.7 Femoral pulses. 4.2.5.8 Abdominal area ( masses, distension.) 4.2.5.9 Hip ( signs of dislocation.) 4.2.5.10 Spine ( deformities ). 4.2.5.11 Foot deformities ( metatarsus adductus, clubfoot.) 4.2.5.12 Genitalia and Rectum. 4.2.5.13 Skin ( jaundice, rash, mottling, cyanosis, birthmarks ). 4.2.5.14 General muscle tone and symmetrical reflexes. 4.2.5.15 Well - coordinated suck and swallow reflex. 4.2.5.16 Ability to fix gaze and follow a human face.

5. FORMS AND EQUIPMENTS: 5.1 Discharge Plan Form. 5.2 Patient's Chart / File.

6. REFERENCES: 6.1 http://pediatrics.aappublications.org/content/125/2/405.full. 6.2 http://www.infanthearing.org/privacy/docs/Oklahoma%20reporting%20rules%20.pdf. 6.3 http://www.newcastlehospitals.org.uk/downloads/policies/nursing/paediatricdischarge 201102.pdf.

7. APPENDIX: 7.1 N/A.

8. APPROVAL :

Name Prepared by: Ghada Falah Al-Harby 1. Abdulla Obeid Al- Harby Reviewed by: 2.Fahad Al -Ammar 3. Ehab El Husseiny Ibrahim 4. Manae Al- Belaihy Approved by: Ahmad Abdulla Al-Omar

Position Staff Nurse Nursing Director Patient Affairs Administration QM Director Medical Director Hospital Director

Signature

Date
22-11-1431 H 24-11-1431 H 29-11-1431 H 29-11-1431 H 29-11-1431 H 01-12-1431 H

Policy Number: PP-BCH-NR/GNR-017- APP-E

Title: DISCHARGING OF NEW BORN

Page Number: 3/3

Approval Stamp

Form Index: BCH-QM-009-E

Policy Number: PP-BCH-NR/GNR-017-APP-E

Title: DISCHARGING OF NEW BORN

Page Number: 4/3

Approval Stamp

Form Index: BCH-QM-009-E