Laelya Miguel

• To work closely with ward teams as a trusted assessor with nurse background to agree comprehensive discharge plans for patients, perform assessments for discharge and to coordinate an effective, smooth and timely discharge into community settings.
• Responsible for the caseload of patients on my designated ward(s) and I work closely with Discharge Navigators who I line manage.
• Responsible for identifying complex discharges that Discharge Navigators will need support with (e.g., difficult conversations with patients/families, coordinating with community/system/out of borough partners).
• Identify cases that require escalating to Senior Discharge Facilitators for additional support.
• Daily facilitate group huddle with the Senior Discharge Facilitator and Discharge Navigators to discuss potential and definite discharges from the wards, and to discuss complex cases to ensure safe and timely discharge from the hospital

As the Discharge Facilitator with nurse background, I established professional relationship with members of the MDT and facilitate development of discharge planning. Each wards have their allocated Band 4 Discharge Navigators who I am responsible for. They provide assistance to the wards and other MDT with discharge planning and assist with completing relevant paperwork for patients' discharge and transfer of patients with complex needs. As a Band 6 Discharge facilitator, I become the named case manager for complex discharges and liaise with patients/family and health and social care colleagues in coordinating the discharge process. Daily, I attend the surgical bed huddle where we discuss concerns or potential blocks of patients' safe discharge and escalate to complex team lead as needed. I am also responsible to provide accurate updates to the clinical site team on planned discharge. It is also my responsibility to ensure completion of relevant paperwork from wards, and to screen documents prior to submitting them to external health and social care partners. I am responsible for the ward discharge navigators, and to take lead of the team in the absence of the Senior Discharge Facilitator.

I started in the Haematology/Cardiology ward in CUH where I looked after patients with Cardiac problems and Sickle-Cell patients. As a staff nurse in Croydon University Hospital, I am responsible with making sure the patient gets the appropriate care he needs by collaborating with the MDT. This includes monitoring patient's health and recording vital signs, including daily ECG's for Cardiac patients, and treating and monitoring pain for sickle cell patients. I communicate with the medical team if patient's health change. I also have to ensure NOK has been updated about the patient's care plan. I have to ensure prescribed medications are given on time and educate patients about managing their illnesses. As a nurse, I also provide support to patients and families. I also communicate with different teams to ensure discharge planning runs smoothly. I make sure appropriate care plans are in place for the patients.

During the Covid19 Pandemic, my ward was transformed into a Covid ward for ITU stepdown. During this period, I look after Respiratory patients who needed respiratory support like patients on Non-Invasive Ventilators, High flow Oxygen therapy, or Tracheostomy.

• As one of the senior Band 5 nurses, I facilitated smooth patient transitions from intensive care units to general wards, ensure proper handover is received so patient can be looked after as per care plan.
• Monitor patient's wellbeing, accurately recognising deterioration and initiating immediate emergency care.
• Maintain accurate documentation of patient records ensuring legal compliance and aiding in efficient handovers at shift changeover periods.
• Support patients with critical conditions and handle emergency situations adeptly. Educate patients and their next of kin about their conditions to increase understanding and compliance with treatment plans.
• Offer compassionate end-of-life care for terminally ill patients whilst respecting their dignity at all times.
• Provide emotional support for patients and their families during difficult times.
• Ensure infection control measures were inplemented to reduce the spread of Covid in the hospital and reducing incidents of cross-contamination in the ward.
• Administered prescribed medications accurately, minimising potential errors or adverse reactions.

• Improve resident's comfort by providing expert bedside care, especially for those who are on End-of-Life.
• Administer medication for pain management and symptom control.
• Provide compassionate emotional support to residents, easing their anxiety. Establish rapport with both resident and family.
• Manage wound dressings, promoting healing and preventing infection, refer and liaise with Tissue viability nurse when needed.
• To be always updated with moving and handling to safely operate hoists, stand aids, wheelchairs and transfer equipment to securely manoeuvre residents.
• Ensure hazardous waste are disposed of properly to prevent infection.
• To catch symptoms early and to liaise with GP to effectively diagnose and treat patients.
• Handle patients' hygiene needs in support of personal dignity and optimum wellness.

I worked as a charge nurse in the nursing home where I have 35 residents under our care. I do the allocations per shift based on the strengths of the team and the needs of the residents. My main responsibility is to ensure that the residents get their medications on time and they are given as prescribed. I also have to ensure they are getting adequate nutrition and hydration, and refer them to appropriate teams if these are not met (SLT, Dietician,GP). Every month we update care plans. I also deal with dressings and TVN referrals. Once a month, I audit medications and re-order them from the chemist. I also ensure repeat prescriptions from the GP are requested on time. I communicate with families and make sure that Advanced care plans are in place especially for those nearing end of life. Care plans are also regularly updated so looking after the resident will always be based on their care plans. In the nursing home, I make sure that our residents always feel safe and dignified until their last breath. When I admit new residents from hospitals, I have to register them to our GP. I do skin inspection and do it regularly to prevent pressure sores. I also make sure resident has prescribed medications available and that care plan is in place. If needed, I contact the hospital if there are any queries about patient's management. If referrals have been made from the hospital, then I follow up to ensure everything is in place. I always involve the family with the care that the team provide.