The main goal of NLD is to identify clinically stable patients in the following categories who we expect will respond to standard therapy, and who can likely be discharged WITHOUT a medical staff re-review following treatment.
This is to help maintain patient flow through the EDSSU and safely get patients home without delays due to our other clinical demands, particularly after 5pm when there is no dedicated JMO in short stay.
Approved pathways for NLD:
The suitability of these patients for NLD must be discussed with the senior clinician on your shift, and their name documented in your notes.
When you determine a patient is safe for NLD pathway, you must ensure:
- The relevant NLD MO/NP checklist is completed (see below).
- Clearly document the medical plan in the clinical notes.
- Make sure you have charted medications / fluids / orders required for the treatment plan.
- Inform the patient of the NLD process and any medical discharge education information they may require!
It is crucial you set the expectation with the patient that they won’t see a doctor before they are discharged if all goes to plan.
You must undertake your discharge education including medication advice, follow up advice prior to them going to EDSSU.
- Complete the patient’s discharge letter on eMR prior to the patient’s anticipated discharge time, including any scripts they might need. These can be left in the patient’s file in EDSSU. Inform EDSSU nurses of any paperwork/scripts the patient needs at discharge.
Completing the NLD Medical Checklist:
NLD checklists need to be completed BEFORE the patient goes to the EDSSU – the icon can only be accessed from the All Patients/All Beds TSH page on FirstNet. Once you have selected your patient, click the YELLOW NLD icon along the top of your FirstNet screen and select the appropriate check list:
Ensure you have entered a diagnosis, and completed the whole checklist, making sure to save the completed checklist 
with the green tick in the left top corner:
There is a nursing checklist for each NLD pathway as well that ensures patients are safety netted and flagged for medical re-review if they haven’t progressed as expected. In this instance, the nursing staff will escalate the patient back to the treating MO or NP, or to the Senior MO on shift.
Please ensure that if your patient is still in the EDSSU at the end of your shift, that you hand them over to the relevant Senior MO on for the shift so that if the patient cannot be discharged home for any reason, the doctor knows about them.
Any questions, ideas or suggestions, or if you have any feedback on the process please contact kate.goulding by email or on the floor to discuss.