1. If parents request to be discharged from Neonatal Unit, then decide based on babys condition if the baby is stable enough to stay at home. If the baby is not stable and needs intensive support, the baby cannot be discharged on request. Counsel the parents about babys condition so that they continue to receive care in the hospital. Address their concerns and make sure that the baby continues to receive care. However, if the parents have no grievance from hospital staff, and due to certain issues at home or with family they wish to leave then this will be LAMA (Leave against medical advice) not DOR.
2. In case of LAMA take a blank sheet of paper, write bio data of baby, working diagnosis, critical condition, and the statement (in urdu) that they are leaving on their own will against the medical advice and have no grievance from hospital staff. Get thumb impression of father with his name (or mother or guardian) on LAMA slip. Advise same medicine and fluids on it that you were giving to the baby. Now, write the same statement in patient chart (in urdu), that the parents have been counselled about critical condition but they wish to leave due to (this reason) against medical advice, and that they have no grievance from hospital staff. Get thumb impression with name of Guardian here too.
3. Every effort should be done that baby does not get LAMA.
4. In a considerably stable baby, you may issue a Discharge on Request (DOR). In this case a hospital discharge slip is issued. A statement of DOR (in urdu) will be written on discharge slip and thumb impression of parents will be taken, and the same urdu statement will be written on chart with the thumb impression and name of father/guardian.
It will be a proper discharge slip, if antibiotic days are to be completed (usually 7 or 10 days) then IV antibiotics will be advised. (Write correct dose and route and frequency, must mention infusion volume and time if drug is given as infusion). Mention if any labs are to be followed yet (mostly blood culture, CBC or CRP), or if any labs should be repeated on followup (mostly CBC AND CRP) or if screening Ultrasound scans are due or Echocardiography time has to be taken.
Mention follow-up after 1 day in SIMS Neonatology or any government hospital nearby if they are leaving for a distant city.
Mention Vitamin D drops 400 IU per day for 6 months
Vaccinations
Mother feeding
Do not forget to add antiepileptics if the baby is receiving IV form, switch to oral form and instruct+educate+evaluate attendents if they can administer antiepileptics at home.
And Hearing+visual+developmental screening from Children Hospital Lahore, Development OPD, in cases of perinatal asphyxia, kernicterus, intracranial haemorrhage, meningitis.
In preterm babies (selected population) retinopathy of prematurity (ROP) screening is also advised, (search ROP Screening in this website).
Narrate Red Flag Signs to parents and mention the same on DOR.
Ask staff on duty to complete all discharge formalities and attach copy of DOR slip in patients chart.
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