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t: 01978 316800   e: info@nightingalehouse.co.uk
t: 01978 316800  e: info@nightingalehouse.co.uk
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Professional referrals

Working together to support patients

Healthcare professionals play a vital role in ensuring patients receive the right support at the right time. At Nightingale House Hospice, we work alongside you to provide specialist palliative care for patients with life-limiting illnesses, as well as support for those close to them. We aim to make the referral process straightforward, responsive, and centred around the needs of your patient.

To support you, we’ve included some handy guidance below to help you determine when and how to refer.

Professional referral form
Guidance when completing the Nightingale House Hospice Referral Form
    • Provide all required patient and contact details.
    • Ensure the patient has given consent and is aware of the referral.
    • Accurately complete the Phase of Illness and AKPS score to the best of your professional knowledge.
    • Specify the main diagnosis, including enough detail to support triage.
    • Include any relevant past medical history.
    • Share any Advance Care Planning details, if available.
    • If you’ve discussed the patient’s preferred place of care or death, please include this information so we can aim to accommodate their wishes.

Please note:

If the form is incomplete, our admin team will return it and request the missing information. A clinical team member will only review the referral once all the required details for triage have been provided.

Urgent referrals: Please contact us directly by phone, 01978 316806, before submitting the form.

Who can be referred?

Healthcare professionals can refer any patients who are living with a diagnosis of a progressive and/or life-limiting illness, including cancer, MND, Parkinson’s PSP, MS and heart failure. Patients must live within Nightingale House Hospice’s catchment area which covers Wrexham, Flintshire, East Denbighshire, the A494 corridor to Barmouth, and the borders, including Oswestry, Ellesmere, Wem and Whitchurch.

Patients may be referred for:

  • Symptom control and pain management

  • Emotional and psychological support

  • Rehabilitation and wellbeing services

  • Advance care planning

  • Family and carer support

  • End of life care

If you are unsure whether a referral is appropriate, our team is happy to discuss this with you.

Our services

Patients can be referred for our wide variety of outpatient services, including:

  • Medical outpatient assessments
  • Wellbeing Programme
  • Rehabilitation
  • Complimentary Therapies
  • Occupational Therapy
  • Family Support

And / or our inpatient services, which include:

  • Respite
  • Symptom Management
  • End of Life Care

Care is tailored to individual needs and delivered by our multidisciplinary team.

What we can offer

Care and support could include:

  • Help with managing and living with symptoms
  • Advance Care Planning
  • Wellbeing support and Rehabilitation, including Fatigue, Anxiety and Breathlessness programme
  • Pre-bereavement, Bereavement and Spiritual support

Nightingale House Hospice also offers Pre-bereavement and Bereavement support to children and young people, under the age of 18, who have no connection to the hospice.

What we can’t offer
  • Long term inpatient care
What happens next?

After receiving your referral:

  1. Our clinical team will review the information provided

  2. We will assess eligibility and urgency

  3. The patient (and referrer where appropriate) will be contacted

  4. Support will be arranged based on clinical need

Professional Referral Form

N.B. Please provide as much detail as possible. If urgent advice is needed please contact 01978 316800 (Mon-Fri 9am-5pm) or 01978 316808 (Out of hours)

Consent

Has the patient provided informed consent for this referral?

Patient Details

Address
Current location of Patient
Please state in ‘Other’ if patient lives alone and enter other location below:

Details about Referral

Please indicate which Outpatient service(s) are required:
To access these services, patients will need to be able to attend onsite appointments.
Please indicate which Inpatient service is required (tick ONE):
For Inpatient Unit referrals, please tick all symptoms that apply
If this is an URGENT referral for admission, please call the numbers above once you have sent the form.
Does the patient have a known or suspected risk of infection?
What is the patient's mobility and functional ability?
Has the patient had a fall recently?
Does the patient have a signed DNACPR in place?
Does the patient wish to have escalation of care?
Where is the patient's preferred place of death?
Is the patient receiving active treatment?
Is the patient currently on oxygen?
How often is the oxygen needed?
Selected Value: 0
Please click HERE to refer to our guidance for definitions and support in completing Phase of Illness, prognosis and AKPS.
Does the patient have a package of care in place?
If the patient has a package of care and/or uses moving and handling equipment, please provide and up to date manual handling assessment.
Has it been explained to the patient and family that Nightingale House Hospice is NOT a long term facility and that once their condition has stabilised, discharge discussions will begin?
Or send an attachment below:
Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.
Does the patient have any allergies?

Confirmation Details

Clear Signature

Please call us and ask to speak to a member of our Patient Flow Team on 01978 316806 if you have any questions.

The Patient Flow Team are available between 9am and 4pm, Monday to Friday (excluding Bank Holidays).

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