Transcript Safe discharge from hospital?

Palliative care education for nursing homes – 4th July 2008
Safe discharge from hospital?
Dr Gudrun Seebass,
Consultant in Care of the Elderly
Huddersfield Royal Infirmary
Should I be here?
Gold Standards Framework aims for
fewer crisis / admissions to hospital
This presentation covers:
•
Transfer situations and
handover arrangements
•
What we do with the
resident in hospital – could
this be done in the care
home?
•
Communication,
communication,
communication
Who gets discharged to a nursing home?
• Move to care home
because of serious
illness
• Return after acute
illness
• Deterioration of
chronic illness
Move to care home because of serious illness
• Active terminal illness
(advanced cancer, dementia unable to eat / drink):
Palliative care handover form,
anticipatory drugs
• Stroke with severe disability
• Frail person with hip fracture
Jane was admitted to HRI due to a chest
infection and was unresponsive. She is now
responsive. Jane has required suctioning while
in hospital.
Jane is to be treated as palliative care.
Jane has a suprapubic catheter in situ. She has
2 syringe drivers, one containing Morphine
10mg and Midazolam 10mg. The other
contains hyoscine butylbromide. She requires
humidified oxygen 40%.
Jane requires pressure area care. She has a
grade one sore on her sacrum. She is nursed on
a nimbus 3 mattress and profiling bed.
Jane is NBM all medications are given via PEG
tube.
If there is anything else you need to know
please contact ward 4 on 347153
Return after acute illness
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Pneumonia
Sepsis
Hip fracture
‘D&V’
Heart attack
…
Change in function?
New need for care / equipment?
Deterioration of chronic illness
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Dementia with difficult behaviour
Did they
Dementia with severe dependence
need the hospital?
Multiple sclerosis
Motor neurone disease
Heart or lung disease with severe dependence / disabling
breathlessness
Is there anything reversible?
Resident’s and carer’s
wishes and expectations
Mental health liaison service for Care Homes: 01924 816 209
Acute Confusion (delirium)
• Disturbance of consciousness
with drifting attention
• A change in cognition (memory, orientation, language,
perception)
• Develops rapidly (hours – days) and the resident is
variable
• Evidence of a physical cause
Acute Confusion - assessment
M:
I:
N:
D:
Metabolic problems (high or low blood
sugar, dehydration, low oxygen levels)
Infection (chesty, offensive urine,
infected skin ulcer)
Nervous system disorder (fit / seizure,
stroke)
Drugs (newly started or recently
stopped): Sleeping pills, antidepressants,
Parkinson’s treatment, Water tablets…
…and look for pain and constipation
Fall
• Injury?
• Back to normal?
• Why did it happen?
A:
B:
C:
D:
E:
F:
Arthritis and aids
Blood pressure
Confusion
Drugs
Environment and
eye sight
Foot wear
Collapse / loss of consciousness
PLEASE tell us what
you saw:
• Change in colour
• Breathing pattern
• Jerking / abnormal
movement
• Was the person upright
• How long did it take
to ‘come round’?
• Postural hypotension /
low blood pressure
• Arrhythmia / irregular
heart beat
• Epilepsy / fit
• Low blood sugar
• Not TIA
Co-ordination
Communication
Care of the dying
pathway
Gold
Standards
Framework
Control
of symptoms
Continuity of care
Carer support
Continued
learning
Hope we both had a peep over the wall…
Thank you for listening
Any questions?