Download 14-15 Care homes LCS completed good practice

Examples of Completed Templates from 2014/15 for the Care
Homes Locally Commissioned Service (LCS)
This document is intended to assist GPs in the completion of the quality templates
required for the delivery of the Care Homes LCS.
They are all actual (anonymised) reports submitted in 2014/15 that are felt to
represent an appropriate level of information and detail that can be used as a guide
for GPs completing the reports in 2015/16
We hope that you will find these useful but if you require any further information,
please contact [email protected] or [email protected]
LCS for Care Homes – Template for Emergency Admissions report
Please do not include any information e.g. name, NHS number, name of
relative, which could identify the patient
Name of Care home
Age of Patient
75
M/F
Time and Date of Admission / A&E attendance / ECP visit
Time
08:00 – 18:00
18:00 – 02:00
Decision made by:
GP
Out of hours GP
x
Female
02:00 – 08;00
ECP
x
Other
Reason/problem
Bleeding from pre-tibial haematoma
1
What was the reason for
attendance?
Bleeding from pre-tibial haematoma
2
What was your diagnosis?
Haematoma previously diagnosed by GP, however had
significantly enlarged and then started to haemorrhage.
3
What was the A&E / ECP
diagnosis?
Pre-tibial haematoma
4
What was the A&E / ECP
outcome?
To admit to hospital under the care of plastic surgeons.
Continued overleaf
5
Was this appropriate?
Yes
6
If NO, why not?
7
How to avoid future
admission/attendance?
Unavoidable – see below.
8
Does this event necessitate
changes to care/crisis Plan(s)?
Yes – to care plan. Amended to reflect recent skin graft and
that is under the care of tissue viability and plastic surgery
teams.
10
Any other comments
Patient has multiple complex medical conditions.
Was on Dalteparin for recent DVT/PE. Anticoagulation
essential to prevent possible life threatening recurrence of
PE. Also on prednisolone for bullous pemphigoid so prone to
easy bruising. Was known to have poor mobility and had had
physiotherapy input. Haematoma occurred after minor
trauma and subsequently led to very significant bleeding
requiring blood transfusion and skin grafting. Both injury and
subsequent admission were both unavoidable given her
complex needs.
Completed by
(GP name)
Signature
Date
LCS for Care Homes – Template for Peer Review of Care Plans report
A MEETING BETWEEN TWO GPs ABOUT CHALLENGES AND BEST PRACTICE
ARISING IN THEIR CARE HOMES WORK: USEFUL LEARNING POINTS 17.2.15
Name of Care Home
(S99): Nursing Home and (S99) Residential Home
Name of Surgery
Name of GP who completed
care plan
Meeting Age of
minutes Patient
attached
Y / N?
below
85
Patient
Gender
M/F
Care Plan 1 Dr ?????? ???????????
Date
Date of
completed peer
review
meeting
2015
17.2.15
Care Plan 2 Dr ?????? ???????????
2015
17.2.15
‘’
90
M
Care Plan 3 Dr ?????? ???????????
2015
17.2.15
‘’
80
F
F
Actions
Care Actions Identified
Plan
1
Actions Identified:
2

Falls are the most likely reason for staff calling out the Paramedics and admissions

Care Homes have a rule that they must call paramedics if a fall results in a bang to the
head, and GPs cannot influence that practice

GP actions: remember to activate the Falls Pathway if this has not already been done
and the easiest route is via the Community Physio which is an excellent homebased
service

GP to watch low BPs and advise staff to encourage adequate fluid intake of residents

GPs / Nurses remember to do sitting and standing BP measurements and avoid
doxazosin (Consultant Geriatrician advice)

Ensure staff are placing their staff appropriately so that closer care in mobility can be
given to the more vulnerable patients
Actions Identified:
3

More patients are being admitted to care homes with multimorbidity and complex
drug regimens

Staff need to obtain medication lists as the patient is admitted, in order to inform the
GP and allow an early medication review as the GP needs to see the most ill patients
first, often before the notes have become available

GP to consider baseline blood tests early on. Check especially for potentially
dangerous drugs like methotrexate, warfarin, spironolactone

Check allergies: have a list of all Residents’ allergies displayed on the wall in the staff
office at the Home, and also a list in the GP’s patient folder

Involve the Practice Pharmacist in 6 monthly reviews of medications either at the
Home or with the GP at the Practice computer

At a visit, write up the visiting sheet and ensure that medications given during the visit
are entered into the Practice system once back there.
Actions Identified:

The End of Life Pathway – staff learn to spot the patients as they slip into the EOL path
and alert the GP and Nurses early on, and involve the families

Staff need to have appropriate training in the setting up and use of the syringe driver
and pink card; if no staff are of Nursing grade then Community Nurses will be involved

GP to write up anticipatory meds early in the time frame because it may take a few
days for the community pharmacist to obtain them

GP to write a Palliative Care note electronically for use of OOH services

IHNS Intensive Home Nursing Service can still be called upon in a Care Home setting

Ensure all DNACPRs are current and original and in the patient folder in the Care
Home.
Any other comments:

We are GPs from different Surgeries, one looking after a Nursing Home and one a Residential
Home. It was a very useful meeting for us allowing us to share areas of good practice and
what works well

We come across similar problems and have approached them in different ways, enlightening
both of us.

Benefits of the LES are that we get a good relationship with the staff there and the patients,
and knowing the patients well helps us to assess them and is likely to be a factor in hospital
admission prevention.
17.2.15.
Template for EOLC – Please complete a template for the first three deaths which occur in the Care
Home in the period September2014 to March 2015, ideally after discussion with care home staff. .
(It is appreciated that there may be less than three deaths during this period)
One Chance to get it Right was published in June 2014 to give guidance to replace the Liverpool Care
Pathway, and a summary is given on page 2. It is appreciated that practices may not always reach
the 5 priorities, but the template seeks to enable practices to identify how far they are reaching the
standards.
1.
a. At what point was the dying
person and their family/carers told
that the person was dying?
b. What decision were made and
how far did this reflect the person’s
wishes
c. How frequently was the person’s
condition reviewed?
1a) Patient was fully aware of her worsening medical
condition over the preceding year. She became severely
unwell with pneumonia 6 days before she died.
b) She declined hospital admission, preferring to have
treatment in the community even if it meant that her
chances of survival were less. This decision was also
discussed with her daughter who agreed as it was
consistent with her previously expressed wishes. The
patient’s daughter was informed 2 days before she died
that that her condition had continued to decline and she
would die. At this stage it was not possible to inform the
patient as she was too drowsy.
c) Her condition was reviewed by a GP 3 times in 6 days.
The GP discussed the differing options for treatment in
the community and in hospital to ensure both the patient
and her daughter were fully informed. The GP also
discussed treatment for symptom control with her
daughter in case of further deterioration.
2.
What communication took place
with the dying person and their
family? What role did the GP have
in this?
3.
How far was the person and their
family/carers involved in decisions
about treatment and care?
They were both fully involved
4.
What occurred to find out the
needs of the dying person’s
family/carers and how far were
these needs met?
There was discussion with the Residential Home Manager
to establish whether they needed additional nursing
support. These needs were fully met by the district
nurses and intensive home nursing team.
5.
Was an individual plan of care
developed which included food
and drink, symptom control,
psychological, social and spiritual
support?
Yes
6
Was a DNACPR form in place, and
what was the review date?
Yes
7
Had a special note been completed
and sent to OOH ?
Yes
If yes, please attach (anonymised)
7.
Which staff, in addition to the GP
and the care home staff, were
involved in the person’s care?
District Nursing Team
Intensive Home Nursing Team
One Chance to get it Right – Leadership Alliance for the Care of Dying People 2014
The new document sets out the approach which should be used in future in caring for dying
people by health and care organisations and staff caring for dying people in England The
approach should be applied irrespective of the place in which someone is dying and focuses
on achieving five Priorities for care when it is thought that a person may die within the next
few days or hours.
1. This possibility is recognised and communicated clearly, decisions made and actions
taken in accordance with the person’s needs and wishes, and these are regularly reviewed
and decisions revised accordingly.
2. Sensitive communication takes place between staff and the dying person, and those
identified as important to them.
3. The dying person, and those identified as important to them, are involved in decisions
about treatment and care to the extent that the dying person wants.
4. The needs of families and others identified as important to the dying person are actively
explored, respected and met as far as possible.
5. An individual plan of care, which includes food and drink, symptom control and
psychological, social and spiritual support, is agreed, co-ordinated and delivered with
compassion.
The document also states that care should be






compassionate;
based on and tailored to the needs, wishes and preferences of the dying person,
and, as appropriate, their family and those identified as important to them;
includes regular and effective communication between the dying person and their
family and health and care staff and between health and care staff themselves;
involves assessment of the person’s condition whenever that condition changes and
timely and appropriate responses to those changes;
is led by a senior responsible doctor and a lead responsible nurse, who can access
support from specialist palliative care services when needed; and
is delivered by doctors, nurses, carers and others who have high professional
standards and the skills, knowledge and experience needed to care for dying people
and their families properly.