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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 • • • • • • Pneumonia Sepsis Hip fracture ‘D&V’ Heart attack … Change in function? New need for care / equipment? Deterioration of chronic illness • • • • • 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?
