assessment, the MDT and discharge Flashcards
what things should be addressed in a medical history?
Current reason for admission
Falls history
Assessment of cognition – collateral history to ascertain if any change
Continence assessment
PMH and disease severity
Current medication list and compliance
Drug allergies
Social and functional history – this includes where they live
(home/Residential home/ Nursing home/Sheltered accommodation), how they are supported and by whom.
How they mobilise and with what aids. Who performs tasks such as cleaning and shopping etc? Do they have any adaptations or safety features within the home i.e. pendant alarm. Do they have any formalised care package?
Alcohol intake and smoking history
Further systemic enquiry
Enquire about wishes and advance decisions regarding care if appropriate – some people may not want investigations etc. or have advance directives or do not resuscitate orders.
what is the comprehensive geriatric assessment?
a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail older person in order to develop a coordinated and integrated plan for treatment and long-term follow-up
leads to better outcomes, reduced readmissions, reduced long term care and greater patient satisfaction
what do the domains of the comprehensive geriatric assessment include?
Problem list – current and past
medication review
Nutritional status
Mental health – cognition, mood and anxiety, fears
Functional capacity - basic activities of daily living , gait and balance, activity /exercise status, instrumental activities of daily living
Social circumstances - informal support available from family or friends,
social network such a visitors or daytime activities, eligibility for being
offered care resources
Environment - home environment, facilities and safety within the home
environment, transport facilities ,accessibility to local resources
what is important to consider when prescribing in older persons health?
- check allergies
- check patient details
- check DDI’s
- Ensure that the dose, frequency and times, and route of administration are clearly identified. Include a start date (and a review/end date if appropriate).
who may be involved in the MDT of a geriatric patient?
Medicine for the older person encompasses the health of the ageing adult, for which the outcomes have physical, psychological and social consequences.
Geriatricians work closely alongside Occupational Therapists, Physiotherapists, Speech and Language Therapists, Dieticians, Specialist Discharge nurses and primary care co-ordinators to ensure that the care needs of the person are met.
what is involved in the discharge of a patient?
Medication to take home (TTO’s).
Transport.
Therapy assessment – ongoing referral to community
Occupational Therapy
or Physiotherapy if required.
Equipment delivery or adaptations to home if
required
Restarting package of care. – If more complex or not in place a section 2 may
be involved to arrange
Outpatient/user’s appointment.
District nurse referral if required or palliative care or community lead referral if
warranted
Transfer back letter for residential/nursing home
why do discharges fail?
One or more elements of the criteria under any one title have failed e.g. obtaining a suitable package of care.
Patient/user health complications.
Communication breakdown between health care professionals and Social
Services.
Family decisions.
Decisions around funding.
what are the aims of discharge planning?
The main aims are to
1) reduce the person’s length of stay in hospital,
2) prevent an unplanned re-admission back into hospital
3) to improve the manner in which community services co-ordinate following a discharge.
what is a section 2?
a referral is made to Social Services to assess funding e.g a care home, or direct payments, or a package of care.
This is known as a Section 2.
A Social Worker is then allocated to the patient /service user and will be responsible for putting together an appropriate package of care.
what is a section 5?
after a section 2 is sent and a social worker is allocated to the patient, a Section 5 is then sent by nursing staff to Social Services, alerting them to the fact that the patient has been declared as ‘medically stable for discharge’.
Once the Section 5 is received, the designated social worker is expected to start taking decisive action towards discharge.
