COTE intro Flashcards
What are some issues/health concerns that can present uniquely in the elderly population?
Comorbidities
Polypharmacy
vague presentations ‘generally unwell’
Historys - dementia, hearing/sight impairment
Examining/consenting - confused, poor function status - is this ethical
Large MDT input and holistic care needs e.g discharge decisions
What members of the MDT tend to be involved in COTE?
Medical team
Nursing and healthcare Team
Physiotherapists
Discharge Team
Occupational therapists
Pharmacy team
Speech and Language Therapsits
Dieticians
What is the role of the Medical team on COTE?
Consultant geriatrician -> lead MDT and care decision
Create plans, lead ward rounds, run clinics, may have a specialist area
Junior doctors - F1/2, IMTs, SpR, trust grades - assist or lead ward rounds, job lists.
What is the role of the nursing and healthcare team in COTE?
Ward sister/nurse in charge - lead MDT and coordinate nursing/healthcare team
Staff nurse -> patient care - admisnter medications, flag concerns, assist with personal care
Healthcare assistants -> support nursing staff with day to day tasks.
What is the role of the physical therapist in COTE?
Aim to assess and improve mobility and functional status
Help return to baseline function
Work closely with OTs to recommend equipment/support that patients may need in/out of hospital
Chest physio -. resp support
Neuro rehab - stroke mobility
What is the role of occupational therapists in COTE?
Work with patients and families to assess for and organise support for discharge/home.
Organise equipment to assist with mobility.comfort such as hospital beds or hand rails
Can visit patient homes to assess and help make recommendations
More holistic approach considering social needs.
What is the role of the pharmacy team in COTE?
Pharmacists - can prescribe or adjust existing prescriptions, very helpful for med advice.
Pharmacy technicians - assist pharmacist
Optimise meds in and out of hospital - medication reconciliations, prevent interactionns/side effects, discuss different formulation and what is available in the hospital.
What is the role of speech and language therapists in COTE?
Help with rehab for speech and swallow often after a stroke
Recommend safe ways or providing nutrition (IDDSI framework)
Organise or recommend investigations for speech/swallowing difficulties e.g video fluoroscopy
Work closely with dieticians
What is the IDDSI (international dysphagia diets standardisation initiative)?
Continuum of 8 levels (0-7) describing the maximum safe swallow level of patients from fluids (0-4) to foods (3-7). Common terminology for food textures and drink thickness.
What is the role of the dietician in COTE?
Help provide good nutrition to patients both in hospital and after discharge
Make recommendations regarding nutritional supplements
Discuss safe ways of giving nutrition e,g nG tubes or TPN
Work closely with SaLT
What is the role of a discharge team in COTE?
Work with patients - faciliaite safe discharge once medically optimsed
Discuss safety place of discharge depending on functions status and support needs
Can help facilitate ‘fast track’ discharge or hospice care for end of life patients.
What is the acute care setting in COTE?
Hospital
What are the different intermediate care settings in COTE?
- Home-based rehab - well for home with extra support e,g physio, may require referral for long term care
- Residential Rehab - intensive rehab or support, temporary community based, may need long term care referal
- Rapid response teams - hospital teams respond to GP and community nurse referrals quickly
- Hospital at home - well for discharge but requires continuing treatment at home e.g bloods or antibiotics
What are the different settings for long term care for COTE patients?
- Carers at home - well but needs help with AoDL, up to 4daily, meals, personal care etc
- Care or Nursing Home - not safely independent, help with AoDLs, may have specialist need e.g dementia homes
- Assisted Living - independent but help is easily accessible, staffed location
- Hospice - end of life, community support, tailored to patient, not only patients who are actively dying.
What are some common challenges seen when trying to discharge a COTE patient?
- Patient/Family/Medical team disagreements about what is right
- Patients struggle to engage with therapy or discussions
- Shortages in community beds or resources can delay discharge - prolonged risks as remain in hospital
- Expensive and emotional exhausting - care homes, social workers
