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C. Year 3: Elderly Medicine > Discharge Planning and Transfer of Care > Flashcards

Discharge Planning and Transfer of Care Flashcards

1
Q

When does discharge planning begin?

1 - when they are admitted
2 - only when medically fit
3 - when carers ask for discharge
4 - all of the above

A

1 - when they are admitted

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2
Q

Patient discharge typically begins when a patient is admitted onto the elderly medicine ward. They are only discharged when they are medically fit. Which of the following are considered when deciding if a patient is fit for discharge?

1 - conscious level/cognition
2 - safe environment
3 - blood results/observations
4 - in-patient monitoring
5 - procedures
6 - nutrition/blood sugars
7 - all of the above

A

7 - all of the above

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3
Q

Do the majority of patients discharged from geriatric ward go home with or without formal support?

A
  • without support
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4
Q

Do patients always go home?

A
  • no
  • discharged based on the safest environment for them, and based on their needs
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5
Q

Patients who are still receiving IV medication are typically not discharged. Is this always the case?

A
  • no
  • there are care teams who can go out and administer medications
  • heart failure for example
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6
Q

Which of the following factors should be considered when planning for a complex patient?

1 - patient wishes
2 - patients interests if lacking capacity
3 - most appropriate location for patient to receive required care
4 - community services available in the area
5 - post-admission funding
6 - all of the above

A

6 - all of the above

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7
Q

Ideally where is the best location for patients to be discharged to?

1 - care home
2 - nursing home
3 - own home
4 - anywhere that can take them

A

3 - own home

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8
Q

What is the maximum level of care that can be offered by the hospital when patients are discharged?

1 - 1 person, 2 x day
2 - 2 person, 2 x day
3 - 1 person, 4 x day
4 - 2 person, 4 x day

A

4 - 2 person, 4 x day

  • 24h care is rarely available through social services
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9
Q

Where can patients be discharged to?

1 - Home
2 - Sheltered accommodation
3 - Care homes
4 - Nursing (patients needing more care)
5 - Residential
6 - In-patient rehabilitation
7 - Specialist rehabilitation
8 - Another trust
9 - Hospice
10 - In-patient palliative care in the acute trust (often appropriate)
11 - No fixed abode (normally consult social services for a hostel)
12 - all of the above

A

12 - all of the above

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10
Q

Which 2 of the following are able to go out and assess and provide help to patients at home?

1 - GP
2 - occupational therapy
3 - home based rehabilitation
4 - junior hospital doctors

A

2 - occupational therapy
- telecare, equipment needed for ADL and single floor living

3 - home based rehabilitation
- typically physiotherapists

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11
Q

What are virtual wards?

1 - doctors remain at home and speak to patients via mobile or tablet
2 - patients do not come into hospital and are managed at home
3 - medical teams who can go out to patients home and treat
4 - all of the above

A

3 - medical teams who can go out to patients home and treat
- administer IV medications
- monitor blood results
- heart failure is an example of this

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12
Q

When discharging a patient home, is the aim of care just to care for patients?

A
  • no
  • re-able patients
  • essentially help patients return to pre hospital admission
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13
Q

What is sheltered accommodation?

1 - care home with nurses
2 - accommodation without nurses, but cares are present
3 - modified accommodation for older patients with frailty
4 - 24h care for terminally ill patients

A

3 - modified accommodation for older patients with frailty
- typically warden assisted
- the same support can be provided that is comparable to care they can get at home

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14
Q

What is care accommodation?

1 - care home with nurses
2 - accommodation without nurses, but cares are present
3 - modified accommodation for older patients with frailty
4 - 24h care for terminally ill patients

A

2 - accommodation without nurses, but cares are present

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15
Q

What is a nursing home?

1 - care home with nurses
2 - accommodation without nurses, but cares are present
3 - modified accommodation for older patients with frailty
4 - 24h care for terminally ill patients

A

1 - care home with nurses
- patients are typically complex
- patients require significant help

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16
Q

What is in-patient rehabilitation?

1 - care home with nurses
2 - accommodation without nurses, but cares are present
3 - modified accommodation for older patients with frailty
4 - community hospital/care home designed to mobilise and rehabilitate patients in 6 weeks

A

4 - community hospital/care home designed to mobilise and rehabilitate patients in 6 weeks

  • other specialist rehabilitation centres are available such as neuro, cardiac or spinal rehab
17
Q

The are different sources of funding for patients when being discharged, depending on what level of care they need. All of the following are funded by the NHS, EXCEPT which one?

1 - occupational health
2 - intermediate care
3 - reablement
4 - specialist rehabilitation
5 - hospice

A

3 - reablement
- funded by social services

18
Q

Which of the following pay for care homes patients need to be sent to?

1 - NHS
2 - patient
3 - social services
4 - all of the above

A

4 - all of the above
- all depends on the patients financial situation

19
Q

What is the cut off based on finances, which determines if the patient has to pay or if the social services/NHS pays?

1 - <£15,000
2 - >£23,250
3 - <£30,000
4 - <46, 500

A

2 - >£23,250
- anything over this the patient has to pay

20
Q

There are 2 additional service offered called:

  • NHS continuing of care
  • NHS fast track care

Which of the following patients would be eligible for this?

1 - patients that require prompt discharge
2 - patients who require maximum package of care
3 - patients with short life expectancy and/or complex/severe unpredictable needs
4 - all of the above

A

3 - patients with short life expectancy and/or complex/severe unpredictable needs

  • these forms of care provide immediate care for patients
21
Q

When assessing what care a patient requires, the level of funding is assessed, which is:

  • <£23,500 = social services pay
  • > £23,500 = patient pays

If a patient is being sent home and requires a package of care does their home get included in the <£23,500 financial assessment?

A
  • no
  • the home is not counted in the savings
22
Q

When assessing what care a patient requires, the level of funding is assessed, which is:

  • <£23,500 = social services pay
  • > £23,500 = patient pays

If a patient is being sent to a care home or other new accommodation, will their home get included in the <£23,500 financial assessment?

A
  • yes
23
Q

To have capacity a patient must have how many of the following:

  • understand the information they have been given
  • retain information they have been given
  • weight up information given to make a decision
  • communicate their decision

1 - all 4
2 - >3
3 - >2
4 - 1

A

1 - all 4
- capacity is time and situation specific

24
Q

What is an advance decision to refuse treatment?

1 - a legal document giving a name individual power over their healthcare
2 - acting in the best interest of the patient, regardless of what they want
3 - decision make when patient had capacity to decline further treatment
4 - all of the above

A

3 - decision make when patient had capacity to decline further treatment

  • ONLY REFERS TO THE REFUSAL OF TREATMENT
25
Q

In an advance decision to refuse treatment, which 2 of the following are not covered under this?

1 - decision not to continue oxygen and the patient has capacity
2 - refuse care to make you comfortable, like keeping you warm, clean, safe, and giving you food and water by mouth
3 - decide not to have further medication to treat lung cancer
4 - request help to end your life

A

2 - refuse care to make you comfortable, like keeping you warm, clean, safe, and giving you food and water by mouth
4 - request help to end your life

26
Q

What is a lasting power of attorney (LPA)?

1 - a legal document giving a name individual power over their healthcare
2 - acting in the best interest of the patient, regardless of what they want
3 - decision make when patient had capacity to decline further treatment
4 - all of the above

A

1 - a legal document giving a name individual power over their healthcare
- used when a patient does not have capacity, BUT if patient has capacity then it supersedes the LPA

There are 2 types of LPA:
- health and welfare
- financial and property

27
Q

Does a do not attempt resuscitation (DNAR) cover all aspects of resuscitation?

A
  • no
  • refers to CPR only
  • DNAR also referred to as DNACPR
28
Q

In a do not attempt resuscitation (DNAR), also referred to as DNACPR, is the decision only for the patient to make?

A
  • no
  • the doctor can advise on if CPR is medically suitable
  • CPR may be futile and not appropriate to undertake and can often get 2nd opinion
  • patients with a rockwood score of 6-9, only 1.8% survived CPR
29
Q

There are a number of different advanced care plans. Which of the following is NOT one of these?

1 - ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)
2 - TEP (treatment escalation plan)
3 - Co-ordinate my Care
4 - PEACE document (Proactive Elderly Advance Care Document)
5 - Next of kin care

A

5 - Next of kin care

Advanced care plans could relate to:
- ICU / HDU admission
- Resuscitation
- Admission to hospital
- Artificial feeding in the event of a stroke
- Major surgery
- Intravenous antibiotics
- Oral antibiotics
- Comfort care only

30
Q

An 82yo previous independent patient who lives alone has a fall with a neck of femur fracture. 2 weeks later the patient is transferring with assistance of 2 carers on Zimmer frame, walks short distances with supervision. Where to should this patient be discharged to?

1 - bed-based rehabilitation
2 - own home
3 - hospice
4 - care home

A

1 - bed-based rehabilitation
- NHS funded

31
Q

A 92yo patient with dementia, lacks capacity, lives alone. Has Social services funded 4x day package of care with house alterations. This is his 4th admission in the last 2 months with fall and long lie. He also has a grade 3 sacral pressure sore. Where to should this patient be discharged to?

1 - bed-based rehabilitation
2 - nursing home
3 - hospice
4 - care home

A

2 - nursing home
- social services if <£23,500

32
Q

An 81 year old female with new diagnosis of motor neuron disease, currently bed and chair bound and is transferring on a hoist. 4 weeks ago she was mobilising with a stick. She has had 2 aspiration pneumonias and does not want a PEG and is keen to go home. Where to should this patient be discharged to?

1 - home
2 - nursing home
3 - hospice
4 - care home

A

1 - home
- NHS fast track would pay for this

33
Q

An 86 year old male is admitted with a large left middle cerebral artery stroke syndrome. 4 weeks later she is PEG fed, but it has been dislodged on 2 occasions. She is impulsive and a very high risk of falls. She has a grade 4 sacral sore and needs full support with all ADLs. Where to should this patient be discharged to?

1 - home
2 - nursing home
3 - hospice
4 - care home

A

2 - nursing Home
- NHS pays Continuing Health Care

34
Q

91 year old with history of Parkinson’s. Lives alone in a 3 story town house in Tunbridge Wells. Presents with her first fall. Over the past 9/12 she has been struggling with meal preparation and dressing in the mornings. Where to should this patient be discharged to?

1 - home
2 - nursing home
3 - hospice
4 - care home

A

1 - home
- patient would pay

C. Year 3: Elderly Medicine (18 decks)

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