Polypharmacy, Discharge Planning, Frailty Flashcards
When does polypharmacy occur?
When 6 or more drugs are prescribed at one time (more than 5)
What to always check when prescribing?
- Correct agent for correct patient and correct diagnosis
- Drug allergies?
- Interactions
- Generic drug name used in CAPITALS
- No abbreviations
- Dose, freq, times, route of administration, start date and end date
- Cautious using decimal points
- Write units rather than u
- Print name and sign
- Review on daily basis, stop meds if not needed
Who works together for care pathway for older people?
- Healthcare workers
- Social care workers
- Patient themselves
- Family members
Main aims of discharge planning
- Reduce length of stay in hospital
- Prevent unplanned readmission
- Improve community services co-ordination
What is mainly involved in discharge planning?
Inter-professional team working:
* Sharing infromation
* Clear communication pathways
* Respect experience and expertise of collegues
* Agree roles and responsibilities
* Work flexibly
What should discharge arrangements maximise?
- QOL
- Independent living where possible
What is often done in terms of funding for discharge?
- Referral made to social services to assess for funding
- Eg for care home or direct payments (cash payment instead of community services to buy personal assistance) or a package of care
- Known as a home first form
When are social workers alerted about patient?
- referral is made
- Then notified when patient has been declared medically fit for discharge
- Then social worker takes decisive action towards discharge
- They incur a penalty if cause delayed discharge
What does discharge involve?
- Medications to take home (TTO’s)
- Transport
- Therapy assessment - ongoing referral to community occupational therapy or physio if needed. can have equiptment delivered to home
- Restart package of care
- Outpatient appt
- District nurse referral if required or palliative care or community lead referral if needed
- Transfer back letter for residential/nursing home
Reason for re-admissions
One or more elements have been inadequate eg:
* Obtaining suitable package of care
* Patient health complications
* Communcation breakdown between health care professionals and social services
* Family decisions
* Decisions around funding
What is frailty?
- Distinctive health state
- Multiple body systems lose their inbuilt reserves
- Most at risk of adverse health outcomes
- Determines which active treatments will benefit pt
How do we prevent admissions of chronically diseased pts from community ?
Specialist teams eg
* Chronic heart failure team
* Bronchiectasis nurses
* Community leads/matrons
Two types of polypharmacy
Appropriate (extend life expectancy and increase QOL) vs problematic
Reasons for polypharmacy
- Multiple health conditions
- Elderly - we are living longer
- Acute hospital admissions - new drigs given
- Treat side effect of drugs thinking they are new disease process
WHy are older people more at risk of the complications of polypharmacy?
- Decreased drug clearance
- Increase risk of adverse drug effects due to changes in metabolism from decreased organ function
