Week 1: Older people (1) (Capacity, CGA, discharge, DNAR, prescribing) Flashcards
what is capacity and when should it be assessed
Ability to make a decision or take action that affects ones life.
- Capacity is doubted
- Significant decision is to be made
principles of having capacity to make a decision
Mental Capacity Act 2007
To have capacity a person must be able to :
- Understand the information relevant to the decision
- To retain that information
- To weigh that information as part of the process of making a decision
- To communicate his/her decision
best interest decision
- Made on behalf of person lacking capacity AND lack of LPA health/valid Advanced Statement
best interest decision
- Made on behalf of person lacking capacity AND lack of lasting power of attorney (LPA) health/valid Advanced Statement
considerations made for best interest decisions
- Is lack of capacity temporary or permanent?
- Which options would provide overall benefit?
- Which option is least restrictive of patient’s future choices?
- Has patient any previously expressed preferences (advanced decision/statement)?
- Have you considered the view of those close to the patient and whether they believe this is in the patient’s best interests?
- Any decision made must be in the best interests of the person
who to consult for best interest decisions
- Next of kin (NoK)
- Family/friends
- Persons involved in care
- IMCA (independent mental capacity advocate)
- If no representatives exist and decision can wait
- Decision long term placement
- Only advises, final decision with healthcare team
ReSPECT form
what is a 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
- quality of life
- functional status
- prognosis
- outcome
A typical CGA team comprises
geriatrician, nurse specialist, occupational therapist, physiotherapist, pharmacist and others as needed (speech and language therapist, dietician)
domains of CGA
- 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
main aim of discharge planning
- Reduce length of stay in hospital
- Prevent unplanned re-admission
- Improve manner in which community services co-ordinate following discharge
normal discharge
- Referral made to SS to access funding e.g. for care home or package of care (this is a section 2)
- Social worker then allocated to the patient and is responsible for putting together package of care
- Section 5 then sent by nursing staff to social services, alerting them to the fact that the patient is ‘medically stable for discharge’
- Social services incur a financial penalty if they are responsible for a delayed discharge
discharge involves
- 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 discharge’s fail
- Unsuitable package of care
- Patient/user health complications.
- Communication breakdown between health care professionals and Social Services.
- Family decisions.
- Decisions around funding.
end of life decision making principles
- advanced decision making by patients
- palliation
- individualised care
- maximising quality of life e.g. letting patients eat and drink
- comfort and dignity
- following advanced directives