Older People in Acute Care
Identification of need and Care Planning
Dr Cesar Rodriguez, NHS Tayside
Dr Sridhar Valtheswaran, NHS Grampian
Clinical Leads, OPAC Collaborative
Screening and person-centred assessment by the MDT at the core of the OPAC Collaborative
The identified needs will inform the personalised care plan: - screening - comprehensive assessment - the Butterfly Scheme - MDT safety briefings
We will focus on:
1. Screening for Comprehensive Geriatric Assessment
2. Delirium Pathway
Screening Tool: ISAR (Identification of Senior at Risk) (adapted)
1. Is the patient prescribed 6 or more drugs?2. Are there any concerns about mobility?3. Has the patient been hospitalised for 1 or more
nights in the last 6 months?4. Has the patient had 2 or more falls in the last year?5. Are there any concerns about memory?6. Before coming to hospital, did the patient need
help at home on a regular basis?2 or more positives → CGA
Testing: 1 day in 5 surgical wards
• 109 patients (79 over 65, 72.5%)• 65 of 79 were screened (59.6%)• 49 of 65 scored ≥ 2 (75%)• Positive answers:– ≥ drugs (23%)– Previous admissions (20.5%)– Mobility problems (20%)– Help at home (17%)
By Katie Ward, Foundation Doctor
Next step
Event on 5th December 2012 to:
• Agree screening tool and cut-off• Agree CGA • Agree documentation
Delirium pathway
• Develop a pathway – Incorporate current good practice– Identify areas for improvement– Joint working & co-ordination
• Test
Delirium Overall Pathway
Screening
Test
• Trauma-Orthopaedics ward– Hip fracture• Risk factor for delirium• Feb-Apr 2012*: 148 episodes; 72% screened with AMT;
20% received geriatric review
– Input from • Geriatric service• Liaison Old Age Psychiatry
*Hip fracture audit, Miss Anna Riemen, Mr C MacEachern
Screening
• Abbreviated Mental Test Score– 10-item
• Single Question in Delirium (SQuID)– “Do you think {name} is more confused than
normal?”
First test
• 2-week period; early October 2012• AMT stickers by junior doctors on admission• 45 persons aged 65 and above• 100% received AMT on admission & SQuID• 18 persons scored < 8 in AMT• 11 of those were SQuID +ve
AMT & SQuID Audit - Mr A Johnston & Mr M Smith
Second test• Introduction of delirium management plan*– 5-step: • Identification• Treatment• “Normalising” routine• Managing behavioural changes• Geriatric & Old Age Psychiatry review
– Plan care needs– Plan discharge
*Dr. Hoyle & Dr. Vaitheswaran