older people in acute care identification of need and care planning
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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. - PowerPoint PPT PresentationTRANSCRIPT
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