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Older People in Acute Care Identification of need and Care Planning

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.

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Older People in Acute Care Identification of need and Care Planning

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  1. 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

  2. Screening and person-centred assessment by the MDT at the core of the OPAC CollaborativeThe identified needs will inform the personalised care plan: - screening - comprehensive assessment - the Butterfly Scheme - MDT safety briefings

  3. We will focus on:1. Screening for Comprehensive Geriatric Assessment2. Delirium Pathway

  4. Screening Tool: ISAR (Identification of Senior at Risk) (adapted) Is the patient prescribed 6 or more drugs? Are there any concerns about mobility? Has the patient been hospitalised for 1 or more nights in the last 6 months? Has the patient had 2 or more falls in the last year? Are there any concerns about memory? Before coming to hospital, did the patient need help at home on a regular basis? 2 or more positives → CGA

  5. 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

  6. Next step Event on 5th December 2012 to: Agree screening tool and cut-off Agree CGA Agree documentation

  7. Delirium pathway • Develop a pathway • Incorporate current good practice • Identify areas for improvement • Joint working & co-ordination • Test

  8. Delirium Overall Pathway Screening

  9. 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

  10. Screening • Abbreviated Mental Test Score • 10-item • Single Question in Delirium (SQuID) • “Do you think {name} is more confused than normal?”

  11. 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

  12. 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

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