Safe discharge from hospital?

1. Palliative care education for nursing homes – 4th July 2008 Safe discharge from hospital? Dr Gudrun Seebass, Consultant in Care of the Elderly Huddersfield Royal Infirmary

2. Should I be here? Gold Standards Framework aims for fewer crisis / admissions to hospital • This presentation covers: • Transfer situations and handover arrangements • What we do with the resident in hospital – could this be done in the care home? • Communication, communication, communication

4. Who gets discharged to a nursing home? • Move to care home because of serious illness • Return after acute illness • Deterioration of chronic illness

5. Move to care home because of serious illness • Active terminal illness (advanced cancer, dementia unable to eat / drink): Palliative care handover form, anticipatory drugs • Stroke with severe disability • Frail person with hip fracture

6. Jane was admitted to HRI due to a chest infection and was unresponsive. She is now responsive. Jane has required suctioning while in hospital. Jane is to be treated as palliative care. Jane has a suprapubic catheter in situ. She has 2 syringe drivers, one containing Morphine 10mg and Midazolam 10mg. The other contains hyoscine butylbromide. She requires humidified oxygen 40%. Jane requires pressure area care. She has a grade one sore on her sacrum. She is nursed on a nimbus 3 mattress and profiling bed. Jane is NBM all medications are given via PEG tube. If there is anything else you need to know please contact ward 4 on 347153

7. Return after acute illness • Pneumonia • Sepsis • Hip fracture • ‘D&V’ • Heart attack • … Change in function? New need for care / equipment?

8. Deterioration of chronic illness Did they need the hospital? • Dementia with difficult behaviour • Dementia with severe dependence • Multiple sclerosis • Motor neurone disease • Heart or lung disease with severe dependence / disabling breathlessness Resident’s and carer’s wishes and expectations Is there anything reversible? Mental health liaison service for Care Homes: 01924 816 209

9. Acute Confusion (delirium) • Disturbance of consciousness with drifting attention • A change in cognition (memory, orientation, language, perception) • Develops rapidly (hours – days) and the resident is variable • Evidence of a physical cause

10. Acute Confusion - assessment M: Metabolic problems (high or low blood sugar, dehydration, low oxygen levels) I: Infection (chesty, offensive urine, infected skin ulcer) N: Nervous system disorder (fit / seizure, stroke) D: Drugs (newly started or recently stopped): Sleeping pills, antidepressants, Parkinson’s treatment, Water tablets… …and look for pain and constipation

11. Injury? Back to normal? Why did it happen? A: Arthritis and aids B: Blood pressure C: Confusion D: Drugs E: Environment and eye sight F: Foot wear Fall

12. PLEASE tell us what you saw: Change in colour Breathing pattern Jerking / abnormal movement Was the person upright How long did it take to ‘come round’? Postural hypotension / low blood pressure Arrhythmia / irregular heart beat Epilepsy / fit Low blood sugar Not TIA Collapse / loss of consciousness

13. Co-ordination Communication Control of symptoms Gold Standards Framework Care of the dying pathway Continuity of care Carer support Continued learning

14. Hope we both had a peep over the wall… Thank you for listening Any questions?