Safe discharge from hospital? 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

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

Who gets discharged to a nursing home? Move to care home because of serious illness Return after acute illness Deterioration of chronic illness Add ‘Medication record and discharge summary’ after this slide

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 Add palliative care handover form after this slide

Jane was admitted to HRI due to a chest infection and was unresponsive 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

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

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

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

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

Fall 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

Collapse / loss of consciousness 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

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

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