Assessment in averting Assessment in averting crisis admissioncrisis admission

Gayle McKee CPN

Ann Scott Nurse Consultant

What is a crisis?What is a crisis?• It’s hard to sum up!

Case Study One• Mr A, recent admission for acute episode and medication

review• Discharged into his wife’s care who is the main carer• Moderate/advanced Dementia with communication

severely compromised• Increased behavioural concerns, hitting out at wife and

carers• Evidence of increased psychosis• What would you suggest as plan of action?

Case Study Outcome• Previous history of constipation and back pain• Checked with wife, no bowel movement for 2

weeks and then diarrhoea/loose stool• GP confirmed gross constipation• Same treated and behavioural issues reduced• Education regarding constipation and overflow

•Case Study Two

• Miss B long history of slow cognitive decline with eccentric behaviour

• Increased reports of acute confusion, paranoia and disturbing neighbours at all times of day and night

• Calling emergency services, police and ambulance on a daily basis

Case Study Outcome

• Admitted to general hospital with raised calcium

• CT brain scan showed evidence of recent stroke, same treated and rehab given

• Confusion reduced client back at home

Best Practice

• GP assessment to rule out physical cause e.g. delirium, acute confusion• Gather information, client, relative, carers, GP, Psychiatrist and other

professionals involved• Identify triggers, risk, carer stress and need for carers assessment• Options – Treatment at home

- Step-up

- Respite

- Admission, ideally planned to reduce stress to client and family/carers

• Education – e.g. dehydration and constipation for carers, professionals and care homes

Bamford reviewBamford review• Started in 2002 and completed 2007

• Looked at law, policy and provisions which affect people with mental health and learning disabilities in Northern Ireland

• Aim to promote equality, social inclusion and positive mental health

Compton ReportCompton Report• Released November 2011• 5 year implementation plan reviewing local health and social

care• Transforming your care• Client centred, integrated working• Services regarding home as the hub• Closing long-stay units with focus on care in the community• Shifting resources from hospital to community• 10 major areas – long term condition• Quality and outcomes

Dementia StrategyDementia Strategy• Launched 2011

• Minister Poots

‘I want to ensure that people with Dementia are treated with awareness and respect, especially by those providing services and that they are supported to maintain their independence for as long as possible.’

Nothing Ventured Nothing GainedNothing Ventured Nothing Gained

• Risk guidance for people with Dementia• Guidance on the best practise in assessing, managing

and enabling risk for people living with Dementia• Balance between being over protective (in an attempt to

eliminate risk altogether) while respecting individuals freedom

• Managing risk in a positive and constructive way by enabling and supporting people with Dementia and their carers.

Gold standardsGold standards• What is ‘Best practise’?• Specialist practitioners • Single point of access 24/7• Crisis response for known and unknown clients• Liaison / behavioural specialist for care homes• Northern Ireland Single Assessment (NISAT)• Education for clients, families and health

professionals

Current Gaps in ServicesCurrent Gaps in Services•Increasing aging population and number of people with Increasing aging population and number of people with DementiaDementia•Lack of community resourcesLack of community resources•Lack of understanding within health and social care Lack of understanding within health and social care professionalsprofessionals

SummarySummary

• Assess physical cause

• Pre-empting carer stress and breakdown

• Improving community services available

• Best practise