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Assessment of competenciesAssessment of competencies

Initiating a clinical assessment Initiating a clinical assessment Part 1Part 1

Taking a Patient HistoryTaking a Patient HistoryJohn Senior CNC Clinical Practice

Auburn Hospital

Module 9Clinical Practice in Acute Care

Learning outcomes

1. Apply a systematic approach to patient assessment and practice physical assessment skills in a simulated clinical environment (ANMC 5)

2 Identify assess and management the rapidly deteriorating 2. Identify, assess and management the rapidly deteriorating patient conduct and document comprehensive client assessments utilizing an appropriate assessment tool (ANMC 6.1, 7.4, 9.5)

3. Incorporate culturally relevant, age specific, nursing therapeutics to address problems experienced by seriously ill clients;

4. describe appropriate communication and personal interaction strategies involved in the assessment of client (ANMC 9)

5. explain and demonstrate the essential elements of cardio-pulmonary resuscitation (ANMC competencies: 1.2; 2.2; 7.4; 9.4)

Care Coordination: Planning from Care Coordination: Planning from Admission to Transfer of Care in Admission to Transfer of Care in NSW Public HospitalsNSW Public Hospitals

PD2011_015

M d iMandatory requirements:

1. Pre Admission / Admission2. Multidisciplinary Team Review3. Estimated Date of Discharge (EDD)4. Referrals & Liaison for patient transfer of care5. Transfer of care out of the hospital

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Pre-Admission and Admission

(Transfer of Care Risk Assessment)

1. Is the patient likely to have self-care problems?

2 Does the patient live alone?2. Does the patient live alone?3. Does the patient have responsibilities to care

for others?4. Has the patient used community services

before admission?5. Does the patient usually take three or more

medications and have their medications changed in the last two weeks?

Example of a patient assessment tool, this one was developed by Western Sydney

Completed on all ‘non-Completed on all nonplanned patients’ when the stay exceeds 24 hours

Planned patients are assessed prior to admission e.g., in pre-admission clinics

Patient interviewPatient interviewNot a conversation

Structured and goal-directed

Three phases:Three phases:

•Introduction

•Focus

•Termination

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Introduction

•Choosing the right time

•Seeking approval and cooperation of patient and/or significant others

•Creating a conducive environment

•Using effective communication techniques

•Being a good observer

Try to ask ‘open ended’ questions

Focus

Discussed more fully in Part 2 i.e. primary and secondary assessment

Termination

•Tell the patient that the interview/your assessment is over

•Ask them if they have any questions

•Tell them what will happen next i.e. don’t leave them up in the air

Now we will go through the Patient assessment form step by step

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Information SourceInformation Source

Examples of other types of assessments;•Children•Trauma•Neurological•Pre-operative•Psychogeriatric

Social, Function and Discharge PlanningSocial, Function and Discharge Planning

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Is the patient likely to have self-care problems?

CognitionCognition

Definition –the mental processes characterised by knowing, thinking, learning, understanding, and judging

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Sensory Deficits / AidsSensory Deficits / Aids

One of the major causes of complaints received by hospital is equipment / belongings going missing

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EliminationElimination

Diet & Malnutrition ScreenDiet & Malnutrition Screen

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Currently there is no specific question regarding taking three or more medications or if there has been a recent change in medications

One of the main desired outcomes is to reduce adverse patient events

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The three main adverse patient eventsThe three main adverse patient events

Medication errors

Patient falls

Not recognising the deteriorating patient

Of the medication errors, which two medications are invariably involved?

Insulin

Warfarin

Aim of this session is to look at two case scenarios that emphasises some of the health issues that face some specifically identified groups in contemporary Australian society.So far we have documented finding by completing a form; discussing specific groups will help us focus on specific needs:will help us focus on specific needs

Two groups to be considered during this session are:

•Mental health•Culturally and linguistically diverse

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Mental HealthMental Health

Case study32 year old lady brought into Emergency by ambulance with cellulites of her right leg She lives with her mother who is her leg. She lives with her mother who is her primary carer as she has long term mental health issues. Her mother states that she normally copes well as far as her mental issues are concerned. She is overweight and has high blood pressure.

Pre-Admission and Admission

(Transfer of Care Risk Assessment)

1. Is the patient likely to have self-care problems?

2 Does the patient live alone?2. Does the patient live alone?3. Does the patient have responsibilities to care

for others?4. Has the patient used community services

before admission?5. Does the patient usually take three or more

medications and have their medications changed in the last two weeks?

Some possibilities to consider:•Treatment of the presenting problem

•Possible development of other pathology, such

Discuss issues relevant to this case

as•Metabolic syndrome – why this patient high risk?•Obstructive sleep apnoea•Medication issues •Smoking

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Culturally and linguistically diverse Culturally and linguistically diverse (CALD)(CALD)

Case studyOne year old child brought into Emergency after suffering a seizure. The seizure is t min t d nd h n p th l is il bl th terminated and when pathology is available the child is found to be severely hypocalcaemic. The family live in a unit and the mother wears concealing type clothing for cultural/religious reasons, even though the child is one year old it is almost entirely breast fed.

Treatment of the presenting problem•Physical conditions that may be greater than in the wider population•Physical differences such as variations skin

Issues to consider

Physical differences such as variations skin colour; why is this an issue?•Wearing of concealing clothing•Trauma – physical and psychological – eg PTSD•Different attitudes to hospitals•Roles of medical staff