Older People in Acute Care Identification of need and Care Planning Dr Cesar Rodriguez, NHS Tayside...

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

Screening and person-centred assessment by the MDT at the core of the OPAC Collaborative

The identified needs will inform the personalised care plan: - screening - comprehensive assessment - the Butterfly Scheme - MDT safety briefings

We will focus on:

1. Screening for Comprehensive Geriatric Assessment

2. Delirium Pathway

Screening Tool: ISAR (Identification of Senior at Risk) (adapted)

1. Is the patient prescribed 6 or more drugs?2. Are there any concerns about mobility?3. Has the patient been hospitalised for 1 or more

nights in the last 6 months?4. Has the patient had 2 or more falls in the last year?5. Are there any concerns about memory?6. Before coming to hospital, did the patient need

help at home on a regular basis?2 or more positives → CGA

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

Next step

Event on 5th December 2012 to:

• Agree screening tool and cut-off• Agree CGA • Agree documentation

Delirium pathway

• Develop a pathway – Incorporate current good practice– Identify areas for improvement– Joint working & co-ordination

• Test

Delirium Overall Pathway

Screening

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

Screening

• Abbreviated Mental Test Score– 10-item

• Single Question in Delirium (SQuID)– “Do you think {name} is more confused than

normal?”

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

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