1. 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

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
Add ‘Medication record and discharge summary’ after this slide

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
Add palliative care handover form after this slide

6. 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

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:

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. 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

12. 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

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?