1. 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

2. 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

3. We will focus on: 1. Screening for Comprehensive Geriatric Assessment 2. Delirium Pathway

4. 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

5. 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

6. Next step Event on 5 th December 2012 to: Agree screening tool and cut-off Agree CGA Agree documentation

7. Delirium pathway Develop a pathway – Incorporate current good practice – Identify areas for improvement – Joint working & co-ordination Test

8. Delirium Overall Pathway PreventionIdentificationManagement Discharge Planning Screening

9. 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

10. Screening Abbreviated Mental Test Score – 10-item Single Question in Delirium (SQuID) – “Do you think {name} is more confused than normal?”

11. 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

12. 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