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