Early detection of deterioration in the older persons in a community setting the Kildare, West Wicklow area Co Kildare part of CHO7

Abstract

An algorithm/pathway for health professionals to use in a community. This is used for early detection of a decrease or change in an older persons alertness and/or cognition that could be an infectious process that lead to a sepsis emergency. Identifying this change early, with pathway of referral, assessment and treatment, will improve an outcome for an older person if the event is a sepsis. Having a pathway/algorithm will support and encourage health professionals and families with what to do when they do identify a change that they are concerned with for their older person. This whole process would provide multiple improvements to detect early changes of the older person with the following benefits: Use of existing services established by the HSE and private sectors A continued focus of wellness of the older person in the community Assessments and treatments remain in a community where appropriate Reduce sepsis mortality rates in the Kildare, West Wicklow area Reduce length of stay in acute care for the older person in the Kildare, West Wicklow area. A process rather than a crisis or emergency Streamlining assessment and treatment of infectious processes from community and acute care by direct access to AMAU and emergency department assessment and treatment Use of existing assessment tools early warning score (EWS scores) and relaying vital information through a mnemonic - Identify, Situation, Background, Assessment and recommendation tool (ISBAR) in the community. Most non acute treatment occurs in an environment where the older person is more comfortable Support for health professionals with direction on most appropriate referral processes and management of the person Coordination from clinical care coordinators and integrated clinical care managers of older persons to coordinate and navigate a person’s journey from the community to acute care. Highlight earlier the appropriate pathway of care to use community services and avoid acute care where appropriate. Pioneer site: COMMUNITY: Nurse led day centre for older persons situated in Naas Co Kildare area. ACUTE CARE: Naas general Hospital Stakeholders: General practitioners (GPs) Integrated Clinical case manager of Kildare West Wicklow Nurse led services of day centre Hospital (acute and non acute) managers Bed management – Naas general Hospital(NGH) Geriatrician services Emergency department consultant - Naas General Hospital Acute medical assessment units (AMAU) within the emergency department - Naas general Hospital Manager of social care Health and Wellness managers Directors Of Nursing acute care and Public health Infection control services Registered general nurses (RGN) Public health Nurses (PHN) Health care assistants (HCA) Families and next of kin (NOK) Community Intervention teams (CIT) Outpatient parental antimicrobial therapy (OPAT) – Intravenous antibiotics in the persons home service Hospital consultants National sepsis team Positive outcomes: Patient family and community involved from day one Using existing and established services within the community for assessment and appropriate treatment. Reduced amount of acute care bed days required for sepsis events