Care Home Deterioration Context There is pressing need to develop - PowerPoint PPT Presentation

Care Home Deterioration Context There is pressing need to develop best & appropriate care practices within the Care home population that account for the personalised care & support planning, vulnerable residents require. Contents 2. Care home deterioration tool (ReSTORE2) 3. Care home assessment pathway 4. Personalised care and support planning 5. Optimal care for care home residents with dementia 6. Care home COVID virtual ward 7. Explanatory text re: the virtual ward & diary 8-9 Emergency palliative oxygen prescription (to be abbreviated & linked to other policy docs) DRAFT

Care home staff e learning resources https://www.youtube.com/playlist?list=PLr VQaAxyJE3cJ1fB9K2poc9pXn7b9WcQg https://westhampshireccg.nhs.uk/wp-content/uploads/2020/02/CS49286-RESTORE2-full-version.pdf DRAFT

CARE HOME COVID ASSESSMENT PATHWAY Soft signs of deterioration CARER CONCERN pulse oximetry +/- NEWS2 Watch for ‘silent hypoxia’ Asymptomatic presentations with low O 2 sats Face to face or Virtual Assessment (often with normal RR, HR & other obs) With knowledge of pre existing TEP if available COVID Symptoms ranked by severity predictiveness BREATHLESSNESS SEVERE (Cat 1) MODERATE (Cat 2) MILD (Cat 3) O 2 < 93% O 2 93-94% O 2 > 94% Myalgia Or any of RR ≥ 25, HR ≥ 131, new confusion Or any of RR 21-24, HR 91-130 Or any of RR ≤ 20, HR ≤ 90 Chill ≈ NEWS2 ≥ 5 ≈ NEWS2 3 -4 ≈ NEWS2 0 -2 *or individualise for patients with chronic hypoxia Severe Fatigue Appropriateness for admission/CPR C L I N I C A L J U D G E M E N T Sputum Determined on an individual basis Dizziness Cough COVID VIRTUAL WARD Nausea/vomiting GP issues COVID Virtual Ward Diary (incl. admission/CPR status) Diarrhoea Monitoring – Symptoms & Trend of O 2 saturations Medical Headache Consider exertional saturations e.g. 40 step walk/stairs Referral Sore throat Modality & frequency of monitoring as directed by GP Some patients may be suitable for purely verbal/written safety netting, others may require calls Nasal Congestion Shared Decision-making Points Loss of taste/smell Home Oxygen and/or palliative Care where appropriate - coordinated via the virtual ward 1-2l/min as required up to 24 hrs a day DRAFT

Personalised care and support planning • Ideally, residents should have personalised care and support plans that reflects their preferences and priorities. These may include a combination of: • one page profiles • advance care plan • emergency care plan • advance decisions to refuse treatment (which may or may not include DNACPR) • In the context of COVID, treatment escalation plans should include: • discussions about potential benefit and burden of different treatment options • documentation of the resident’s views about these options, and their preferences and priorities in the light of COVID infection (important not to assume that prior expressed views in the context of progressive life limiting condition will remain unchanged in the context of COVID as an acute infectious illness) • plans about treatment escalation steps and limits, and how to optimise symptom relief, care and support wherever the person chooses to be • who else should be involved in these discussions, including whether or not the resident has authorised a Lasting Power of Attorney for Health and Welfare DRAFT

COVID 19 and Dementia in care home residents Three quarters of care home residents live with dementia Presentation – people with dementia may have difficulties in communication affecting expression of the symptoms so awareness of the signs of COVID is important (“look beyond words”) (1,2) Management – people in the later stages of dementia may have challenges in understanding the reason for isolation and handwashing practices (3,4) Person Centred Care – be aware of the resident's past history by, for example, the “This is me” document (5) Practical steps caring for residents while wearing PPE and during COVID testing (6) • Have your name and picture clearly visible on clothing; • Laminate a smiley face and flowers on PPE • Use tone of voice and open body language to demonstrate warmth • Draw or use written words to communicate where appropriate • Explain why you are taking a sample - these may need to be repeated • Play some favourite music to aid relaxation • Ensure hearing aids and glasses are worn and working Sedation – should be avoided if possible to manage purposeful wandering (7) Delirium – people with dementia and more likely to become delirious which can be prolonged (8) Advance Care Plans and Powers of Attorney can guide treatment plans End of Life Care – residents may have been there for some time so that end of life can be particularly stressful for carers who often say “it’s like losing a member of our family” (9) DRAFT

COVID VIRTUAL WARD Consider Admission Severe or Home O2 <93% /palliation Are you Better/worse? • Shortness of breath? Suspected COVID patient Moderate Consider COVID Virtual Ward • Function (ADL)? Monitoring Monitoring at clinician’s discretion 93-94% In the Care home • What are your Oxygen Focusing on old, frail & challenged Or Admission saturation trends? Suspected COVID patient All patients will be monitored with oximeters Consider Mild In own home, discharged from hospital Monitoring or Non-conveyed by ambulance > 94% Discharge Time stamps of patients who deteriorate SAFETY NETTING Days 5-7 Silent hypoxia COVID Virtual Ward Referral form If patients meet any of the following criteria, they need 999 Days 7-11 Significant breathlessness Severe breathlessness Info / summary / symptoms Beware of a reduction in O 2 sats • Unable to complete sentences O2 sats frequency at clinician’s discretion • Rapid, significant deterioration in breathing in the last hour Function • New breathlessness at rest Treatment escalation planning • Sudden onset of breathlessness Shock or peripheral shutdown • New confusion or reduced level of consciousness • Extremities – cold and clammy to touch • In the majority, full recovery is usual Pallor – skin colour is mottled, ashen, blue or very pale • Reduced urine output – little or no urine in last 24 hours within 10-14 Days Functional impairment • Inability to self-care/ perform ADLs DRAFT

COVID VIRTUAL WARD For Follow up of suspected or confirmed COVID-19 patients with oximetry monitoring on patients: • In own homes or care homes • For monitoring in the community, discharge from the hospital, non-conveyance from ambulances Clinician determined frequency (TDS or if feels worse) of diarising of oxygen levels/function, using the virtual ward diary Surveillance of patients in the community at the discretion of the clinician- frequency/modality Patient diary to monitor trends. Clear directions for patients to call back if deteriorating. • Symptoms Feeling better/worse/same Breathing better/worse/same • Oximetry O 2 Saturations Heart Rate / Temp Coordination role for community home oxygen/palliation DRAFT

Emergency oxygen provision in Care homes https://player.vimeo.com/video/283011112 Covid HOOF Questions Response Where does COVID get documented? No 11- additional information write “Covid patient short term install” Box No 3 Clinical Code If clinical code 21 available tick this if not 20 and any other co morbidities e.g. COPD is 1 What do I request? Current advice is 1 static concentrator 1-2l/min 24 hrs tick nasal cannula How Do We get equipment removed Single use for patient and then securely removed by supplier care home will be instructed of process How quickly can the oxygen be For emergencies, oxygen can be installed within 4 hrs delivered Patient is not coping on 2l/min Discuss with Home Oxygen team / GP/ Hospital next steps Who do I phone to organise this Links to the form and guidance is on the supplier page. urgently What electronic forms do I have to fill 1. IHORM (Initial Home Oxygen Risk Mitigation Form) in, and in what order? 2. HOCF (Home Oxygen Consent Form) and then 3. HOOF (Home Oxygen Order Form) https://www.england.nhs.uk/coronavirus/publication/home-oxygen-order-form-hoof-letters-and-guidance/ DRAFT

https://www.dolbyvivisol.com/services/healthcare-professionals/home-oxygen-services/england/ihorm-and- HOOF and IHORM can be hoof-part-a/ downloaded from this site Region you work in O2 Supplier and ordering details • South West Air Liquide Healthcare • London Oxygen must be ordered through the portal https://www.airliquidehomehealth.co.uk/hcp Prescriber Support Team is on 0808 202 2099 (24/7) • North West • East Midlands • Yorkshire and Humber Baywater Ltd • West Midlands Oxygen must be ordered through the portal https://apps.baywater.co.uk/onlineportal/Account/Register • Wales Clinical Support 01270 218050 (24/7 • East of England British Oxygen Company (BOC) Oxygen must be ordered through the portal https://www.bochealthcare.co.uk/hop/ (excluding Milton Keynes) Clinician Registration: https://www.bochealthcare.co.uk/hop/RegisterAsNHSStaff.aspx • North East Clinical Support 0845 609 4345 (24/7) • South Central Dolby Vivisol Oxygen must be ordered by sending a HOOF by email from an NHS.net personal email account to (INCLUDING Milton Keynes) Email: hoof.dv@nhs.net • South East Coast DO NOT send from generic nhs.net accounts. Clinical Support 0800 917 9840 option 5 (24/7) DRAFT