Title : Nursing home residents direct review in emergency depart - A registered advanced nurse practitioner supported approach
Nursing home residents (NHR) are among the most vulnerable members of our community, with complex care needs and increased frailty. Often the Emergency Department (ED) is the first point of care for NHR during acute illness. The Nursing home liaison service combined with age related assessment unit provide mainstream gerontological attuned approach to care for this increasingly vulnerable cohort of patients on the acute floor.
A case study presented below identifies the referral pathway and treatment of a NHR following a pre-alert from nursing home gp/senior nursing staff regarding transfer to acute care.
An 96 year old gentleman was transferred to ED with deranged Urea and electrolytes (U&E) . the had a history of BPH and rec Long term Urinary catheter and stage 5 CKD. Gp had been treating for urinary tract infection for 2 weeks and following urine sensitivity recently switch to appropriate oral antibiotics. Pre alert enables the facilitation of review directly on transfer t emergency department. NHR had full physical assessment and out ruled underlying causes for changes to U&Es. Catheter was flushed and bloods taken. The NHR was given a bolus 500mls Nacl solution intravenous and discharged back to nursing home. Bloods had improved and it was advised that NH administer Subcutaneous fluids overnight. The NHR was booked into the AMAU clinic two days later and long term catheter was changed and bloods were repeated, which had improved nursing home were advised to monitor for signs of dehydration and treat with subcutaneous fluids as required.
In contrast to similar presentation 2021. 66 year old gentleman with deranged U&E’s history of Traumatic brain injury, mci and CKD reviewed in emergency room and 11 hours spent in ED and discharged back to Nursing home
This service aims to main stream acute care delivered to NHR on the acute floor, putting the NHR at the centre of their care and ensuring advanced care directives can be followed as expressed by the resident.
Audience Take Away Notes:
- How to develop a nurse led pathway that expedite care for older people livening in residential long term facilities (nursing home) through the acute services
- This pathway is specific to nursing home residents care to enhance their journey through the acute services in order to avoid delayed patient experience times in emergency departments therefore reduce the adverse effects of prolonged periods waiting to be seen
- The importance of having specific pathways for older people in an ageing population