North Wales Chc Implementation Group

NORTH WALES CHC IMPLEMENTATION GROUP

CHC TRAINING 2007

CASE STUDY Mr E

-GWYNEDD/ANGLESEY LOCAL HEALTH BOARDS / NORTH WEST WALES NHS TRUST.

NHS NURSING ASSESSMENT OF PATIENTS' NEED FOR CARE BY A REGISTERED NURSE. (RNC / 03)

Consent given by patient/Family for assessment to proceed
Signed: / Date: / Consent given by patient/family to share information with other relevant professionals: Signed: / Date:

1. Personal Details (Please complete or Affix Addressogram.)

Hospital:
Community Hospital A / Ward: / Community Base:
Name of Patient:
Mr E / Date of Birth:
6/10/1930 / NHS / D Number:
Address:
The Farm / Name and Address of Next of Kin/Advocate:
Mrs E
S/A
Relationship: Wife Tel No.
Date of Admission: / Anticipated date of Discharge:
Consultant: Name and Contact Details: / G.P. Name and Contact Details:
2. Assessor Details:
Name of NHS Nurse Assessor:
Staff Nurse
Designation: / Name of Social Worker:
Contact Address:
Telephone No: / Contact Address:
Telephone No:
Date Nursing Assessment Completed: / Date Social Assessment Completed:
Signature of NHS Nurse Assessor: / Signature of Social Worker:
3. Care Home Details:
Name and Address of Care Home of Choice:
Home address
Telephone No: / Name of Responsible Registered Nurse in Care Home:
Designation:
4. Funding Details: (To be confirmed by Social Worker)
Is the Patient Self Funded:
Delete as appropriate / Yes / No
Name of Social Services Funding Authority / Enter Name of Local Authority as appropriate. e.g. Gwynedd / Anglesey / Conwy etc.
Patients' Name
Mr E / Date of Birth / NHS / D Number.

1. Clinical Details:

Describe briefly the reason for admission:
Deterioration in condition.
Uraemia
Multiple Sclerosis
Current Diagnosis:
Multiple Sclerosis
Describe briefly the patients' past medical history:
MS
MI
Cellulitis
Any known allergies: please list:

N/k

Describe briefly the patient's lifestyle prior to admission: e.g. home conditions, functional capabilities etc.
Mr E has suffered from MS since he was 27 years old. He is cared for by his wife. They had no other help, they had always refused.

Please list current medication.

Drug Name / Dose / Frequency / Route
Diclofenac / 50mg / TD / Oral
Paracetamol / 1g / Four times daily / Oral
Trimethoprin / 200mg / BD / Oral
Aspirin / 75mg / Daily / Oral
Omeprazole / 20mg / Daily / Oral
Synacthen / 0.5mcg / Weekly (Weds) / OM
Frusimide / 40mg / BD / Oral
Atendol / 25mg / OD / Oral
Gabapentin / 300mg / Three times daily / Oral
Patients' Name
Mr E / Date of Birth / NHS / D Number.

1. Details of other professionals involved in this persons care:

Service / Date referred / Reason for referral / Date of assessment
Social Work / Discharge planning

7.Details of Specialist Equipment required if applicable; This relates to any equipment that is required over and above what is normally provided by the Care Home and must be supported with a statement from the relevant professional.

Type of Equipment Required / Rationale for use / Recommended by;
Name and designation of professional recommending
Profiling bed / Pt unable to re-position himself
Airwaive Mattress / Grade 2 pressure ulcer. High risk of deterioration
Ceiling track hoist and slings / Pt immobile and unable to weight bear
Patients' Name
Mr E / Date of Birth / NHS / D Number.

8.Personal Care and Physical Wellbeing / Activities of Daily Living.

1. Breathing.

No problems with breathing.

1. Elimination:

Bladder:
Indwelling catheter
Date of Baseline Continence Assessment (if applicable)
Bowel:
Mr E needs to be hoisted from bed onto a bed pan. Prone to constipation.
Date of Baseline Continence Assessment (if applicable)
Products Required;
Pads

1. Mobility / Safety.

Mr E is immobile
Manual Handling / Risk Assessments.
As long as correct equipment/hoist used, Mr Evans is not at risk

1. Eating and Drinking

Eats well. Can feed himself but soon tires and needs assistance. Drinks using a straw.
Nutritional Assessment.
Dietician
Speech and Language Therapist.
Patients' Name
Mr E / Date of Birth / NHS / D Number.

1. Compliance with Medication.

All medications need to administered but Mr E is compliant.

1. Personal Hygiene.

Needs to be washed and dressed. Mr E unable to assist.

1. Communication.

No difficulties.
Sight: no problems
Hearing: no problems Speech: No problems

1. Tissue Viability. Waterlow Score.

Mr E has a pressure ulcer on his sacrum. This is dressed daily with Mepilex

1. Sleep Pattern.

Usually sleeps well

1. Palliative Care.

Not applicable

1. Mental Health / Behaviour

No problems but can be anxious at times

1

GWYNEDD/MON LOCAL HEALTH BOARDS/NORTH WEST WALES NHS TRUST.

NHS NURSING CARE PLAN ILLUSTRATING THE PATIENTS' NEED FOR CARE BY A REGISTERED NURSE.

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
BREATHING:
No difficulties
ELIMINATION:
BLADDER:

Indwelling Catheter

BOWEL:
Prone to constipation / Prevention of ascending infection. Maintain catheter patency
Administer suppositories if needed. / Weekly to change bag. Every 3 months to change catheter.
As required.
Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
Mobility/Safety
Mr E is immobile. He is hoisted from bed to chair
No registered nurse involvement /

Maintain safe environment

EATING AND DRINKING

Mr E eats and drinks well but does tire easily and then needs assistance but does not need the help of a registered nurse
Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

Sheet No:

Continuation.

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
COMPLIANCE WITH MEDICATION
Good. Medication administered by Mrs E. no assistance needed from registered nurse.
PERSONAL HYGIENE
Needs assistance with all hygiene needs but this can be managed by family and carers.
Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

Continuation.

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
COMMUNICATION:

No difficulties

/ Daily dressings and assessment as pt condition dictates.
TISSUE VIABILITY:
Mr Evans has a pressure ulcer on his lower sacrum . Daily dressing of Mepilex / To prevent further deterioration of tissue. To heal pressure ulcer.
Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

Continuation.

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
SLEEP PATTERN

Normally sleeps well with night sedation

PALLIATIVE CARE:

N/a

Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

Continuation.

EVALUATION OF ASSESSED HEALTH NEEDS: (a separate sheet per problem may be used if desired) FOR TRANSFER TO:______Care Home

Name
Mr E / DOB. / HOSPITAL/WARD / COMMUNITY BASE
Briefly describe those elements of care that require the involvement of a Registered Nurse / Describe the desired outcome of Registered Nurse interventions / Describe the frequency of Registered Nurse intervention
MENTAL HEALTH / BEHAVIOUR.

Is anxious at times but otherwise no difficulties

Additional Comments
Signature of NHS Registered Nurse Assessor / Signature of Care Home Registered Nurse. / Date

1

GWYNEDD/ANGLESEY LOCAL HEALTH BOARDS / NORTH WEST WALES NHS TRUST

NHS NURSING ASSESSMENT OF PATIENT'S NEED FOR CARE BY A REGISTERED NURSE.

STATEMENT AND RECOMMENDATION:

NAME OF PATIENT: /

Mr E

PREFERRED CARE HOME: /

Home address

ANTICIPATED DATE OF TRANSFER:
Describe how the information for this assessment was obtained:
e.g. Previous and current assessments, Info gained from patient / family / other professionals/ etc. / Previous and current assessment. Pt and family and other h/c professionals
Is there a bed available at the preferred Care Home on the anticipated transfer date? / Yes / No
If No please indicate other choice.
Can the preferred Care Home meet the patient's needs as indicated in the NHS Nursing Care Plan? / Yes / No
If No please indicate reason:
Is there a copy of the Care Home Care Plan attached? / Yes / No
If No please indicate reason:

STATEMENT: Please tick appropriate box

The above patient is ELIGIBLE for NHS FUNDED NURSING CARE provided by a registered nurse in a Care Home (Nursing)
This decision is based on my professional assessment of his/her care needs as per care plan.
The above patient is ELIGIBLE FOR NHS CONTINUING CARE as described in the Eligibility Criteria. This decision is based on my professional assessment of his/her care needs as recorded in the evaluation of assessed care needs and have been determined in relation to the nature, complexity,predictability,stability, and intensity of needs.
The above patient is NOT ELIGIBLE for NHS FUNDED NURSING CARE provided by a registered nurse in a Care Home (Nursing)
This decision is based on my professional assessment of his/her care needs as per care plan. The patients needs can be adequately met in a Care Home (Residential)
Signature of NHS Registered Nurse Assessor: / Date:

GWYNEDDANGLESEY LOCAL HEALTH BOARDS / NORTH WEST WALES NHS TRUST.

NHS NURSING ASSESSMENT OF PATIENT'S NEED FOR CARE BY A REGISTERED NURSE.

CHECKLIST.

PRE-ASSESSMENT:

Yes / No / Signature / Date
Patient / Family / Next of Kin / Advocate informed of NHS funded Nursing Care.
Patient information booklet "What it means to you" given
Patient / Family / Next of Kin / Advocate informed of pending assessment to determine eligibility for NHS funded Nursing Care.
Consent given byPatient / Family / Next of Kin / Advocate for assessment to proceed
Consent given byPatient / Family / Next of Kin / Advocate to share information with other professionals involved in care
Complaints / Appeals procedure explained
ASSESSMENT:
Was the Family / Next of Kin / Advocate present at assessment?
Have all parts of the assessment proforma been completed?
Has the NHS Nursing Care Plan been completed?
Has the Statement and Recommendation page 7 been completed?
Is there a Social Worker involved?
Has a Social Assessment been completed?
Is the Social Assessment attached?
Does the multidisciplinary team agree that a placement in a Care Home (Nursing) is required
Has this been discussed with the Patient /Family / Next of Kin / Advocate.

Checklist continued.

Yes / No / Signature / Date
Has a Care Home (Nursing) been identified? by the Patient /Family / Next of Kin / Advocate?
Has the Care Home Registered Nurse visited, agreed and signed the NHS care plan?
Is the Care Home able to meet the persons needs?
Has a transfer date been confirmed?
PROCESSING THE REQUEST FOR FUNDING.
Has all the necessary documentation been collated?
Forwarded to relevant Local Health Board?(LHB)
Has funding approval been confirmed by the LHB?
Transfer undertaken

Completed applications for NHS Funded Nursing Care should be forwarded to the Continuing Care Manager at the relevant Local Health Board.

Social Services Funding will be processed via the Social Worker.

Contact Addresses:

Anglesey LHB
17 High Street
Llangefni.
Anglesey
LL77 7LT
Tel No 01248 751229 / Conwy LHB
Nant y Glyn Road
Colwyn Bay
Conwy
LL29 7PU
Tel No.01492 536587 / Denbighshire LHB
Ty Livingstone
HM Stanley Hospital
St Asaph
LL77 0RS
Tel No. 01745 583275
Flintshire LHB
Preswylfa
Hendy Road
Mold
Flintshire
Tel No 01352 700227 / Gwynedd LHB
Eryldon
Campell Road
Caernarfon
Gwynedd
LL55 1HU
Tel No 01286 672451 / Wrexham LHB
Ellis House
Kingsmill Road
Hightown
Wrexham
LL13 8 RD
Tel No 01978 290 883

Social Work Report

Mr E has suffered from MS since the age of 27. Mr E lives at home and is cared for mainly by his wife Mrs E. The last few weeks leading to a hospital admission with a urinary tract infection, has seen rapid and sudden deterioration or relapse in Mr E’s original MS condition.

It is my belief that Mr E’s sudden deterioration falls under Criteria 3 of the eligibility criteria for Continuing NHS Health Care. Up until a few weeks ago Mr E was able to transfer himself from his bed to the wheelchair. He was able to feed himself. Now Mr E is not able to move at all only to the extent of lifting one hand up to his chin. He needs to be fed and has some problems with swallowing. He is incontinent and has a long term catheter. He needs hoisting by two people for all transfers. He has not been able to manage sitting in a chair whilst in hospital. He suffers from very painful spasms and dizziness. He needs all care with all activities of daily living. He has vulnerable pressure sore areas and already has a small blister on right upper leg.

I would argue that Mr E’s present condition would also be eligible for continuing NHS Health Care under Criteria 1 (WHC(2004) (54) in that the complexity and intensity of his health care needs means that regular input is required by one or more of the NHS multidisciplinary team. Presently a full OT assessment is required for safe discharge to ensure that Mr E’s home is furnished with the necessary equipment e.g. ceiling hoist, sheepskin slings, special air mattress and hospital bed and reclining chair. The district nurse is/will regularly be involved in his home care. Also there will be a home care package of 2 home care workers four times daily to take care of all aspects of daily getting up, washing, toileting and putting to bed.

I believe that Mr E’s primary need is a health need and therefore he is eligible for Continuing NHS Health Care.

Social Worker

Medical report

To Whom It May Concern:

This 76yr old gentleman was admitted with a history of urinary tract infection and confusion. He was diagnosed with MS when he was 27yrs old and has coped remarkably well with little input from outside agencies until now. His condition has deteriorated rapidly over the last few weeks since his last admission with a urinary tract infection. Mr E retained some ability to transfer and feed himself but currently he is totally dependent on others and needs 24 hour care. I do not see this situation improving at all in the near future and feel that this rate of decline may well continue.

The possibility of inserting a suprapubic catheter has been discussed with Mr and Mrs E but currently Mr E would prefer to manage his urinary problems with an urethral catheter.

Mr E is keen to return home as soon as possible and I would value your assistance in arranging this as soon as is possible.

Yours faithfully

Dr G

NORTH WALES CHC IMPLEMENTATION GROUP

CHC TRAINING 2007

CASE STUDY Mr E

ADDITIONAL INFORMATION

Letter from LHB

Dear Ward Sister

RE: Mr E, currently inpatient at Community Hospital A

I am writing to inform you of the outcome of the Continuing Health care panel meeting held at the LHB last week. Based on the information submitted to the LHB, the panel members were unable to make a funding decision as the information presented was contradictory.

The nursing assessment presented to panel indicates that Mr E’s condition against criteria 1 is predictable and regular input by one or more members of the NHS MDT is not required. There is no evidence of complexity of health needs whereby frequent re-assessment due to the interaction of multiple factors is necessary. He is not at risk to himself or others. There is no evidence of a rapidly deteriorating or unstable medical, physical or mental health condition and criteria 2 and 4 would not apply.

However both the social work and medical reports indicate that Mr E’s condition has deteriorated over the last few weeks and the medical report suggests that the deterioration is likely to continue.

On this basis the LHB panel would recommend that the MDT reconsider Mr E’s eligibility for CHC and represent the case to panel. In the event of a MDT dispute than the dispute process should be invoked.

Many thanks for your support

Continuing Care Manager

GWYNEDD/ANGLESEY LOCAL HEALTH BOARDS / NORTH WEST WALES NHS TRUST.

NHS NURSING ASSESSMENT OF PATIENTS' NEED FOR CARE BY A REGISTERED NURSE. (RNC / 03)

Consent given by patient/Family for assessment to proceed
Signed: / Date: / Consent given by patient/family to share information with other relevant professionals: Signed: / Date:

1. Personal Details (Please complete or Affix Addressogram.)

Hospital:
Community Hospital A / Ward: / Community Base:
Name of Patient:
Mr E / Date of Birth: / NHS / D Number:
Address:
The Farm / Name and Address of Next of Kin/Advocate:
Mrs E
S/A
Relationship: Wife Tel No.
Date of Admission: / Anticipated date of Discharge:
Consultant: Name and Contact Details: / G.P. Name and Contact Details:
2. Assessor Details:
Name of NHS Nurse Assessor:
Staff Nurse
Designation: / Name of Social Worker:
Contact Address:
Telephone No: / Contact Address:
Telephone No
Date Nursing Assessment Completed: / Date Social Assessment Completed:
Signature of NHS Nurse Assessor: / Signature of Social Worker:
3. Care Home Details:
Name and Address of Care Home of Choice:
Home address
Telephone No: / Name of Responsible Registered Nurse in Care Home:
Designation:
4. Funding Details: (To be confirmed by Social Worker)
Is the Patient Self Funded:
Delete as appropriate / Yes / No
Name of Social Services Funding Authority / Enter Name of Local Authority as appropriate. e.g. Gwynedd / Anglesey / Conwy etc.
Patients' Name
Mr E / Date of Birth / NHS / D Number.

1. Clinical Details:

Describe briefly the reason for admission / reassessment :
Admitted to the DGH with septic shock from home having recently been discharged from Community Hospital B in the last fortnight. Was then transferred here for further assessment including social re-assessment and an application for Continuing Care funding in the home environment. Mr E has had Multiple Sclerosis since he 27 but has managed to live a fairly normal life until the past 10 years. He now requires all care in every aspect of daily living and has numerous risk factors which compromise his health.
Current Diagnosis:
Multiple Sclerosis
Rapid deterioration in condition
Faecal incontinence
Describe briefly the patients' past medical history:
Multiple Sclerosis since the age of 27
Myocardial Infarction in 2003
Recently numerous admissions with UTI’s and septic shock
Frequent and regular urinary tract infections
Any known allergies: please list:

Penicillin, Cefalexin, Macrolides:- anaphylaxis and swelling

Describe briefly the patient's lifestyle prior to admission: e.g. home conditions, functional capabilities etc.
Lives with his wife in a bungalow all on ground level. District nurse has been visiting on a daily and sometimes twice daily basis in the last week. Has had limited mobility for past eight years and up until 2 months ago was transferring with 2 using banana board.

Please list current medication.