Health Transition Nurses
Transition Assessment for young people moving to adult health services.
Personal Assessment for:
______
D.O.B______
Date started ______Date completed ______
Lead Transition Nurse ______
Index:
Part 1. Contact Information.
Part 2. Assessment of health needs.
Part 3: Important present issues for the Young Person that are not predominately health related
Part 4: The Young person’s perspective about their life at this time, and the transition process. As well as the viewsof their family.
Part 5: Checklist of referrals/discussions to be considered and initial action points:
Part 6: Introduction to Transition Nurses and process.
Part 7: Transition Service contact details and how to raise concerns or complaints.
Part 1: Contact information:
Please complete consent to share information form before proceeding, and hand pages 17 and 18 to Young person / family.
Name:………………………………………………………………………………………….
Likes to be called:…………………………………………………………………………….
Address:……………………………………………………………………………………….
………………………………………………………………………………………………….
Tel No’ Home:……………………….Mobile …….…………………………………………email……………………………………………………………………………………………
Preferred Language……………………………….Interpreter needed……..yes/no …….
Allergy status…………………………………………………………………………………..
Next of Kin (main carers)
Name …………………………………………………………………………………………..
Relationship to Young Person…………………………………………………………......
Preferred Language…………………………………………………………………………..
Address…………………………………………….. Contact No’ ……….………………….
Interpreter needed? : Language………………………… Who for? : ……………......
Who has parental responsibility?
Name:………………………………………………………………………………………….
Relationship to Young Person……………………………………………………………….
Address………………………………………………………………………………………
Name of GP:…………………...... Phone No: …………………………………
Location: …………………………………………………………………………………….
Safeguarding:
Do any of the following statutory processes apply? (please circle)
Child Protection Plan / CAF / Child in Need / Child who’s looked after
Are there or has there ever been any safeguarding/ wellbeing issues or concerns?
……………………………………………………..…………………………………………...
Name and contact of Safeguarding Social Worker if any
……………..………………..………………………………………………………………….
Name and contact ofany other Social Worker/sinvolved
…………………………………….……………………………………………………………
Name of referrer to transition:……………………………………………………………
Part 2: Assessment of Health Needs:
How the young person communicates:
How does the young person communicate that they are in pain or discomfort?
Health professionals involved
Name / Designation / Location and contact numberOther professionals/agencies
Name / Designation / Location and contact numberSummary of Past Medical health
Current medical conditions/health needs
Please list any care plans currently in place e.g. Care management, emergency or palliative etc. ? Include date for review and who written by: ______
Present Medication List:
Medication / Dose / Route / FrequencyDressing/Hygiene
The young person is self-caringfor washing and dressing/Details of assistance required:
WashingDressing
Does the young person receive assistance from outside services/agencies to attend to hygiene needsif so who? ______
Toileting
Does the young person receive support from the continence team? Yes/No
Details of any support and products received: ______
Does the young person/parent/carers feel there are any unmet hygiene/toileting needs?: ______
______
Nutrition, eating and drinking.
Does the young person experience problems with feeding? Yes / No
Method/s of feeding/nutrition:Type of any feeding tube and size:______
Feeding regime / details of feeding problems / key points-techniques etc
Mobility(and equipment needed)
Does the young person need/use equipment to aid mobility, fulfil activities of living?
Equipment Type / Dateissued / Who issued by / Any ProblemsBreathing
Does the young person have a history of breathing problems?
Airway
Does the young person require assistance to maintain their airway? Yes/No Details:
Suction required? : Oral / Nasal / Tracheostomy
Oxygen
Does the young person use oxygen at home? Yes/No Details:
Ventilation
Does the young person use mechanical assistance to aid breathing? Yes / No
Details (when used, ventilator make, date started, care plan in place?) ______
______
Do they use a cough assist Machine? Yes / No
Details (when commenced, by who)______
Any unmet needs?______
Oral Health
Does the young person have any issues with oral health? ______
______
Name / location / number of Dentist
Last dental app’t ______Next:______Referral needed? ______
Sleeping
What is normal routine? How disturbed is young person’s sleep?
Do they have any medication, strategies or special equipment to aid sleep?
Has a bed assessment been done?
If so by who and when ______
What kind of bed and mattress does young person have?
______
Do young person and parent/carer feel that the current bed and mattress meet their needs? ______
Skin integrity
Does the young person have a history of problems with skin integrity/pressure sores?Any current issues with skin integrity?
Seizures/spasms
Does the young person have seizures and/or spasms?______
Emergency care plan in place? (include who written by and review date, and obtain copy if possible)?______
How do seizures / spasms present? How often? How are they managed?
Education
Does the young person attend school/college? No/Name______
Name of SENCO/Keyworker______
Statement of educational needs? Yes/No Relevant info:
______
Benefits/finance
Which benefits do they have, does the young person/carer feel they need any support with accessing the appropriate benefits?
Family history and parents/carers support network
Who lives with the young person?
Are there any factors/issues (past or present) within the family that may affect care of the young person?
Who is/are the main carer/s?______
Any help with care from family/friends?
Any help from any other agencies e.g. hospice, respite, home-care or shared care?
Housing
Is the young person able to use equipment in their home if needed? Yes/no
At the point of assessment do the family find living in the property;
Manageable with difficulty with extreme difficulty
Is further assessment needed?______
______
Any other points that the young person, family and assessor feel is relevant and has not been covered in assessment so far:
Name: DOB: / NHS No’ / RAE:C&C transition health team Assessment Doc (updated October 2014 – M Haines)
Health Transition Nurses
Part 3: Important present issues for Young Person that are not predominately health related
Part 4:Part 4: The Young person’s perspective about their life at this time, and the transition process. As well as the views of their family.
Present Social opportunities e.g. support groups, activities they enjoy
Plans/aspirations for the future:
Family’s thoughts/concerns about the transition process
Young person’s thoughts/concerns about the transition process
Part 5: Checklist of referrals/discussions to be considered, and initial action points:
Checklist of possible referrals/discussions:
Social Worker / SS Transitions TeamBradnet / Carers Resource
FIS / Wheelchair Services
SS OT / Day services Respite
Barnado’s (sibs, counselling, SEN advice) / SEN Advisors (Future House)
LD Services / Shine
CAMHS/Adult Mental Health team / Scope
Mencap / Headway /Cerebra
Snoop / Youth Services and/or Mesmec (LBGT)
Children’s Physio/OT / Adult Neuro Physio/OT
Dietician / SALT
PHB Advisor / Family Fund
Martin House
Children’s Palliative Team (Comm’) / Adult Palliative Team (Comm’ Marie Curie)
Adult Palliative Team (BRI)
District Nurses
Specialist Nurses:
Epilepsy
Stoma
Renal
Continence
Nutrition / Further consultant referrals:
Initial Action Points:
Part 6: Introduction to Transition Nurses and process.
This page to be left with the young person
Transition Nurses. An introduction:
Information for families and carers, to discuss with the young people affected by this service.
If you are a young person around 14 – 21 years old who has a long term physical and medical condition or you have Learning Disabilities or Autism, it can be scary and stressful to think about moving away from the various parts of the health service which presently help to look after you, and are designed to care specifically for children and teenagers.
At this time of course you are also going through changes in the educational provision offered to you, possibly moving to college or some other setting, groups of friends, carers and other social situations may be changing. You may be expected to have a lot more independence and make more decisions for yourself and your financial situation will be changing.
We are a new team of specialist ‘Transition Nurses’ set up in March 2014 to help you through this time in your life. We will look at the health services you presently receive from children’s services and actively co-ordinate your transition to those provided by the mainstream NHS (adult services). We will also help to direct you towards services and people (either statutory or voluntary) that will help you with other aspects of your life such as care, independent living, social opportunities,financial management and so on….
This assessment is a collection of information about the health care that is presently provided to you, and it will allow us to develop plans to show how and when these services will be taken over by adult services. This process will be the key to helping you move as smoothly as possible through this exciting part of your life as far as health service and other help you get from statutory and voluntary services are concerned.
Our philosophy is to keep the needs, desires and aspirations of the Young People we work with at the centre of everything that we do, our job is to support, advise and facilitate you to live your life in the way you wish and support you to play your unique positive part in society.
Transition Nurses:
Claire Smith: 07432 574101
Mike Haines: 07956 062300
Part 7 : Transition Service contact details and how to raise concerns or complaints.
This page to be left with young person
Your Transition Nurse will be either:
Claire SmithTransition Nurse
Child Development Centre
St Luke’s Hospital
BD5 0NA
01274 365585
07432 574101
Fax 01274 365127 / or / Mike Haines
Transition Nurse
Child Development Centre
St Luke’s Hospital
BD5 0NA
01274 365585
07956 062300
Fax 01274 365127
If you have any concerns or complaints regarding input from your Transition Nurse, please feel you can talk to them openly and honestly, we want to get it right for you.
If you feel you can’t do this, or your concerns aren’t addressed, please contact the service manager:
Denise Stewart
Community Matron
Women and Children’s services
Ward C2
St Luke’s Hospital
BD5 0NA
01274 542200
07534283996
Consent form: sharing your personal information
Service user’sName: ………………………………………………………………….
Date of birth:………………… NHS Number:……………………..
Practitioner responsible for obtaining consent:
Name: Transition Nurse BTHFNHSTrust
Action by practitioner
I have explained to the service user: (Tick the boxes when complete)
what personal information we want to share
why we want to share their information
who we want to share their information with
the consequences of sharing the information
the consequences of not sharing the information
that their information will be kept secure
their rights under the Data Protection Act 1998, Section 7.to access their personal information
their right to withdraw or restrict consent
the complaints procedure.
Please read this form carefully
If you have any concerns discuss them with the practitioner before you sign.
Service user’s statement
It has been explained what information the agency would like to share about me, who they want to share the information with and why they want to share it.
I have been made aware of what might happen because of my information being shared and what might happen if I do not allow my information to be shared.I understand that if I agree to my information being shared I have the right to limit how much is shared or withdraw my agreement at any time.
Consent Page 1 of 2
Consent form: sharing your personal information
Declaration by Young Person (Service User):
Iconsent to the Transition Nursing Team from Bradford Teaching Hospitals Foundation NHS Trust sharing my information on a need to know basis, with other professionals in Health, Education and Social Care (Including my GP) and for these services to share information they may hold with the Transition Nursing Team. This is for the purpose of coordinating and improving the health care offered to me as I move from Children’s to Adult Orientated health services.
Print name:
Sign: Date:
If the young person is unable to sign but has indicated their consent by other means, a witness should sign below to confirm consent.
I confirm that the person named above has indicated their consent for Bradford Teaching Hospitals Foundation NHS Trust Transition Nurses to share their personal information.
Witness name: ……………………………… Relationship to service user: ……………..
Sign: …………………………………………. Date: …………………………………………...
Declaration by Parent/Legal guardian/Deputy for welfare of Service User:
Iconsentto the Transition Nursing Team fromBradford Teaching Hospitals Foundation NHS Trust sharing my information and information regarding my child/ward/young person for who I am deputy, on a need to know basis, with other professionals in Health, Education and Social Care (including their GP) and for them to share information they may hold, with the Transition Nursing Team. This is for the purpose of coordinating and improving the health care offered to the Young Person as they move from Children’s to Adult Orientated health services.
Print name:
Sign: Date:
If the person above is unable to sign but has indicated their consent by other means, a witness should sign below to confirm consent.
I confirm that the person named above has indicated their consent for Bradford Teaching Hospitals Foundation NHS Trust Transition Nurses to share their personal information.
Witness name: ……………………………… Relationship to service user: ……………..
Sign: …………………………………………. Date: …………………………………………...
Consent Page 2 of 2
Name: DOB: / NHS No’ / RAE:C&C transition health team Assessment Doc (updated October 2014 – M Haines)
Health Transition Nurses
Name: DOB: / NHS No’ / RAE:C&C transition health team Assessment Doc (updated October 2014 – M Haines)