Sandra Capito, Yooralla
-
Upload
informa-australia -
Category
Healthcare
-
view
119 -
download
0
description
Transcript of Sandra Capito, Yooralla
Discharge Planning for People
with Disability Discharge Planning Conference: July
24 and 25 2014
Sandra Capito
Disability Nurse Consultant
Outline
Understanding disability services and how they work
Population health statistics for people with disability
Incidence of readmission and client outcomes-case studies
Specialist discharge planning for a person with a disability – where we
struggle and best practice
Communication is the key
Resources
What is a disability?
WHO-Disability is a complex, dynamic, multidimensional and contested
definition
“May be viewed as a medical or social model in which people are
viewed as disabled by society, not their bodies.” (WHO 2011)
Disability is an umbrella term for impairments, activity limitations and
participation restrictions that negatively impact on the way a person
interacts with their environment
May be congenital or acquired
Client Cohort
Ventilator support – VRSS Austin Hospital
Live independently in units supported by staff as required
Cognitive, physical, autism spectrum
Across age groups – 18 months up to aged
Medical conditions associated with aging- earlier onset in people
with some disabilities
Multiple and complex disabilities and health support needs
Staff Cohort
Disability support staff have a range of experience and skills.
Certificate III or IV in Disability is the most common, but a very
large percentage are learning as they go.
There is no qualification in the AQF that trains in the management
of health in the disability sector; this cohort have no pharmacology
education
The scope of practice for disability support workers varies from
state to state
What can disability
support workers do?
When appropriately trained, disability support workers can perform
the following procedures:
• Enemas and suppositories
• Tube feeding
• Catheter care
• Administer medication via set dose injector pen such as Epipen
• Nebulisers and vaporisers
• Blood glucose testing
• Shallow Suctioning
• Administer medication
• Oxygen administration
Tasks disability support
workers can’t do
Disability support workers cannot perform the following under any
circumstances:
• Administer medication by intramuscular or
intravenous injection.
• Insert or remove PEG tubes or catheters.
• Monitor or manage intravenous lines and
attachments.
• Managing sliding scale diabetes.
Yooralla Health Support Team Only disability service in the state with nurses working in health
management and staff training capacity
Health assessments; identification of support needs and planning-
transition and change of health
Develop health support plans
Clinical support during acute health events-hospital transitions, palliative
care
Train staff to provide health support-sit outside AQF
Impact on health management and support policy and
practice within the organisation
Disability health
Compared with people without a disability aged 15-64, those with
severe or profound disability were:
• More likely to have check ups with the GP: 81% verses
54%
• 2.5 times more likely to do so every 6 months
• 10 times more likely to do so once a month
Disability Health
Learning Disabilities Observatory – Hospital Admissions That
Should Not Happen.
Failure of primary health care
More common is people with disability of all ages – in the general
population more common in the elderly
Commonest cause of admission is epilepsy and convulsions,
constipation, diabetes, influenza/pneumonia
There admissions are long than for the general population
Healthcare for all Sir Jonathan Michael’s UK inquiry into access to healthcare for
people with learning disabilities.
Summary of findings:
• Insufficient effort to make reasonable adjustment to support equity of service
• Health service staff have limited knowledge about learning disability; not familiar with sources of assistance they may use
• Poor partnership between service providers; this is particularly problematic when a person cannot communicate their care needs themselves, or their support requires complex planning
Healthcare for all
Reasons identified for the inequity;
• People with disability are not visible within health
systems – data to identify needs is not available
• Lack of awareness of the health needs of people
with disability in primary health care
• Discrimination is not monitored in health care
services
• Poor undergraduate training
Identified reasons for
health gaps
Diagnostic overshadowing – a diagnosis of LD/ID as the accepted
cause for an unrelated illness/symptoms
People with learning disabilities, who challenge services – longer
appointments, hoists, communication aids
Capacity and consent
Not meeting carer needs – planning transitions of care
Case Study
June-Dec 2011 – Seen by medical staff 24 times – GP and A&E
presentations. Admitted 16 times; repeated story of increased debility
and ill health, behaviours indicating pain. Increasingly withdrawn –
would lie curled up on her bed
Dec 2011 discharged following an admission for chest infection but was
unable to ambulate around the service or transfer – Returned to A&E
Markers for CA
Palliative care was initiated
Died three months later
Specialised Discharge
Planning
It’s planning for discharge very early in the story
Start at pre-admission for planned hospitalisation
On admission for unplanned hospitalisation
Central hospital discharge liaison point/contact
Sometimes the right decision is to prolong hospital stay to ensure
that all planning is complete prior to discharge
Specialised Discharge
Planning
Discharge:
Improving communication tools to remove ambiguity
Summaries including communicating with key disability support
staff
Gain/release form addresses privacy issues and release of
information
Clear plan of action re: upcoming outpatient activity etc.
Specialised Discharge
Planning
• New medications
• Chemical restraints
• Pain management
• Post-op care
• Changes in feeding/ADLs
• Follow up appointments/recognising special needs at
discharge
Specialised Discharge
Planning
Avoiding hospital admissions -
Preventive practice
• Robust engagement with Primary Care – GP Annual Health
checks
• GPMP/TCA
• Screening – Breast screen, Pap Tests, bowel screening etc.
Communication as the key What Yooralla can do…
HST becoming a liaison point
Provide succinct and concise information about the client
• How s/he moves
• How s/he is fed
• How s/he communicates
• How pain is expressed – changes in behaviour
• Health support documentation including current
medications etc.
Communication as the key
Introduction to the eHealth record
Adequate information from GP
Importance of hospital staff to read the supplied information
Reasonable adjustment prior to admission
Communication as the key
Disability to be flagged on hospital database
Post-discharge follow up
Resources
Office of Public Advocate
http://www.publicadvocate.vic.gov.au/about-us
Department of Human Services
Hospitalisation of people living with disability supported
accommodation services
http://www.dhs.vic.gov.au/_data/assets/pdf_file/0009/747711/1_ho
spitalisation-of-people-living-in-disability-support-accommodation-
summary-1112.pdf
In 2007 MENCAP, a British disability advocacy group published a paper that
described the death of six people with a disability.
Death by Indifference.
The paper was followed by multiple Ombudsman, Parliamentary, NHS
Department of Health investigation and reports that identified the many and
manifest ways the health services failed to identify and meet the needs of this
client cohort.
These reports were followed by Jonathan Michaels report Healthcare for All
that identified recommendations for how health services could meet their
legislative and moral responsibilities for the care of this group
of patients
2012 MEDCAP Death by Indifference: 74 and counting
Death by Indifference:
The MENCAP Paper that started it all