Care homes learning together initiative: a collaborative approach to care home medicine
Aims
To identify residents with challenging medical and/or psychological problems in residential care and apply principles of comprehensive geriatric assessment.
Compare this structured approach to best practice guidelines (the Framework for advanced health in care homes)1 and combine with education sessions to enhance multiprofessional learning.
Methods
Using a multiprofessional team led by a primary care physician supported by a primary care pharmacist, general practitioner (GP) trainee, specialist registrars in geriatric medicine and adult mental health services, and care home staff.
Two care homes under sole GP practice identified, and residents identified by care home staff and family invited to attend consultation.
Clinical information sought through primary and secondary care databases including dispensing information through the patients summary care record (SCR).
Two patients reviewed per 3-hour session:
pre-evaluation discussion with multidisciplinary team followed by clinical assessment
re-convene for discussion of proposed management plan
complete education topic and set new for following sessions.
Compare with key domains in guidelines.
Results
Five sessions attended in two care homes. Seven patients assessed to date, one requiring acute admission.
Patient demographics:
four male, three female; mean age, 81 years
mean number of comorbidities, seven
six of seven patents had confirmed dementia (the seventh patient was too unwell for further classification).
Five educational sessions:
advanced care plans were discussed in each case with the patient and family (where available) with advanced care plans now coded as ‘significant problem’ in the GP database
seven do not attempt cardiopulmonary resuscitation forms completed
medication review in all residents with amendments made – overall reduced tablet burden
five of seven patients had a plan to change psychotropic medication
positive feedback obtained from all clinical participants.
Conclusions
Multidisciplinary teamworking is practical and enjoyable with educational value.
Care home residents are a complex, frail and elderly population with a high degree of social isolation with family engagement.
Physical and mental health assessment (including dementia) can be performed, and activity can be applied to many of the domains set out in NHS England's Framework for enhanced health in care homes1 model.
Medications review helped to reduce inappropriate medication use.
Discussion improved confidence and language around advanced care planning.
Telephone consultation to family proved useful.
Shared communications via information technology solutions have limitations (especially advanced care planning) but novel workarounds can be found.
Conflict of interest statement
None declared.
- © Royal College of Physicians 2019. All rights reserved.
Reference
- ↵
- NHS England
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