Clinically inappropriate |
End-stage renal failure, not for resus or any further hospital contact – terminal care. Having treatment for oesophageal Ca so not considered appropriate. Seen frequently by GP who has known pt for years. Further decline from CVA and death in July – focus not on long-term dementia care but short-term supportive measures the priority. Extreme frailty. Already had her care needs met in nursing home. Patient well, no obvious cognitive issue on GPCog. Patient had returned to pre-admission levels of cognition. Memory problems/confusion have not been an apparent problem. There have been several other ongoing and new physical problems, which have dominated his consultations. Too frail and ill – died. Patient was on palliative framework at the time of admission for treating a reversible problem. Treatment was symptomatic/palliative. This patient has known encephalopathy causing confusion, low AMTS. Has had too many other concerns, patient does not feel concerned enough at present. Age 98, resident in a care home not for resus, ie of no benefit. Advanced age, multiple pathologies. Advanced age, severe COPD, wellbeing not affected. Not felt to be significant on holistic approach.
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GP’s expected abnormal cognition in context of acute illness |
Patient had sepsis due to renal abscess at time of admission. V frail. Dip in cognition attributed to acute admission with AKI. Patient admitted with septicaemia leading to his poor cognition. An admission AMTS is unhelpful. Many elderly patients are confused when acutely unwell. A discharge AMTS would be much more useful and we might then follow up. Unwell at time, no concern since.
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Patient/family decision |
Patient does not feel concerned enough at present. Further admission with GI bleeds. Patient has refused three times for memory referral, including home visit assessment by specialist team. Son aware. Patient declined any further intervention when assessed. Did not express concerns with memory at consultation. Daughter declined referral to memory clinic because of mother’s frailty.
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Process issues |
Patients should be instructed to make an appointment to see their GP a few weeks following discharge to discuss this. I do not have spare time in GP to review the patient records of five patients in detail. If you would like info that is accurate you will need to send some admin staff into surgeries to do this work. Discharge letter v poor, diagnosis confusion, no other details. No AMTS score sent to GP. If the person doing the screening had checked with the next of kin first, or with us, they would not have duplicated the process! This needs to be done in a more joined up manner*
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GP notes re ongoing management |
There is no letter alerting to her low AMTS score. I will follow up dementia screening on next encounter with patient – note made on her record to do this. GP to assess at next review, (seen by DN). Patient to be reviewed as planned (no concern re cognition by DN).
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