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Triage Considerations in Geriatric Patients - L Barclay

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Summary

This on-demand teaching session provides essential medical insights for healthcare professionals on geriatric patient care. Learn the different considerations during assessment, triage, and discharge of geriatric patients in the Emergency Department, as well as understanding and confidence in managing common freely syndrome, managing mental illness and understanding the different referral services available. Additionally, gain a better understanding of palliative and end of life care, as well as identifying vulnerable patients to ensure they are cared for properly.

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Learning objectives

Learning objectives for the teaching session:

  1. Identify common geriatric symptoms and the conditions associated with them.

  2. Explain how to properly assess and triage geriatric patients presenting at the emergency department.

  3. Describe how to recognize and respond to signs of sepsis, confusion, head injury and mental illness in geriatric patients.

  4. Evaluate the need for a multi-disciplinary team approach to geriatric care.

  5. Produce a safe discharge plan for geriatric patients, including post-discharge support.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

apologies. I was just trying to get on their realized. The other computer doesn't let me share screen, so I think I'm ready to go. Just know if you just give me a few seconds. Can everyone see that? Okay. Yeah, Course. Okay, so So this morning, I have come on due to presentations. The first presentation I'm going to talk about is clearish Considerations and the geriatric patient. So what happens at the front door Went over the patient presents to our emergency department. So I'm just gonna give you a week of background to the geriatric patients. So in geriatric medicine, the definition really, it's to healthcare. For a novel, usually over the age of 65 these patients often percent a r e d, but seldom with one single condition and usually have multiple corner better. It's across the physical and mental health spectrum, with the other challenge officially and to social circumstances. So these patients made percent percent by ambulance a loom from a nursing home with make percent. But for just mobile a A with the care. Those are the sorts of things that we're seeing as nurses out the front door. So can for that person in the E. D. We as a team need to recognize and develop our understanding and confidence and manage in common freely syndrome. Such a confusion falls holy pharmacy as well as as usually and deceive Garden and the older people. So these are topics that we discussed right? The day was different speakers through their presentations. We need to appreciate that over half of our Edie attendances are related to the older person. These symptoms are commonly overlooked attention to these. How's the potential to greatly improved care? We need to work alongside the multidisciplinary team to include our pharmacy, a social work Fazil on ot Colics to make sure that we're getting the best outcomes for these patients. Triage, screening and assessment of the geriatric patients. So one registration and three hours to already I've looked at some of the more common categories that these patients may fall into. So falls head injury on well, adult, which could stream into a new confusion, a sepsis picture or rapid onset, which may indicate this patient is morrell of life care or for palliation. Also, mental illness is a big one on. That's what you look at your cf garden on your vulnerable adult, So I've looked at each of them separately, so we're just going to look up false briefly night. So actually, as we need to document if the falls or more frequent is the mobility planing, is there any any contraband if factors, a confusion or the falls mechanical in nature? So it's important whenever you tree, I see is patients at the front door that you're getting a clear picture as to what the background in background is for the patient on. If there's any history around the falls and needs to be a holistic assessment on include any injury if that's applicable on if the patient lives alone, it's very important that that's on the triage comments. If there was an elderly partner or 11 and a nursing home, I can appreciate it. The front door that it's very difficult to get a collateral have stricter. Sometimes that patient is alone on the rail, relate, and if it's a confusional, staff were unable to relay any of that information. But again, looking at the information documentation that you have available stuff the combination I as having a real effort the May as she Is there anything additional on that? Is there a nursing home document with the passion? All those things just add to the stream and off the patient and how we can't graze the patient as the patient presented with a head injury. So assessment reactions to include Ho the head injury happened was that witnessed wasn't duty of full or a collapse episode. We also need to ask, as the patient on the coagulate, it's if they are, they need to go into an orange stream, evidence of any injury or new confusion. Again, home circumstances is really important in these elderly patients special whenever we're trying to facilitate this charge of the other side, and it's always good to include could this in the triage comments and again, a glass glaucoma scale. So you have your news. But we also want to know. Is this patient alert on trash? Are they respond to voice pee in or are they unresponsive? So all those things build a picture for the clinician's, Then, when they patient was three into the department? Or has this patient presented the front door and stream as an unwell adult? This branches I am till off different things, but I have just picked me and ones that really our own geriatric care. So possible sepsis. So is the patient. Tachycardia. Kite intensive Have their per pay wrecks a triage? Have we alerted medical staff and streamed appropriately? Have put that on orange because if you're not close and 10 orange stream triage, if the patient is a new confusion, when did the confusion start? Is there any triggers? Is there an increased agitation or urinary symptoms? Have were. Glass could call my skill in this patient. And is there a history of heroin direct that's in yellow because that will be streamed as yellow unless you have a patient that has new confusion on the neurological study it eyes very. It's very, very little. So this patient is more or less unconscious to use your own clinical knowledge. A triage. But this is only a gauge as to hope. These patients generally be streamed from there. Right rapid onset cover stool, many areas for ya. Sh so rapid onset or deterioration. But one of the things it does it does cover. Is the patient palliative, or are they for end of life care? So that's one of the ones I just picked out because of work because of the topic we're discussing today. So again, you need to note that triage is the patient. Agitated are the M. P M. Have you recorded a peon score? Have the any community? And then I've been in a community and put our the new one to the multidisciplinary team already either in the hospital or in the community. So that will be the pile of care services the district nursing services. Do they have a syringe driver and police on Are the poly If so, all those things are very important And how we manage the care then within the D department mental illness. That's that's something that's getting more and more common, but something that I don't think we focus on enough. So do they have a document? A past medical history of dementia, depression or a learning disability? Are the hell listen e and or has it been any self harm or out the whole ms Yes. Is this older person vulnerable, or have they shown any signs of abuse or see if garden concerns? Is the patient accompanied on? Have we completed or mental health performer. So it's just looking at all those key things that that'll trigger trigger off things and the conditions main asked as to how we we move forward or what documentation we complete special needs permanent. I know when the last study day I talked about this, I'm going to talk about it again because it's very important. And it's something that a team we're overlooking. So have we completed are noted that this if this older person has impaired hearing or speech impaired more Bella, a impaired site, any coldness of impairment. Are there long term oxygen therapy, or do they suffer from a learning disability? So can we please recognize importance of the sports, the triage and provide some of the very vital information? This information is very important. It's just that it should be amount of Reeboks a triage, and that's something we're currently working on. So just always consider that, and especially and the person that's a bit older. Ah, law off those things. Do you come into play? So no, it's living at home. We deliver that's care and 80. So here's nurses and conditions. Do we manage these patients and deliver the high quality care. So looking at healthcare professionals on additional services that we have available in a day, so have we considered a draped assessment unit referral for follow up the feel A assessment service. Have we see if they never this patient on discharge, I can. They're veal of a follow up phone call from DEA you the next morning on further assessing that required how you further come a sample start patients Western the day. So I knew our E 80 services currently stood. Don't but we still have a social worker for step down beds or increased packages of care with, um, any day. No, that's Monday to Friday. 9 to 5 of our services to note will be able to increase the park. It of care for a patient, but they can't stay up a patient dying. So that would be something that we need to be left for Monday morning physiotherapy assessment just to help with the mobility issues. And do they require assistance off one or two because that's important. When the social worker comes to place this patient, they look for a physical and a new T assessment for the step down bed or for the increase packet You care occupational therapist to see if the discharge just patient they may require additional equipment for their home. So have we request that that's equipment through the center of a fair amount of mint system? On that something, um, all of the band sex staff would be aware off. That's a system that works through the district nursing team on any additional equipment that a patient may require for best charge on whether it's a realist toilet seat or a handle for a bed or a pullup bar. That all goes through that system. And there's a number at the nurse's station, and you can also get them, um, via switchboard. Does the patient require diabetic nurse review? So we have to stay off all the multidisciplinary team members that we work with with any d. So is this patient diabetic? Would a diabetic nurses you help and facility and discharge end of the community for this patient on? You know that there's two diabetic specialist nurses within the hospital site and you get them on their date food or their bleed through switchboard. Would hospital diversion team be an appropriate option? So does this patient need a V. I have been off. It's in the community. So could we discharge this patient? CF lay with the hospital diversion team, and please have we considered mental health lay his own services. So is that something that the patient needs to be referred to and reviewed by before there discharged and again they will. Then a plan in place for accumulate a CP ends to fall on the patient's up. Have we include the patient's railed of next of kin and the decision making process with the patient's consent? Of course, this is something that I think we just need. Teo get away bit better. I know we are on proven but, um, patient's relatives need to be informed with the patient's consent off the discharge planning on diuretic talk about more about that later on in the afternoon. It's just to note again on have we document all the care that we've given and do we have a safe discharge plan? So all those points are things we need to consider whenever this patient is for discharge? Have you considered the professionals that can same post same post us to other services and the community to see if the discharge our patients, because a lot of these elderly patients are Bayer at Home Hospital is not the rape it ray place for these patients, especially if it's on their social issue. They are bare place. That home and their own environment especially affect dementia possible as really upset. And for these patients, so just some final considerations. So years referable a disciplinary team. Colleagues provide the ultimate care for your patient with the resource that's available. And just remember, it's the little things that we do that make a tremendous impact on on order person's life. So that's my first top down. And thank you very much for listening on defending. One has any questions. They compartment the chapter, and I'll try my best to answer the thanks very much like so there's no questions at once. So maybe if you want just fell into your next one and then maybe some questions at the end. Okay, Perfect. Thank you