NHS Winal AnnualClinical ReviewsforDoreenBeddows

Evidenceof CarePlan Requirementfor hourly checks,three stafffor transfersand

supervisionby an RN

A ) Letterfrom Elderholmeconfirmingthe additionof hourly checksan22May 2008

1) Review form acknowledgingthat informationwithin the reportis basedon the

CurrentCarePlan.

2) Notesthat thereareno changes

to careneedsasat 15.01.09

3) within Review weekly nursingrequirementsincludes"Check everyhour"

4) Notesthat all careneedsshouldbe supervisedby an RN

5) Records"checkhourlyfor bypassing"on 09.11.08thusconfirmingthe additionof

*hourly''in the current
activecareplan

6) Records"monitoredfor signscf pain"

7) Records"monitor for potentialsuffocation"and"increasefluids" 13.10.08

8) Notesthat Elderholmehavebeenaskedto requestGPto makea referralto Rehab

to addressthe needfor hourly monitoring.
NB: This form is dated09.06.10andis signedby two NHS Reviewnurses
Elderholmealteredthe careplan two dayslater without discussion.

9) Notes"No changesto careneedsor careplan" an21.04.2}fi

10)Records"3'd personis alwaysrequiredwhenbeing transferredto and frorn bed or

bath"

1l) Recordscheckedhourlyto assess

for pain,bypassingor correctheadpositioning
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THI,EPHONE:{}lltl 3l* {Etl(t
#* FAX: {1151l4i t-lt?

Mr [rn Beddows
? Weald Drive
Linle Sutton
South Wirral
cH66 4YW

22odMay 2008

Ref: ConcemsMeeting and OutcomPs

DearLen
heldon Tuesdal'20'htVlal200E
I am ruritingto confirmdetailsof bothour discussion
in lenerdated
andthc outcomgsagreedin relarionto )Ourconcemshighlighted 1-our
l6'$a1 300S.
rrr'di*cur:cd I
lrr irrdr:rtrr r:nrurdI halc lJdrc:r.-'dlll arcasas

ObsqrationMonitoring
beconsidered
/N Duringour discussiontheconcernof Doraennot receivingwhatcould cstheter
moni-torile**ft *g"Js to poshionor rtut suprapubic
( ane \y timelyor appro,priate
lY-Pu*ring #
;4r -area forgrante'd
P uqrt of complacency
" wasdlscusse( inthatit couldu, "iri"t-nu*tteke
hasbeenrcpositiorrcd but tris is aswe
thatDoren thmughthenight*;dy moning *9lo whichnurs€s
dui to nuniesootchecking,*r*fore as.w€ q"d
alsodiscusscd
toensure
*tnmitment DotEEn's
srisisperformd
ffi.1[iil;;ilJ-*r*i. inteffsls by
* regulnr
obaervationsl chlftald hcr presentpositionshouldbechecked
ttrc nl$38in ctrargeof Dorecn'scare'
notunrealistis for staffbcit a
I wouldalsowislrto confirmaswe discusd drstit is
call in andquicklvctrccksheis olc
carctor a nursewhenpassingDoteen's.** to (?cilJ
hercarhere-r is notbpassiig *J *o:,nt anyphysicat.
lookingro ensune "", sheis pain
such;Gi". Witft t g;rdt iJ*o,titouing Doreento ensur€rviththe
signs*f disrress
Uerevieruiigthedoc'mentatfin rvithirrthehome
lrecas*,,-discusscdf is that
".iff
-Ssndex" Paincharts.hor,tevcr*'har is rnorcappropriate
1lsrrro purchasing
notjust deliverhfr
nurscssndcaresrafTuketimcto getto knowDoreenand

""""Jp
:--,Jl^a ^nsdY-lr

ChristineM Whiteside
RegisteredHomeManage/IVlatron
 anel ReviewForrn Wirral
HAS THIS APPLICATIONBEEN TH UGH THE APPROPRIATEQUALITYA$SURANCEPROCESSES?
IF NOT. PLEASESEEK ADVICE YES/ / NO
Name of Individual: Doreen Dateof Birth: 10103/1945 Gender: Female
HomeAddress:- CurrentLocation:ElderholmeNH

GP:-Dr Meyer GP Address& Tel:-NestonRoad,Willaston

Local Authority: Wirral
CurrentMHAStatus:N/A PreviousMHAStatus:N/A
CurrentLegalStatus: PreviousLegal Status:
Referrer:-PaulineHurst Designation:-PSDReviewingOfficer
Referrer'sTel:-01515142295 Referrer'sFax:-
Address:-CCT,Old M Ethnicity: - lsee SWIFTNo:- NHS/HOSP
No:-
guidance note.1)
, Birkenhead

ls the Individual /Advocate aware a agreeableto this application, and

Has the Congr:ntform been com ? (lf capacityis evident) Yes

ctientrvpe.eteaserrc[iiieAFi
Learning Disabilities Disabilities(under Older Person Mental Health (65+)

Health(under 65)

Fast Track Screeningi- {seeguidance

Does the individualhave a rapidlyde No / (pleasecontinue Yes [ (FastTrack.
enteringa terminalPhase? wilhthisapplication) referto formCC3)

Reviewof :' ContinuingHealthC Funding

Planned Review / UnplannedReview D
RequestedBy: Solicitor U FamilY M P N SocialCare 0 Health Professional

Pleaseensurethat the u haveprrovidedincludes:

The CurrentCarePlanand - detailinginterventions

Assessment and intendedoutcomes
. Other- PleaseSpecify

Panel Review Form Updated Version 10103/09

Page 1 of 3
##WIRRAL PanelReviewForm Wirral
Pt irni:rl {*rE: l'rrrrl

the lastreviewby panel,the care fiasachi6v6dtlig bllswing:

Unresolved
issues:
Changesto PEGtube and feedingreg Needswheelchairlooking at as headrestraintis not
bladderwashoutshaveminimised keepingheadin the right position
problemsshEhad

Qinqeth+lastreviewby panel,therehave r the followingchangeof circumsbnces:

(Pleaseincludedetailsof anychangesin I or natureof Needs)
LegalStatus; From:
Accommodation: From.
Other:-{PleaseSpecify)

(PleasetiCkas a

RemainUnchanged:

DBtailsof the changein careplans,costinge

etc.l
Gonditionallythere is no change Doreen.She has had some changesto her treatmenUcarebut
thesedo not chanqethe statusquo.

Temporary:
{forapprox._ m

Pen picture - Continuing Health review. There is no change in Doreen's condition. She has had
some changesto her treatmenUca this does not change the status quo,
Doreen continues to demonstrate a mary health need.
n.
Reviewer(FullName)PLEASEPRINT... .J.A#,FJ......,.."fi f.?=--
.D t.{L{;,6.fi {......
ments: I confirm that the

t cL-a.-\'-i',' +i flr
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1" h^ ^ii-vrtotra-d 1.4 /A- $rtL;-

Fanel ReviewFo FinalVersion01/04/08

Page 3 of 3
 WeeklyNursing for DoreenBeddows

Checkeveryhourfor signs pain,bypassing peg. 5rninsperhourx 24:6 hrs

or detached
Enemaand bladder every3 days2 l/3 timesperweekx %hour = lhr 20 mins
Medicationvia peg and flush 3timesper dayx lOmins:30mins x ? davs = 3hr30minr
Changndressingsabout4 nesFerweekx l/4hr : lhr
Changep€g andcatheter t hrperweeksay :Ohr 15minr
Setupfeed 4 timesper 1/4hreachtime includingflush :7 hrs
Attendingduringbath illst eqwpmentonceper week = thr
Attendingduring transfer andfrom chair l5min x 2 x ?days :3hrs 3Ominr

Totalweeklynursing 23 hrs35rnin
J lVeeklyCareworker

Bedbath eachday2 x 30 x7 :7 hrs

Hoisting Fansferand 3 x 3 0 m i n s x x27 - 2I hrs
Weekly subrnersionbath specialistequipment 2 x I hr - 2hrs
Tumeveryfour hours2 xl5minutesxdxT :21 hrs

Total weekly careworker :51. hrs.

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Designation: GontinuingHealtfiCare Location:Oxtoh Clinic
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AND
ls ableto maintainfullconiroloverbowel or has a stablestoma,or mev have occasionalfaecal
care is routine
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8. Skin(includingtissueviability):
frequencyof application.Speclalistinvolved? -.
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pressuredamage:and/orpressure qf intastskin" or with "partialthickness$kin loss

involving epidermis
and/ordermis"; or a minor
OR
A skinconditionthatrequiresclinical
Pressure damageor openwound(s), pressure s) eitherwith"partialthickness
skinlossinvolving andlordermis,
epidermis
or "fullthickness
skinlossinvolvingdamageor rsisto subcutaneous tissue,butnotextending bone,tendonor
to underlying
jointc€psule',whictrislarerespondingto
OR
A skin conditionwhichrequiresa minirnumof andwhichis responding
reassessment to treatment.
OR
whichrequires
Highriskof skinbreakdown would
severaltimeseachday,withoutwhichskinintegrity
intervention

Open wound{s),pressureLrlcer(s)with "full th skin loss involvingdamage or to subcutaneous tissue,but

extendingto underlyingbone. tendon or joint whichare not responding
to treatmentand requirea minirnumof
monitoring/reassessment.
OR
A skin conditicnwhich requiresa minimumof

Openwound(s),pressureulce(s)with-full skinlosswithextensivedestruction
and trssuenecrosis
bone,tendonorjointcapsule"
underlying or
OR
Multiple
woundswhichare notrespondino to

FinalVersion
01/04/08
{CC2)Confidential
 Wirral
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Name:
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GurrentLocation: DateofAdmission;
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9. BreathingRetioneletevidence
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no issueswithshortnessof
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and
to managementand timitsome daityactivities.
OR Requires
anyofthefollowing:
low leveloxygentherapy(24%).
room air ventilatorsvia a facialor nasalmask,
othertheraoeuticaooliancesto maintainairflow
ls ablet0 breatheindependently
througha , thattheycan managethemselves,
or withthe supportof carergor care
workers.
OR CPAP{Continuous Positive
Airways
OR Breathlessness dueto symptomsof chest whicharenotresponding treatment
to fherapeutic andlimitallactivities
sf

requlres
suctionlo maintain

10.DrugTherapies
and Medication:lncludin
symptomcontroland howfrequentlyis it \.=dr-Y.e/-eJ.A*
t5.-.-ldtl&€*=" .r-r^*rAt... { t-1 -'{Jt*
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or mayhavea physicat,mentalstateor cognitive

withmedication
impairment supportto take
requiring showsconccrdancewith medicationregime.
OR Mildpainthat is predic'lable
andlor is with certain activitiesof daily living. Pain and other symptomsds not have an

. Non-concordanceornon-compliance,
. (forexample
Typeof medication
. Routeof medication(for example
OR - Moderatepainwhich follows a predictable or othersymptoms
whicharehavinga moderate
effecton otherdomains
Requiresadministration of medicationregime nurseor careworkerspecifically trainedfor thistask,and
becauseof potenlialfluctuationof the medical or mentalstate,thatis usuallynon-problematic
to manage.
OR - Moderatepainsr other a siqnificanteffecton other domainsor on the
Requires
administration
of medieation
regime nutseor careworkerspeciflcally
trainedfor thistask,andmonitoring
becauseof fluctuationof the medicalcondition mentalstate,that is usuallyproblematictomanage.
OR - severerecurrent
or constantpainwhich
OR - Risk of non-concordance
with rnedication them at severerisk of
Hes a drug regimethat a registerednurse to ensurs effective symptom a
managemsntessociatedwith a rapidly and/or deteriorating condition.
OR - Unremittinoand overwhelminq pain

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of a careror care workerts minimisethe risk of harm.

that occur sn most daye,do not treatment,and result in a severerisk sf harm"

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on a case-by-ca basis,where an individualmay have particularneeds which do flot fall into the care
domains describedabove. lf explanatory added at the end of the domainsare not sufficientto documentall needs. it is the
responsibility
of the assessorsto determineand the extent and gpe of this need here.

The severityof thisneedand its impacton the in thejudgement

needto be weighted, of the assessors,
in a similarwayto the
otherdomains. Thisjudgement shouldbe on the risl€ associatedwith the need and the skill neededto managethe need. This
weighting
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Page1 of 3
FinalMarch2009
Confidential{CC4)

N H S R e c d of Nursing Care Needs Wircal

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Page 2 of 3
FinalMarch2009
Ganfidential (CC4l

Drvq-c^'r b- c\cl"'-lf= i c'.ft3 \uqQ

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Page3 of 3
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