Clinician’s and all nursing staff should ensure that they are aware of the policy around appropriate planning with regards to hospital visits, admissions and discharge for a person who has a learning disability. (Also refer to the trust admission and discharge policy.)
Many people with a learning disability can be very anxious about medical treatment and hospital environments and this anxiety can sometimes be expressed in behaviour which can be challenging for staff to manage.
Remember that any form of behaviour is a method of communicating and sometimes this is the only way people are able to express themselves.
Prior to any planned admission or hospital appointment the individuals carer, support worker, community learning disability nurse or the hospital Acute Liaison nurse will ensure that the person is offered the appropriate individual support required to facilitate the visit. This may include trial visits, arranging special adjustments such as time of appointment, environmental factors and pictorial social story of the anticipated hospital journey or experience.
When support is required this will include providing the relevant information about the individual:
- Hospital/care passport
- Medication charts or details of medication
- Guidelines if appropriate that are required to support the person
- On occasions it may be necessary to discuss sedation to reduce anxiety and this may have already been discussed with the individuals G.P
- Any previous medical history if available or known.
Not all people with a learning disability are known to the local Community Learning Disability Team as the team work on a referral only basis.
The out-patient department or acute learning disability liaison nurse can be contacted prior to an appointment if any specialist equipment such as a hoist is required or to discuss any other special adjustments they may be required to ensure the individual patient has a positive outcome.
The acute liaison nurse can help prepare the individual for the appointment by liaising with the department / named consultant to plan how to best proceed with appointment. Also may involve arranging see read materials to explain the procedure.
Where patients present with phobias/ extreme anxieties or challenging behaviour consideration to the following areas are necessary in order to ensure their health needs are met.
- Avoid having the patient waiting around as this may increase the anxiety levels further offer first or last appointment when the clinic is quiet.
- Where available a single quiet room to be offered or suitably quiet waiting area and this will reduce anxiety and possible distress to other patients.
- Sedation should be planned in advance as required.
- Where a patient has challenging behaviour the Learning disability support staff or carer will be present to support and liaise with the Learning Disability nurse to ensure the appointment is planned to consider risks and how these will be best managed.
Where appropriate the Learning Disability nurse will support and be present at the appointment and also assist during the consultation to help the individual understand and clarify information.
The day surgery secretary will send out an appointment time for the Pre-op assessment on receipt of the referral. Once received if times need to be altered to suit the need of the patient this can be negotiated. Contact the acute learning disability nurse for help in coordinating this if required and for discussion regarding any other support necessary.
A hospital / care passport should be updated or completed if not already done and accompany the patient when they attend the Pre-Op assessment and on the day of surgery and handed to the nurse in charge.
Routine Planned Admissions
The admissions department will send out a date for admission to hospital as soon as a referral has been received.
Pre OP assessment should follow the same guidelines as with out-patients above and take place in a timely manner to allow the patient to process information and discuss care needs when it is felt the individual may require extra support.
Consideration should be made to combining procedures for example blood tests can be taken if someone is anaesthetised
Best interest discussions may also need to be had around these issues.
The bed manager can be contacted prior to admission to arrange a side room if a carer going to support and or again to reduce anxiety in a busy ward environment.
Urgent or Emergency Admissions
Urgent admissions are usually via the Accident and Emergency department or as a result of attending an out-patient appointment. It is hoped the patient will have their hospital/ care passport with them but if not then the carers to be contacted to bring in or complete a fresh one as soon as they can. Copies of the passport can be found on the trust intranet or on www.surreyhealthaction
As soon as a case of emergency admission the Learning Disability Nurse should be contacted or in her absence then social services duty can be contacted to gain more information especially if the patient is not supported.
Carers should stay if present until at least patient is transferred to a ward and if special extra care arrangements required i.e. 1:1 then this to be discussed with the ward clinical leader and care provider
On admission a service user and/or his/her carer will be advised of a provisional date for his/her discharge. This date will be reviewed on a daily basis and may involve a number of the hospital team. The nurse in charge will liaise with the individual and/or his/her carer about safe discharge to home from hospital.
The relevant discharge co-coordinator should be informed of any admission of a person with a learning disability and dialogue established with the Carers, learning disability liaison nurse and care manager.
Any factors which may prevent discharge back to the person’s home should be flagged to the discharge cocoordinator/ matron as soon as possible.
Prior to discharge, a multidisciplinary meeting of all key parties (including family member’s as appropriate) involved in the care of the person should be convened to plan the discharge, especially where there has been a significant change in the service user’s health needs.
This change in need may require Health needs assessments to be undertaken and or decision support tool assessment for change in funding from social care to health and/or review the need for temporary respite care or a permanent alternative placement.
A discharge meeting may not always be necessary if good planning has been made but the learning disability nurse should be informed so she can ensure the discharge is safe and all aspects of after care and support are in place.
The care home staff/ support workers involved may have to co-ordinate training for carers to manage the changing health need so this may need to be arranged.
The Learning Disability Liaison Nurse should assess if a formal referral to the Community Learning Disability Team needs to be made where the patient appears to have additional care needs, as a result of their learning disability and change in health so on discharge their needs can be met and co-ordinated within the community.