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Early detection of deterioration in the older persons in a community setting the Kildare, West Wicklow area Co Kildare part of CHO7

Authors:Mary Roach

Abstract An algorithm/pathway for health professionals to use in a community. This is used for early detection of a decrease or change in an older persons alertness and/or cognition that could be an infectious process that lead to a sepsis emergency.Identifying this change early, with pathway of referral, assessment and treatment, will improve an outcome for an older person if the event is a sepsis.Having a pathway/algorithm will support and encourage health professionals and families with what to do when they do identify a change that they are concerned with for their older person.This whole process would provide multiple improvements to detect early changes of the older person with the following benefits:Use of existing services established by the HSE and private sectorsA continued focus of wellness of the older person in the communityAssessments and treatments remain in a community where appropriateReduce sepsis mortality rates in the Kildare, West Wicklow areaReduce length of stay in acute care for the older person in the Kildare, West Wicklow area.A process rather than a crisis or emergencyStreamlining assessment and treatment of infectious processes from community and acute care by direct access to AMAU and emergency department assessment and treatmentUse of existing assessment tools early warning score (EWS scores) and relaying vital information through a mnemonic – Identify, Situation, Background, Assessment and recommendation tool (ISBAR) in the community.Most non acute treatment occurs in an environment where the older person is more comfortableSupport for health professionals with direction on most appropriate referral processes and management of the personCoordination from clinical care coordinators and integrated clinical care managers of older persons to coordinate and navigate a person’s journey from the community to acute care.Highlight earlier the appropriate pathway of care to use community services and avoid acute care where appropriate. Pioneer site:COMMUNITY: Nurse led day centre for older persons situated in Naas Co Kildare area.ACUTE CARE: Naas general HospitalStakeholders:General practitioners (GPs)Integrated Clinical case manager of Kildare West WicklowNurse led services of day centreHospital (acute and non acute) managersBed management – Naas general Hospital(NGH)Geriatrician servicesEmergency department consultant – Naas General HospitalAcute medical assessment units (AMAU) within the emergency department – Naas general HospitalManager of social careHealth and Wellness managersDirectors Of Nursing acute care and Public healthInfection control servicesRegistered general nurses (RGN)Public health Nurses (PHN)Health care assistants (HCA)Families and next of kin (NOK)Community Intervention teams (CIT)Outpatient parental antimicrobial therapy (OPAT) – Intravenous antibiotics in the persons home serviceHospital consultantsNational sepsis teamPositive outcomes:Patient family and community involved from day oneUsing existing and established services within the community for assessment and appropriate treatment.Reduced amount of acute care bed days required for sepsis events


sepsis, community, dementia, nurse, isbar, ews

How to Cite:

Roach M. Early detection of deterioration in the older persons in a community setting the Kildare, West Wicklow area Co Kildare part of CHO7. International Journal of Integrated Care. 2017;17(5):A590.

DOI: on 17th October 2017