Guidance notes on the role and function of Organic Old Age Psychiatry wards (NHS Lanarkshire)

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1 Guidance notes on the role and function of Organic Old Age Psychiatry wards (NHS Lanarkshire) Author: Dr Adam Daly, Consultant in Old Age Psychiatry, Clinical Director Old Age Psychiatry November 2014 This document is principally written to inform colleagues working in general hospital sites of the nature and function of the following organic old age psychiatry wards: Ward 3, Wishaw General Hospital, Wishaw Brandon Ward, Udston Hospital, Hamilton Glen Orchy Ward, Coathill Hospital, Coatbridge Current model of care regarding admission The Old Age Psychiatry model of care is based on the Mental Health Strategy; we aim to support people to live independently at home, and to avoid admissions where possible. The majority of both work and sources of admissions for Old Age Psychiatrists are from the community. The final decision to admit to our beds from this setting is limited to consultant psychiatrists but will always follow a multidisciplinary assessment. We are often able to find a better alternative to hospital admission. Admission would be only sought once all other sources have been exhausted, not least because an avoidable admission can often be detrimental to a person s wellbeing. The same multidisciplinary approach must be taken when considering admission from general hospital beds, as a bed in an organic old age psychiatry ward may not be the best option for a person. This process will usually involve the team currently looking after the patient, the liaison team, and the organic psychiatry ward team. The purpose of an Organic Old Age Psychiatry ward is to reduce the Stress and Distress experienced by a patient (and thus the signs such as agitation and aggression that result from this) to a level where they can be managed outwith a hospital environment. It is usually not possible to remove all symptoms completely. Further treatment can then take place if necessary in the Community (for example a patient s home, nursing home etc). When the decision to admit is being considered a number of factors must be taken into account: Symptoms: The nursing and medical expertise in our organic psychiatry wards relate to managing severe and recurrent stress and distress symptoms, chiefly those resulting in high levels of aggression. Ward dynamics/ environment: Our organic psychiatry wards are often a very stimulating environment, with high levels of noise and distress being experienced. If a patient is likely to be made more distressed by this it should be taken into account. Alternatives: If a patient can be managed in an alternative setting (for example a nursing home) then this would be a preference, as it is likely to reduce the risk the patient is exposed to on the ward and the number of moves the patients will have overall. Person Centred Care: Decisions should benefit the patient and be the least restrictive alternative. Patient, family and any legally empowered decision makers opinion, or any information within an advanced statement or anticipatory care plan must be considered.

2 Physical Health needs: The resources in the Old Age Psychiatric wards are limited, particularly out of hours, because the majority of our beds are not on general hospital sites. If there is the possibility of significant continued medical needs this needs considered. Age: Younger adults with dementia are managed on either an Old Age Psychiatry Organic Ward or a General Adult Psychiatry ward, depending on the needs of the patient. Risk to others: The patients admitted to these wards will usually pose a high level of risk to others or, less often, to themselves. Risk to patient: Owing to the reason that patients are being treated there, there is a high level of risk to patients from other patients. There are a number of mechanisms and procedures in place to reduce the risk but there is still a high risk of injury. Diagnosis: The ward is chiefly occupied by people who have dementia, i.e. progressive, degenerative neurological disorders that impair daily or social functioning. The staff in the ward are highly skilled at caring for these conditions. People with conditions which will improve, such as delirium (whether a cause has been identified or not) would rarely be better managed on organic old age psychiatry wards, even once causes have been treated/excluded, unless the risk to others is very high. Those who have a cognitive impairment of a static nature (such as brain damage, however caused) are also not best managed on these wards as the wards are not tailored toward rehabilitation. It would be the norm that a patient assessed by the Old Age Psychiatric Liaison team remains in their general hospital bed, but with advice on management and expediting discharge when appropriate. If extra staff are required in such a scenario, the ward the patient is currently on are responsible for arranging this.

3 Escalation Procedure It has been suggested that an escalation process would be helpful in the rare instance that a decision cannot be reached by the teams involved of how to proceed. (OAP=Old Age Psychiatry) Normal Decision Level Current Ward consultant OAP Liaison Consultant OAP Ward Consultant Escalation Level 1 (at this stage a case conference would be expected) Service Manager for Mental Health Wishaw General: Margaret Serrels Hairmyres: Paula McDaid Monklands: Trish Rhodie OAP Clinical Director: Dr Adam Daly (Consultant in Old Age Psychiatry) Escalation Level 2 Hopsital Chief of Medicine and Hospital General Manager* Mental Health and Learning Disabilites Associate Medical Director (Alastair Cook) and General Manager (Jim Wright) *Levels of escalation marked * have yet to be agreed with general hospital services. Out of hours admissions An admission out of hours should be exceptionally rare, but would need authorisation from the on call consultant psychiatrist. This document was discussed and agreed at the following NHSL Old Age Psychiatry Conusltants Group (Nov 2014) NHSL Old Age Psychiatry Clinical Governance Group (Nov 2014) NHSL MH&LD Clinical Governance Group (Dec 2014)

4 CHECKLIST FOR CLINICAL GUIDELINE POSTING ON INTERNET (short version) Complete ALL sections CLINICAL GUIDELINE INFORMATION Name of the clinical guideline: Role and functional of Organic Old Age Psychiatry Wards (acute care & Mental Health) This MUST be in line with the naming convention: Drug name / Procedure, Condition, Patient Group, (Scope)* Refer for guidance to Key List of Terms (MESH) available on Website *Scope = primary care referral / acute care / specialty or service /general use/specific professional group e.g. Please specify the review date for the clinical guideline: 01/11/2017 The review date must not exceed 3 years from date of guideline development Glycaemic Control in Adults with Type 1 Diabetes (acute) Antifungal Agent Selection Guideline for Invasive Fungal Infections in Adult Patients (acute general ward) Methotrexate Administration pathway for Gastroenterology patients (acute day unit) Constipation in Children Guideline for management (paediatric outpatients) Lead author of the clinical guideline Name: Dr Adam Daly Department: Old Age Psychiatry Directorate: Mental Health and Learning Disabilities Designation: Clinical Director and Consultant Psychiatrist (Old Age Psychiatry) Work address: Udston Hospital, Farm Road, Hamilton ML3 9LA

5 Telephone number: Head of Department Name: Dr Alastair Cook Department: Mental Health and Learning Disabilities Designation: Associate Medical Director (Mental Health and Learning Disabilities) Work address: Netherton House, Wishaw General Hospital, 50 Netherton Street, Wishaw ML2 0DP Telephone number:

6 CLINICAL GUIDELINE CLASSIFICATION (PLEASE TICK ALL THAT APPLY) Please note: The primary search of the NHS Lanarkshire Clinical Guideline Resource will be on the clinical guideline title. To enable easier storage and retrieval of the clinical guideline, please tick all that apply from the classification below. Acute Services Division All Acute HM MK WGH Associated Hospitals Health and Social Care Partnerships Both CHPs / HSCPs North CHP / HSCP South CHP / HSCP THE NAME OF THE SERVICE / SPECIALTY YOU TICK BELOW WILL BE USED AS A KEY SEARCH TERM if the name of your service is not included or you refer to your service using another term ( e.g. care of the elderly you regularly use geriatrics) can you provide the term: Also: Dementia Service / Specialty Service / Specialty Service / Specialty Service / Specialty Acute Pain Endoscopy Minor Injury & Nurse Treatment Psychiatry Addictions ENT Surgery Neonatology Psychological Services Anaesthetics Gastroenterology Neurology Public Health Medicine Audiology General Medicine Obstetrics Radiology Biochemistry General Surgery Occupational Therapy Renal Medicine Cancer services Genito-urinary Medicine Oncology Respiratory Medicine Cardiology Gynaecology Ophthalmology Rheumatology Medicine Care of the Elderly Haematology - Labs Oral & Maxillofacial Surgery Sexual Health Service Child Protection Haematology - Medicine Orthodontics Smoking Cessation Community Nursing Healthcare Associated Infection Orthoptics Speech & Language Therapy Continence Service High Dependency Out of Hours Stroke

7 Critical Care Infectious Diseases Outpatients Surgical Pre-assessment Day Surgery Intensive Care Paediatrics - Medicine Theatres Dental Services - Acute Learning Disabilities Paediatrics - Surgery Tissue Viability Dental Services - Community Long Term Conditions Nursing Palliative Care Transfusion Services Dermatology Mental Health - Adult Pathology Trauma & Orthopaedic Surgery Dietetics & Nutrition Mental Health - Child & Adolescent Pharmacy Urology Emergency Medicine Mental Health - Forensic Services Physiotherapy Vascular Surgery Emergency Receiving Mental Health - Old Age Psychiatry Podiatry Other, specify below Endocrinology & Diabetes Microbiology Prisoner Healthcare SECTION I: SUBMISSION DETAILS Please the following to Clinical guideline (in Microsoft word format if possible) Fully completed checklist If you have any questions regarding this checklist or process, please contact Frances Kinnear via or telephone (I only work Wed and Friday pm)

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