Admission Avoidance. Scenario 1 Urinary Tract Infection

Transcription

1 Admission Avoidance Course Scenario 1 Urinary Tract Infection Course lead Colette Laws-Chapman Faculty Course / Curriculum Admission Avoidance Target Delegates Scenario name Urinary Tract Infection Group Size 12 Patients Name: Patients Age: Major Problem John Adams 77 years old Medical ABCDE Approach Early recognition of UTI Appropriate Referral / SBAR Suggested NTS / Technical Call for help early Effective Handover Learning Goal Narrative Description Admission Avoidance Factors Early recognition of illness Appropriate referral using SBAR Patient requires thorough assessment and GP review Arrange review of patient John is a 77 year old man with a long-term in-dwelling catheter. John has been complaining of a burning sensation and has not been himself the last day or so. His previous urinary tract infection was six months ago. He has mild dementia. The catheter was last changed 3 months ago and is in-situ due to benign prostatic hypertrophy. He had breakfast this morning and went back to his room. He normally comes down to the communal area but has not been seen since then. He will be reviewed by the care assistant who starts the initial assessment. They are then joined by the second care assistant soon after. The second car assistant is looking for his /her colleagues as they were due to go for a break together. After reviewing the patient, they agree the patient should have a GP review and so they phone the GP/care manager to request this. The GP is already on his way to see another resident and will review this resident first. The GP should commence oral antibiotics and arrange review within 48 hours informing the care assistant of what things to look out for. The GP will most likely request a urine sample a plant can enter at this point to help with this. Admission Avoidance - Scenario 1-UTI. Page 1 of 7

2 Staffing Faculty Control Room: NA - Actor Faculty Role Players: 1x Plant Candidates: 2 x Care Assistants entering one at a time 1 x General Practitioner. Case Briefing Manikin preparation Room set up Simulator operation Props needed Notes to faculty To All Candidates John Adams is a 77 year old man. He has resided in the care home for the last 12 months. He has a long-term in-dwelling catheter. He only takes a statin for high cholesterol and aspirin once a day. He has no allergies. He is normally a very happy and active resident in the care home. NA - Actor To Role Players Actor John Adams Plant care assistant (if needed) Set up as a residential home bedroom Actor dressed in loose clothing. Catheter leg bag attached. N/A Catheter (taped to patient) & bag Bed, table, lamp (if possible), jug of water with cup. Single bed linen Pop-up cupboard, rug, magazines/books, pictures / paintings on wall, Royal Memorabilia Gloves & aprons outside room, alcohol gel GP bag stethoscope, BP, prescription pad, tongue depressors, auroscope District nurse notes for the catheter The aim of this scenario is for candidates to 1) Recognise that John is unwell due to a UTI 2) Recognises that John needs a GP assessment and review 3) Makes an appropriate referral to the GP using an SBAR format Admission Avoidance - Scenario 1-UTI. Page 2 of 7

3 Observations: Initial Not necessary as an actor but candidates can take actors own observations PAR score HR Normal 0 O2 sats Normal 0 BP Normal 0 Temp Normal 0 RR Normal 0 GCS 15/15 0 Total PAR Score 0 BM = N/A AMTS = N/A Pain score: Mild discomfort lower abdomen Admission Avoidance - Scenario 1-UTI. Page 3 of 7

4 Results of Investigations Bloods N/A Gases N/A Other If taken urine dip shows positive for everything except glucose Glu Ket Pro Blood Leu Nit Admission Avoidance - Scenario 1-UTI. Page 4 of 7

5 Patient Role Scenario You are John Adams, a 77 year old man with a long-term in-dwelling catheter. You last had a urinary tract infection six months ago. Today, you have a burning sensation down below and have not been feeling yourself. You suffer from mild dementia. You can t remember when the catheter was changed last but it was put in because of your prostate. You will be reviewed by the care assistants who should phone for a GP review. The GP should commence oral antibiotics and arrange review within 48 hours informing the care assistant of specific things to look out for. You have been a resident in the care home for the last one year and only take a statin for high cholesterol and aspirin once a day. You have no allergies. You are normally very happy and an active resident in the care home. Past medical history: Hypercholesterolaemia, Benign Prostatic Hypertrophy, Mild Dementia Drug history: Statin once a day, Aspirin 75mg once a day Allergies: None Social history: You never married but worked in the local biscuit factory and was always the life and soul of the factory. Since retirement you have lived alone, gradually becoming a recluse. Your hobbies from childhood have been collecting royal memorabilia and wherever possible following the royal family. Instructions If it is suggested you have a urine infection, you can state that when you had it last, it was really bad and you were in hospital for three days on a drip. It started like this last time (six months ago) as well but we thought it would get better on its own we is you and another carer who has since left. When the GP arrives you give a clear account of a one day history of burning sensation down below. You don t feel feverish and you feel a bit tired but otherwise OK. You are happy with whatever plan the GP decides. Admission Avoidance - Scenario 1-UTI. Page 5 of 7

6 Plant Role Carer (only if required) You only enter the scenario if it is not going to plan. Your role will be to guide the participants. The care assistant should call for the GP informing them of a deterioration in the resident. They request an assessment by the GP and possible need for antibiotics. The Scenario will end with the GP making an assessment. Scenario: Urinary tract infection in a 77 year old care home resident Past medical history: Hypercholesterolaemia, Benign Prostatic Hypertrophy, Mild Dementia Drug history: Statin once a day, Aspirin 75mg once a day Allergies: None Social history: John never married but worked in the local biscuit factory and was always the life and soul of the factory. Since retirement he lived alone, gradually becoming a recluse. His hobbies from childhood have been collecting royal memorabilia and wherever possible following the royal family. Admission Avoidance - Scenario 1-UTI. Page 6 of 7

7 Participant Briefing Care Assistant 1 Scenario: Residential Care Home Time of day: Late morning You are a residential carer in the care home and know the patient, John. You are aware that he has a long-term catheter in place. You have come to see John as he has not come down to the communal area after breakfast. Participant Briefing Care Assistant 2 Scenario: Residential Care Home Time of day: Late morning You are due to take your break with your colleague. You go look for her and ask her if she is ready tot take her break. Participant Role General Practitioner Scenario: Residential Care Home Time of day: Late morning You are intending to visit another resident of the care home and the care team have called to inform you of a second patient. You were already on route when they called to inform you about John Adams. Faculty: Inform the GP of the information passed from the care centre to the GP practice prior to their visit. Admission Avoidance - Scenario 1-UTI. Page 7 of 7