Admission Avoidance Course Scenario 6 Infected Pressure Ulcer

Transcription

1 Admission Avoidance Course Scenario 6 Infected Pressure Ulcer Course lead Colette Chapman-Laws Faculty Course / Admission Avoidance Target Curriculum Delegates Scenario name Infected Pressure Ulcer Group Size Community nurses, Residential carers, District nurses, GPs, Community based therapists, Diabetes specialist nurses 12 Patients Name: Patients Age: Major Problem Learning Goal and Admission Avoidance Factors Narrative Description Ethel Johnson 84 years old Medical Infected pressure ulcer Leading to sepsis Requires admission Medical / Clinical ABCDE approach Assessment of a pressure ulcer and initial management Earlier recognition and management of ulcers can prevent admissions Unwell patients do need admission Suggested NTS / Technical Call for help Communication Anticipate and Plan Teamwork Ethel is an 84 year old lady who has mild dementia and has been a resident for some time. She suffers from poor mobility because of arthritis and has had a previous operation on her hip after falling around 9 months ago. She has heart problems and has had two heart attacks before. She is on Aspirin, a Statin, Bisoprolol and Vitamin D tablets. These medications have not changed in the last six months. She had a urine infection around 10 days ago and had antibiotics - the last urine sample that was sent to the lab was completely clear. However, as a result, her mobility has become even poorer and she developed an ulcer which was noticed yesterday morning and she is awaiting a review from the district nurse today. The district nurse arrives today and goes to review Ethel with the carer. Ethel is awake and talking but seems a little more confused than normal. She is a bit clammy and her clothes are a little wet. She feels warm to touch and she has obvious signs of sepsis (breathing fast and tachycardia). She has a pressure ulcer which is oozing from the dressing. It is painful to touch and she does not like it being Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 1 of 6

2 touched. Staffing The carer is aware that there is a GP present who they can call to review the patient as a priority. The GP should arrange admission to hospital by phoning for an ambulance. Faculty Control Room: 1 x Sim man controls 1 x Pt voice Faculty Role Players: 1 x Plant (carer) Case Briefing To All Candidates Ethel is an 84 year old lady who has mild dementia and has been a resident for some time. She suffers from poor mobility because of arthritis and has had a previous operation on her hip after falling around 9 months ago. She has heart problems and has had two heart attacks before. She is on Aspirin, a Statin, Bisoprolol and Vitamin D tablets. These medications have not changed in the last six months. Candidates: 1 x Care Assistant 1 x District Nurse 1 x General Practitioner. Manikin preparation Room set up Simulator operation Props needed Notes to faculty She had a urine infection around 10 days ago and had antibiotics - the last urine sample that was sent to the lab was completely clear. However, as a result, her mobility has become even poorer and she developed an ulcer which was noticed yesterday morning and she is awaiting a review from the district nurse today. Wig (female) Night clothes Lesion on lateral hip/buttock area to be dressed like an infected/oozing ulcer Clothes to be slightly damp Location: Resident s room Walker nearby No significant change in observations required Dressing pads Custard for wound / +food colouring Nil Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 2 of 6

3 Observations: Initial PAR score HR O2 sats 96% 0 BP 105/70 0 Temp RR 22 0 GCS A 0 Total PAR Score 3 BM = 7.6 AMTS = N/A Pain score: Really does not like being moved or touched over pressure sore In the first 5-10 minutes PAR score HR O2 sats 96% 0 BP 103/68 0 Temp RR 26 2 GCS A 0 Total PAR Score 5 Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 3 of 6

4 Results of Investigations Bloods N/A Gases N/A Other N/A Glu Ket Pro Blood Leu Nit Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 4 of 6

5 Patient Role Resident (Manikin) Location: Resident Care Home Instructions Ethel is an 84 year old lady who has mild dementia and has been a resident for some time. She suffers from poor mobility because of arthritis and has had a previous operation on her hip after falling around 9 months ago. She has heart problems and has had two heart attacks before. She is on Aspirin, a Statin, Bisoprolol and Vitamin D tablets. These medications have not changed in the last six months. Past medical history: Previous MI x2, Arthritis, previous #NOF, Drug history: Aspirin, Statin, Bisoprolol and Vitamin D Allergies: None Social history: Ethel was a dressmaker and made all her own and her families clothes as well as working as a tailors assistant when the family fell on financially hard times. She has helped the home in the past with making table cloths and napkins for the home. She gets upset when she cannot sew any more due to her arthritic hands. Plant Role Senior Care Assistant (Plant) Instructions You are an experienced carer who knows the centre well and many of the patients. You are able to guide other participants and prompt them to progress the scenario. During the scenario you alert the team that a GP has arrived to review another resident and you offer to get the GP for them. Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 5 of 6

6 Participant Briefing Care Assistant 1 Ethel is an 84 year old lady who has mild dementia and has been a resident for some time. She suffers from poor mobility because of arthritis and has had a previous operation on her hip after falling around 9 months ago. She has heart problems and has had two heart attacks before. She is on Aspirin, a Statin, Bisoprolol and Vitamin D tablets. These medications have not changed in the last six months. She had a urine infection around 10 days ago and had antibiotics - the last urine sample that was sent to the lab was completely clear. However, as a result, her mobility has become even poorer and she developed an ulcer which was noticed yesterday morning and she is awaiting a review from the district nurse today. Participant Briefing District Nurse Ethel is an 84 year old lady who has mild dementia and has been a resident for some time. You know she suffers from poor mobility and has had heart attacks in the past. She is on Aspirin, a Statin, Bisoprolol and Vitamin D tablets. She had a urine infection around 10 days ago but has recovered. You have come to see her today to assess a new pressure sore. You are accompanied by the carer. Participant Briefing General Practitioner You have just arrived to the care centre to review a resident who was recently discharged from hospital. Before you see that resident, someone has asked you to review Ethel, another resident in the care centre. Admission Avoidance - Scenario Six - Infected Pressure Ulcer. Page 6 of 6