ADMINISTRATIVE GUIDANCE NOTES GUIDELINES FOR THE PRACTICE OF INVOLVING CARERS Written/Produced By: Title/Directorate Date: Jane Rowson Clinical Matron July 2006 Person Responsible for Monitoring Compliance & Review Signature & Date Cathy Stone: Director of Nursing Multi-disciplinary Evaluation/Approval Name Title/Speciality Date: Care for the Carer s July 2006 Laura Rickaby Hospital Liaison Worker/Project Worker July 2006 Nicole Banister Patient Information Co-ordinator July 2006 Paula Groome Social Services July 2006 Liz Fenton Chief Executive for Care for the Carer s Sept 2006 Ratification Committee Issue Number (Administrative use only Date of Issue & Version 2006248 Oct 2006 V2 Next Review Date Date Ratified Name of Committee/Board/Group Sept 2008 06/10/06 Cathy Stone on Behalf of Nursing & Midwifery Policies Committee
STATEMENT A carer is a person who looks after a relative or friend who needs support because of age, physical or learning disability or illness, including mental illness (National Carers Strategy, 2001). Nationally 1 in 10 people in the UK is a carer for the elderly or sick (2001 Census). This equates to 5.7 million individuals, 500,000 of whom live in East Sussex. East Sussex Hospitals NHS Trust is committed to working in partnership with carers to ensure the best outcomes for patients and to provide the information, support and involvement which carers need to carry out their role. Communication between nurse, patient and carer will be our goal. We will incorporate this into each ward s philosophy of care with the aim of involving the patient and carer in all decision-making, where possible. Training will be provided for nurses to include general awareness of carer concerns and needs and those specific to often marginalised groups of carers, such as same-sex partners, young carers and minority ethnic carers. Training in disability awareness will be available to all staff within the Trust, to include communication skills and the use of basic sign language. All booking-in letters for elective admissions will refer to the availability of a carers pack, including an explanatory leaflet summarizing these Guidelines, and a Care Passport. By providing services which promote independence and choice, and by providing flexible, responsive support for carers, the sustainable caring situation can be maintained (DOH). 1. Purpose 1.1 The aim of this policy is to ensure that we meet the needs of our patients and their carers in the delivery of our service. It is intended that staff will identify the carer of the patient on initial assessment of their needs. Once the main carer has been identified it must be documented who they are and their relationship to the patient within the patients Single Assessment Process (SAP) form. 1.2 It is recognised that there is much to work to be done in involving carers in the planning and delivery of care whilst their partner, relative or friend is in hospital. The hope is that this policy is used as a provider of guidelines and as an ongoing tool to develop the needs of both carer and patient during their stay in hospital. 2. Admission 2.1 Staff will aim to identify the main carer or carers during an initial assessment of the patient s needs and to enter this information on the patient s SAP form. Page 2 of 5
2.2 Agreement must be obtained to share personal information on care with the carer where the patient is able to give their consent and documented appropriately within SAP. 2.3 Where possible, a meeting with the carer will take place within four hours of inpatient admission. This will enable the carer to contribute information about the patient s needs, home circumstances and the carer s expertise in caring for the patient. 2.4 In situations where the patient has communication or comprehension difficulties, the carer may contribute information on the patient s condition and/or care. 2.5 If a meeting cannot be achieved within four hours, then a designated nurse on duty will telephone the carer as soon as possible. 3. During the stay 3.1 The carer s expectations and concerns should be noted; it is our aim that the carer is welcome to work with staff and can discuss their input into the care of the patient, if appropriate, which will then be incorporated into the nursing documentation. 3.2 It is essential to ensure the carer does not become disempowered and takes care of their own wellbeing and that by continuing with the care of their relative whilst in hospital they do not compensate their own health. 3.3 If at any time the carer wishes to speak to the Doctor who is responsible for their relative it is the responsibility of the nurse in charge to facilitate the meeting by contacting the team. If at any time the carer wishes to discuss issues of concern and has been unable to speak to a member of staff a Clinical Matron is available seven days a week from 7.00am to 7.00pm. Each ward has a Clinical Matron responsible for them and they can be contacted via switchboard. 3.4 The carer will be provided with all necessary training to enable them to care for the patient - such as feeding techniques, catheter care and hoisting competence. The Multi-disciplinary Team should ensure that the patient and carer are comfortable with the carer s ability to carry out the tasks, either in hospital or at home. 3.5 Explanation of probable treatment regimes and practices will be given to the carer enabling anxieties and fears to be acknowledged and explored. Treatment regimes seeking to promote independence can seem harsh to patients and carers and cause concern unless properly put in context. Valid consent to treatment is absolutely central in all forms of healthcare, from providing personal care to undertaking surgery. Where an adult patient lacks the mental capacity to give or withhold consent for himself or herself no one else can give consent on their behalf. However, treatment may be given if it is in their best interests, as long as it has not been refused in advance in a valid and applicable advance directive (Refer to Policy for Consent to Examination and Treatment). 3.6 Carers can often have valuable experience of the impact of medication on the person they care for. The type, frequency and administration of medication, especially any form of sedation will be discussed and all appropriate information Page 3 of 5
given by staff. Where medication is given against the judgement of the carer, they will have the right to register this viewpoint in the medical notes. 3.7 Visiting times differ with each ward within the hospital, it is generally written at the entrance of each ward when visiting is allowed. This may change with the discretion of the Nurse in Charge and should always be flexible for carers. 3.8 The estimated discharge date will be made with the carer to ensure they are aware of the plans for discharge as soon as possible and no discharge will be made without giving at least 24 hours notice to the carer and Multi-disciplinary Team 3.9 A range of leaflets will be available on the wards, signposting carers to help and information from statutory and voluntary agencies. 3.10 As soon as possible after admission, the carer must be offered a carers by social services assessment and the benefits explained to them. Carers providing substantial care for another person have the right to an assessment of their ability to provide, or continue to provide, care on a regular basis. This includes a right to a carer s assessment even when the cared for person has refused an assessment for, or the provision of, community care services. (A Practitioners Guide to Carers Assessments under the Carers and Disabled Children Act 2000) 4. Discharge 4.1 As the carer will resume responsibility following discharge, it is in everyone s interest to ensure that the carer has the relevant information and skills to manage at home with the appropriate support. It is important that the Multi-disciplinary Team is aware of the role the carer will take following discharge; ensuring that the carer is willing to take on the responsibilities, this will not only aid patients and carers, but will also help to prevent readmissions. 4.2 The Discharge Policy (refer to the Trust Discharge Policy) should be adhered to and a named discharge nurse allocated to the patient and carer to enable a smooth discharge planning process. 4.3 The Multi-disciplinary Team involved with the discharge planning process will ensure that adaptations to the home and the required package of care is ready to be implemented as soon as the patient is discharged. Community Matrons will have been approached with a referral and their decision to accept the patient onto their case load will be known prior to discharge. 4.4 A carers assessment will have been carried out and any recommended carer support, such as respite, discussed and implemented. 4.5 Care for the Carers has a Hospital Liaison Worker. Their role is to provide information, advice and support to carers whilst the person they care for is in hospital or they are accessing hospital services. The Hospital Liaison Worker is based at both the Eastbourne District General Hospital and the Conquest Hospital in Hastings. They will ensure that ensure that the carer is aware of all available specialist organisations, e.g. Care of the Carers, Crossroads, Age Concern, Alzheimer s Society, Association of Carers. Page 4 of 5
5. References National Carers Strategy, 2001 Policy for Consent to Examination and Treatment. ESHT 2004 A Practitioners Guide to Carers Assessments under the Carers and Disabled Children Act 2000 Page 5 of 5