Hospital Admission Booklet for Acute Hospital Admissions

Guidelines and Symbols

October 2010

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• Thehospitalinformationbookletaimstoassistinthedevelopmentof individualised careplans forpeoplewith learningdisabilities inhospitalsettings,forexampleTheVictoriaInfirmary,TheSouthernGeneralHospitalorLeverndaleHospitaletc.

• Theseguidelines are intended to support thepersonfilling in thebooklet.

• Itishopedthatthehospitaladmissionbookletwouldbecompletedalongside the person with a learning disability, by someone whoknowsthepersonwell,suchasafamilymemberorapaidworker.

• Thebooklet shouldbe completed as near to the timeof hospitaladmissionaspossible.

• Anewbookletshouldbecompletedforeachtimethepersongoesintohospital.

• Please take the booklet with you when the individual goes intohospitalandgiveittothememberofstaffwhoadmitstheperson.

• ALSO,pleaseremembertotelltheLocalLearningDisabilityTeam(LLDT),oftheadmissionandthatyouarecompletingabooklet,seeattachedsheetforcontactdetails.

• Complete thisbooklet as if youwerewriting it for someonewhodoesn’t know the individual at all, and try to be as accurate aspossible.

• Whencompletingthebooklet, ifyoudonothavetheinformationrequestedoryoudonotknowtheanswer,pleaseindicatethis.

• Makesurethehospitalstaffknowhowtocontactthepersonwhocompletedthebookletortheirproxyincasetheyneedtoaskanyquestions.

• Ifanindividualhastogointohospitalasanemergency,thebookletshouldbecompletedassoonaspossibleafterwards(withinatleastoneday)andhandedintothehospitalwardwherethepersonhasbeenadmitted.

• Please ensure that any aids, adaptations and equipment requiredgoeswiththepersonwhentheyareinhospital.

• Symbols are included at the back of this booklet to supportcommunication.

• TheHospitalInformationBookletaimstoassistinthedevelopmentof individualised care plans for people with Learning Disabilitiesand further inform staff within acute care.The booklet has beendevelopedinpartnershipwithusersandcarersandawiderangeofprofessionals.Thebookletisevidencedbasedandhasbeenpiloted,evaluated and reviewed extensively including Governance bodiesandPartnershipProviderForums.Manythankstoallinvolved.

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Thefollowinginformationmaybeofhelpwhencompletingthehospitaladmission booklet. Please refer to this guidance when completing thebooklet.

Introduction• Thissectionlooksatgatheringkeyinformation.Forpeoplewhoare

supported by paid workers this information may be found in theindividualscareplan.

• This sectioncontainskey informationabout theperson, includingtheirname,addressetc.ItalsoincludesdetailsoftheirGPandLocalLearningDisabilityTeam(LLDT)member.

• The persons care first number is a unique identification numberusedbysocialwork,ifyouhavedifficultyinfindingthiscontacttheLLDT.

• Similarly,thepersonsCHInumberisauniqueidentificationnumberusedbytheNHSitcontainsthepersonsdateofbirthfollowedbya4digitnumber, itshouldbefoundinanyrecentcorrespondence/lettersfromhealthprofessionals.IfyouhavedifficultyinfindingthispleasecontacttheLLDT.

• Ifsomeofthisinformationisunavailableorunknown,thisshouldn’tpreventthebookletbeingcompletedorsentintohospitalwiththeindividual.

• MentalHealthCareandTreatmentAct(MHA)mayapply.

Informationaboutthepersoncompletingbooklet• Thissectionisaboutthepersoncompletingthebooklet,pleasesign

anddateandremembertohighlightyourcontactdetailstothewardstaffincasetheyneedtoaskanyquestions.

HowIcommunicatepain:• This section should be used to provide information on how an

individualcommunicatespain.• Itisimportanttoremember,thatsomepeoplewithlearningdisabilities

areunabletoreportpainandcanhavedifficultyindescribingthetypeandintensityofpainthattheyareexperiencing.

• Peoplewhoknowapersonwell,canbe thekey factor inhelpingothersrecognisewhenapersonwithalearningdisabilityisinpain.

• Pleasewritedownall theways inwhichtheperson indicatespaine.g. thepersoncanverballycommunicatepain,points toanareathatispainful/sore,anybehaviourchanges,theirfacialexpressions/bodylanguagemayindicatepain.

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• Thisinformationshouldbeincludedintheindividualscareplan,orifneedbe,discussthiswithotherpeoplewhoknowthepersontogetafullpicture.

• Youcouldincludeanyhelpfulwaysyouknowtohelpthepersonsmanagepaine.g.redirection,humour,medication,havingabath,havingamassage.

• Itwouldbehelpfultoindicateifthepersonswillaskor indicateiftheyrequirepainkillers(sometimescalledanalgesia).

• •The DisDat is a distress assessment tool. It is designed to helphealth professionals identify distress cues in people with learningdisabilitieswhohaveseverelylimitedcommunication.Pleaseattachiftheindividualhasone.

Healthrisks:• Peoplewithalearningdisabilitycanhaveverycomplexhealthneeds

thatrequirespecialattentionandsupport.• Using the corresponding box to indicate if any of these risks are

presentgivingabriefdescription,youcanexpandonthese issuesusingthespaceontheNotespage.

• Please consider if the person requires close supervision from thehospitalstaffandwhatthingsthehospitalstaffcandotohelpthepersonstaysafe.

Someexamplesare• Eating:

» CantheindividualfeedthemselvesordotheyneedsupportANDwhattypeofsupportisrequired.I.e.onetoone,verbalprompt?

» Cantheindividualtellstaffthattheyarehungryorfullup?» Doesthepersonhavespecificroutinesaroundmealtimes?» Wouldthepersonbeabletounderstandthattheymayhaveto

fast?» Isthereanythingthatimpactsontheperson’sabilitytoeati.e.

sensoryimpairment(visual),dementiaoranyotherconditions?» Doesthepersoneatthingstheyshouldn’t(thisiscalledpica)

• Drinking:» People with learning disabilities may be at risk of dehydration

wheninhospital» Thepersonmaynotbeabletoindicateiftheyarethirstyandmay

notaskstaffforadrink.» Does the person require additional prompts and additional

attentiontomakesuretheydrink?

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» Isthereanythingthatimpactsontheperson’sabilitytodrinki.e.sensoryimpairment(visual),dementiaoranyotherconditions?

» Isthepersonabletotakeadrinkfromabedsidecabinetwithoutsupport?

» Does the person drink excessively or recognise what fluids aresafetodrink?

• Swallowing» Istheindividualatriskofchokingwheneatinganddrinking?» What type of help reduces the chance of the person choking,

i.e. someone helping the person eat, specially prepared foodconsistency.

» Whattypesoffoodanddrinkmakesthepersonchoke?» Isthepersonawareofthisrisk?

• Mobility» Isthepersonmobileordotheyneedsupportandifsowhatkind

ofsupport?» Dotheyrequiresupporttogetinandoutofbed,aretheyatrisk

offallingoutofbed?» Dotheyrequiretobeturnedwheninbed?» Doesthepersonwander?» Is there anything that impacts on the person’s mobility (i.e.

sensoryimpairment(visual),dementiaoranyotherconditions?• Toileting

» Isthepersonabletousethetoiletoraretheyincontinent?» Doesthepersonwearcontinencegarments(pads)?» Does the person have constipation and what helps them with

this?» Doesthepersonhaveacatheter?» Isthepersonabletowalktothetoiletordotheyneedsupport

togetthere?» Doesthepersonrequireverbalpromptstousethetoilet?

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• Epilepsy» Isverycommoninpeoplewithlearningdisabilities.» Pleasewritedownthetypeofseizuresthepersonhasforexample

toniccolonicorpartialseizuresetc.» Pleasenoteanyknowntriggersetc.» Youcouldincludetheirepilepsycareplaniftheyhaveone.» Pleaseincludeanyrescuemedication.» Youcoulddescribethebestwaytohelpthepersonwhenthey

haveaseizureandwhattheyarelikeafterwards.

Please indicate in theboxprovided if the individual experiences anyofthesehealthneeds.

• Visualandhearingimpairment» Visualandhearingimpairmentsareverycommoninpeoplewith

learningdisabilities.» Hearing and visual impairments are frequently unrecognised

andareunder-reportedandcanimpactonapersonsbehaviour,their ability to understand their environment and day to dayinteractions.

» Please remember to send thepersonsglasses, hearing aids etcintohospital.

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Permissiontotreatment,thefollowingpointsmaybeusefultoconsider:

• A welfare guardian is a person appointed by the courts who canlegallymakedecisionsonperson’sbehalfregardingwelfarematters.Awelfareguardiancanmakedecisionsaboutthepersonscareandtreatmentandmustbeconsultedabouttreatmentwhilstthepersonisinhospital.

• Forfurtherinformationpleaseseewww.mwcscot.org.• If the person has a welfare guardian then their name should be

includedinthissection.• If thepersonhasawelfareguardian the informationshouldbe in

theircareplan.IfyouareunsurediscusswithyourlinemanagerorcontactLLDT.

• The individuals support worker is not able to give consent totreatment.

• Pleasedocumentusingthetickboxesanyissuesaboutconsenttomedicaltreatmentthatthehospitalstaffneedtobeawareof.

• Indicateinthespaceprovidedthepeoplethatareinvolvedinhelpingthe individualmakedecisionsabouttheircare, thepersonmayormaynotbetheirwelfareguardian.

• ThelastsectionsuggeststhathospitalmedicalstaffshouldcompleteSECTION47PART5oftheAdultswithIncapacityAct.

• Part 5 of the Adults with Incapacity (Scotland) Act 2000 gives ageneralauthority tomedicalpractitioners totreatpeoplewhoareincapableofconsentingtothetreatmentinquestion.

• Medicalpractitionerswillberesponsiblefordeterminingincapacityandfortheissueofthemedicalcertificateconfirmingincapacity.

• For further information please see www.enable.org.uk/docs/An_Introduction_to_the_Adults_with_Incapacity_Act.pdf

CommunicationProfile• Communicationdifficulties are commonamongst individualswith

learning disabilities and can be a significant barrier to accessingappropriatehealthcare.

• The person may require support with expressing themselves,understanding what is being said and making themselvesunderstood.

• Therefore, it is important that we can provide information abouttheircommunicationneeds.

• Please indicate thepersonsfirst languageandother language the

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personunderstands.• Usingthetickboxes,pleaseadviseontheperson’scommunication

profile.• Please make sure that you involve all the people who know the

person, so that you come to a consensus and are as accurate aspossiblewithyourdescriptions.

• Ifthepersonusesacommunicationaidorpassportensurethatthisgoesintohospitalandstaffareawareofthis.

• Youmaywishtotellthehospitalstaffaboutwhatisthebestwaytocommunicatewiththeperson,whatworksandwhatdoesn’t.

• AdditionalinformationcanberecordedonNotespage.

Medication:• Please note any know medication allergies the persons has, also

indicateanyotherknownallergiesforexamplepenicillinorallergicreactionstofoodetc.

• In the tableprovided,writedownall thepersonsmedicationandincludeany‘overthecounter’medicinesthatthepersontakes.

• Beasaccurateaspossibleandattachthemostrecentprescriptionsheetifyouhaveone.

• Toaidaccuracy,allmedicationinformationMUSTbetakendirectlyfromtheperson’sprescriptionsheetortheprintedmedicationsheetthatisdispensedfromthepharmacist.

• Thisinformationmayalsobefoundonprintedmedicationboxlabelsorprintedlabelsonadosetteboxdispensedfrompharmacist.

• Pleasetrytocompleteallsectionsofthispagesothatstaffarewellinformedaboutmedicationthatthepersonistaking.

• Itisimportantthathospitalstaffknowifmedicationistakenintabletorsyrupform.

• Remembertonoteifmedicationneedstobethickenedortakenwithwater.

• Pleasenoteanyhelpthepersonneedstotaketheirmedicationsuchasdoesthepersonneedtobegiventhemedicationorwillrespondtoaverbalprompt.

• Some people may have to take their medication without theirknowledge.Ifthepersontakestheirmedicationcovertlypleasenotethisandincludetheircovertmedicationpolicy.Thisshouldbefoundintheircareplanandisagreedbytheperson’sfamily,carers,GPandotherprofessionals.

• Forfurtherinformation:www.mwcscot.org.uk/web/FILES/Publications/Covert_Medication.pdf

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• Pleaserememberitisthehospitalstaffsresponsibilitytoensuretherightmedicationisgiven.

Informationaboutgeneralhealth• Pleaseindicatethecauseofperson’slearningdisabilityforexample

geneticcausessuchasdownssyndrome,pre/postnatalinjury.

Specifichealthneeds• Peoplewithlearningdisabilitiescanexperiencespecifichealthneeds

thataremorecommonthan in thegeneralpopulation, thesecanincluderespiratoryproblems,epilepsy,mentalhealthandbehaviourproblems.Peoplewhodonotknowthepersonmayrequirealotofhelptorecognisethesehealthneeds.

• Tohelpsupporttheindividual inhospital, it is importanttolistallknownhealthneeds.Pleasebeasaccurateaspossible,forexampleit is really easy to mix up dysphagia (swallowing problems) withdysphasia(difficultyinspeaking).

• Ifthepersonshasapaidcarer,youshouldgetthisinformationfromthepersonscareplan,youcouldalso lookat letters fromHealth/SocialWorkprofessionalscorrespondence.

• Please include information about the specific health needs forexamplediabetes,epilepsy,respiratoryconditions.

• Ifrequired,youcangiveadditionalinformationonNotespage.

Risk• Peoplewithlearningdisabilitiescanbeatriskofaccidentsandinjuries

occurringwheninhospital.• Inorderforhospitalstafftosupportandkeepanindividualwitha

learningdisabilitysafeitisimportanttheyknowaboutanythingthatmayposearisktothepersoni.e.falls,wandering,aspirationetc.

• Pleasetickappropriatebox,youcantickmorethanonebox.IfyourequiretogiveadditionalinformationpleaseuseNotespage.

Tissueviability• Some people with learning disabilities can have problems with

pressuressores, theycanbruiseeasilyorcanhaveskinormedicalconditionsthatmakethemsusceptibletoskinproblems.

• Tissue viability can include pressure ulcers (bedsores), putting onbandages, or other issues concerning the health of the person’sskin.

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• Pleaseticktheappropriateboxorboxesandclearlymarkanyareasofconcernonthediagram,youcanalsogiveabriefdescriptioninthespaceprovided.

• If you require to give more information please do so on Notespageforexampleindicatetheneedforpressuremattressesorsleepsystems.

Eatinganddrinking• Some Individuals with learning disabilities are at increased risk of

havingeating,drinkingandswallowingdifficulties.• Pleaseindicateasaccuratelyaspossiblewhatthepersonseatingand

drinkingneedsare.• Some people require to have their food and drink prepared to a

certainconsistencyanduseadaptedcrockeryorcutlery.• Otherpeoplerequirefullphysicalsupportwheneatinganddrinking.• Somepeoplewithlearningdisabilitiesrequiretobehavetheirfood

anddrinkthroughanasogastricorgastrostomytube,pleaseinformthestaffofthebestwaytohelpthepersonwiththis.Forexamplethepersonmaybeabletohavesmalltastersoffood.

• Somepeoplemay have routines aroundmeals times for exampletheyeatwithaspoonoreatfoodinaspecificorder.

• Thisinformationshouldbeinthepersonscareplan.

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Activitiesofdailyliving• This is a snapshotof the things that youdo for someone tohelp

themlivetheirlife.

Mobility• Some people with a learning disability require help with their

mobility.• Usethespaceprovidedtohighlightthehelpthepersonneedsto

getabout.• It is important to ensure that any aids e.g. wheel chairs, walking

framesetcgointohospitalwiththeperson.• Please also consider any issues that may impact on the persons

mobilitye.g.footcare,posturalmanagement,theenvironmentetc

Personalhygiene• Somepeoplewithlearningdisabilitiesrequirehelptomaintainand

maximisetheirpersonalcare.• Using the spaceprovided indicatewhathelp thepersonneeds to

wash, dress and clean themselves this can be in the morning orduringtheday.

Toileting• Thiscanincludeincontinence,constipationortheuseofcontinence

garments(pads)andcatheters.• Please note any help the person needs to use the toilet, this can

includeproblemswithincontinence,constipationorwalkingtoandusingthetoilet.noteifthepersonmayneedacommode.

Sleeproutine• Pleaseindicateanysupportneedsorroutinesthepersonhas.

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• Arrangementsfordischarge» Pleasegivecontactdetailsofcarer,typeoftransport,amountof

noticerequiredandanypostdischargemedicationneeds.» Trytokeepinformationsuccinctandaccurate,ensurethecontact

personincontactableevenatnighttime.• Additionalinformation

» Specific health needs, lack of information and communicationbarrierscanimpactontheeffectivecareforpeoplewithlearningdisabilitiesinhospital.

» Itisimportantthatweprovideaccurateandreliableinformation.» Please use this section to cover things like emotional and

behaviouralsupport,thepersonsroutines,likes,dislikesandhowandwhenthepersonpreferstosleep(sleeppattern).

» This page can be used to offer additional information it mayincludesignpostingtospecificsupportplans

» Previoushospitaladmissions» Recentmedicaltestsandwhentheywerecarriedout» Anyfearsorphobiasforexamplegettingbloodtaken,anymedical

interventionssuchashavingacanularinserted.» Risksaroundpullingoutlinesandtubes.

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