CURRICULUM

Domain – Disability care (case)

May 18, 2024 / No Comments

Mark, a 48-year-old regular patient from a residential group home has been brought in by his carers after having a fall yesterday. Mark has severe intellectual disability, epilepsy and a history of disinhibited behavioural disturbances.

Mark is on multiple medications including valproate, levetiracetam, sertraline, risperidone and quetiapine. He has difficulty answering clinical questions correctly and is mostly nonverbal. He is usually quite happy to see you but today appears silent and withdrawn. He limps to your room. Overnight he was quite agitated, and staff gave him stat temazepam as prescribed by another doctor. 

What communication strategies could you use to take a history and perform a clinical examination?

What issues about consent will you need to consider with Mark?

What assistive technology could you use to communicate with him?

How would you approach this consultation if English was not Mark’s first language?

Communication Strategies

  1. Use Simple Language and Clear Instructions:
    • Speak slowly and use simple, clear language.
    • Avoid medical jargon or complex sentences.
    • Use yes/no questions when possible.
  2. Non-Verbal Communication:
    • Pay close attention to Mark’s body language, facial expressions, and gestures.
    • Use visual aids or picture cards to help convey information or ask questions.
  3. Involve Carers:
    • Engage with the carers who know Mark well. They can provide valuable insights into his baseline behavior and recent changes.
    • Ask carers to help interpret Mark’s non-verbal cues.
  4. Patience and Reassurance:
    • Allow Mark extra time to respond to questions or instructions.
    • Provide reassurance and maintain a calm, comforting demeanor.
  5. Use of a Familiar Environment:
    • If possible, conduct the examination in a familiar and comfortable setting for Mark to reduce anxiety.

Issues About Consent

  1. Assessing Capacity:
    • Determine if Mark has the capacity to give informed consent. Given his severe intellectual disability, he may not be able to provide consent independently.
  2. Substitute Decision-Maker:
    • If Mark lacks capacity, identify a legally authorized substitute decision-maker (e.g., a guardian or family member) to provide consent on his behalf.
  3. Best Interests:
    • Ensure that any decisions made are in Mark’s best interests, considering his known preferences and welfare.
  4. Documenting Consent:
    • Document the consent process thoroughly, noting who provided consent and the rationale for any decisions made.

Assistive Technology

  1. Communication Apps:
    • Use apps designed for non-verbal individuals that utilize pictures, symbols, or text-to-speech functionalities to facilitate communication.
  2. Picture Boards or Cards:
    • Implement the use of picture boards or communication cards to help Mark express his needs and understand questions.
  3. Voice Output Communication Aids (VOCAs):
    • Devices that produce spoken words when symbols or pictures are pressed can be useful.

Approach If English Is Not Mark’s First Language

  1. Interpreter Services:
    • Arrange for a professional medical interpreter who is fluent in Mark’s primary language. This can be done through in-person services or via phone/video.
  2. Bilingual Carers:
    • Utilize carers who speak Mark’s primary language to facilitate communication.
  3. Translated Materials:
    • Provide written or pictorial materials in Mark’s primary language to aid understanding.
  4. Cultural Sensitivity:
    • Be mindful of cultural differences in communication styles and medical understanding. Adapt your approach to be respectful of Mark’s cultural background.
  5. Clear Documentation:
    • Ensure all communication and decisions made are clearly documented, including the use of interpreters or translated materials.

Clinical Examination Approach

  1. General Observation:
    • Begin with general observation of Mark’s behavior, gait, and any signs of distress or discomfort.
  2. Focused Examination:
    • Perform a gentle and focused examination of the area affected by the fall, ensuring to explain each step clearly and seek non-verbal consent.
  3. Pain Assessment:
    • Use non-verbal pain scales or indicators to assess Mark’s pain level.
  4. Behavioral Assessment:
    • Assess for any signs of agitation or changes in behavior that could indicate pain, discomfort, or other underlying issues.
  5. Involve Carers:
    • Have carers assist during the examination to help keep Mark calm and to provide insight into his usual responses and behaviors.

By adopting these strategies, you can provide a thorough and compassionate assessment of Mark while adhering to Australian health practice guidelines.

How would you gather additional information about the fall and subsequent agitation overnight?

How would you arrange investigations? How you would obtain investigations if this was a rural location or an after-hours consultation?


Gathering Additional Information

  1. Interview Carers:
    • Details of the Fall:
      • Ask the carers to describe the circumstances of the fall, including the time, location, and how it happened.
      • Inquire about any immediate injuries or symptoms noticed after the fall.
    • Agitation Overnight:
      • Ask about Mark’s behavior overnight, including what specific actions or signs indicated agitation.
      • Inquire if there were any potential triggers for the agitation, such as pain, discomfort, or environmental changes.
  2. Review Care Records:
    • Look at Mark’s care records for documentation of the fall and any interventions provided.
    • Check for notes on his usual behavior and any recent changes.
  3. Medication Review:
    • Review his medication administration records to see if any doses were missed or given differently around the time of the fall.
    • Check for recent changes in medication that might have contributed to his agitation.
  4. Direct Observation:
    • Observe Mark for any signs of injury, pain, or distress that might be linked to the fall.
    • Note any changes in his gait or physical condition.

Arranging Investigations

  1. Initial Physical Examination:
    • Perform a thorough physical examination to identify any immediate signs of injury or pain.
  2. Basic Investigations:
    • Order basic investigations such as X-rays if a fracture is suspected, or CT scans if there is a concern for head injury, depending on the physical findings.
  3. Blood Tests:
    • Consider ordering blood tests to check for any underlying issues that might be contributing to his agitation, such as electrolyte imbalances or infection.

Investigations in a Rural Location or After-Hours Consultation

  1. Local Resources:
    • Identify the nearest facility capable of performing necessary investigations. This may include a local hospital, urgent care center, or medical imaging facility.
    • Utilize telehealth services to consult with specialists if needed.
  2. Transport Arrangements:
    • If investigations cannot be performed locally, arrange for transport to the nearest appropriate facility. This could involve using an ambulance or patient transport service.
  3. Point-of-Care Testing:
    • Use point-of-care testing devices available in rural or after-hours settings for immediate assessments (e.g., portable X-ray machines, basic blood tests).
  4. Follow-Up Plan:
    • If comprehensive investigations cannot be performed immediately, create a follow-up plan for Mark. This might include:
      • Monitoring his condition closely for any changes or deterioration.
      • Scheduling the necessary investigations at the earliest opportunity when facilities are available.
      • Ensuring that carers are informed about signs to watch for and when to seek immediate help.
  5. Communication with Other Providers:
    • Coordinate with local healthcare providers, including GPs, hospitals, and allied health professionals, to ensure continuity of care and appropriate follow-up.
  6. Documentation:
    • Document all findings, discussions, and plans thoroughly, ensuring that any healthcare providers who may see Mark subsequently have a complete understanding of the situation.

How do you identify an acutely unwell patient with impaired communication/cognition?

If Mark were an Aboriginal or Torres Strait Islander, how would your differentials change (eg undiagnosed diabetes or renal disease)?

Identifying an Acutely Unwell Patient with Impaired Communication/Cognition

  1. General Observation:
    • Behavioral Changes:
      • Look for changes in behavior such as increased agitation, withdrawal, or lethargy.
    • Physical Signs:
      • Observe for signs of distress, pain, or discomfort.
      • Note any new or worsening symptoms such as limping, difficulty breathing, or unusual movements.
  2. Vital Signs:
    • Check Vital Signs:
      • Measure blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
      • Note any deviations from Mark’s baseline readings.
  3. Physical Examination:
    • Focused Examination:
      • Perform a thorough physical exam, paying attention to areas where Mark shows signs of pain or discomfort.
      • Look for bruises, swelling, or other signs of injury.
    • Neurological Assessment:
      • Assess Mark’s level of consciousness, pupil responses, and motor function.
  4. Input from Carers:
    • Behavioral Baseline:
      • Ask carers about Mark’s usual behavior and any recent changes.
    • Specific Symptoms:
      • Inquire about any signs they have noticed, such as changes in appetite, sleep disturbances, or unusual vocalizations.
  5. Use of Pain Scales and Tools:
    • Non-Verbal Pain Scales:
      • Utilize pain assessment tools designed for non-verbal patients, such as the Wong-Baker FACES Pain Rating Scale or FLACC scale.
  6. Medical History:
    • Review Records:
      • Check Mark’s medical records for recent changes in medication, ongoing medical conditions, and previous episodes of acute illness.

Differentials in an Aboriginal or Torres Strait Islander Patient

When assessing an Aboriginal or Torres Strait Islander patient like Mark, consider additional differentials due to the higher prevalence of certain conditions in these populations:

  1. Undiagnosed Diabetes:
    • Symptoms to Watch For:
      • Hyperglycemia or hypoglycemia symptoms, such as confusion, weakness, or altered consciousness.
    • Investigations:
      • Check blood glucose levels, HbA1c if indicated.
  2. Chronic Kidney Disease:
    • Symptoms to Watch For:
      • Edema, changes in urine output, hypertension, or symptoms of uremia (nausea, fatigue).
    • Investigations:
      • Assess renal function through blood tests (e.g., creatinine, eGFR) and urine analysis.
  3. Infections:
    • Higher Susceptibility:
      • Be vigilant for signs of infections like skin infections, respiratory infections, or sepsis.
    • Investigations:
      • Perform appropriate cultures and blood tests to identify infections.
  4. Cardiovascular Disease:
    • Symptoms to Watch For:
      • Chest pain, shortness of breath, or unexplained fatigue.
    • Investigations:
      • ECG, cardiac enzymes, and other relevant cardiovascular assessments.
  5. Rheumatic Heart Disease:
    • Symptoms to Watch For:
      • Symptoms of heart failure or valvular dysfunction.
    • Investigations:
      • Echocardiography, auscultation for murmurs.

Culturally Appropriate Approach

  1. Engage with Cultural Liaison Officers:
    • Utilize Aboriginal or Torres Strait Islander health workers or liaison officers to facilitate communication and provide cultural support.
  2. Cultural Sensitivity:
    • Be aware of cultural beliefs and practices that might influence Mark’s healthcare. Show respect for his cultural background and traditions.
  3. Family and Community Involvement:
    • Involve family members and community elders in the care process, respecting their role in decision-making and support.
  4. Holistic Approach:
    • Consider the social determinants of health, including housing, access to healthcare, and social support, which can impact Mark’s health outcomes.
  5. Education and Support:
    • Provide health education in a culturally appropriate manner, ensuring that Mark and his carers understand the condition and management plan.

By considering these differentials and adopting a culturally sensitive approach, you can provide comprehensive and respectful care to Mark, ensuring that all potential health issues are appropriately addressed.

What factors would you consider with regards to Mark in the community versus the emergency department?

If Mark were an Aboriginal or Torres Strait Islander, what specialised services or personnel could you include as part of your management plan?

How do you approach polypharmacy in residential care?

Factors to Consider: Community vs. Emergency Department

In the Community

  1. Continuity of Care:
    • Ensure Mark’s primary care team and regular carers are involved.
    • Maintain familiarity and consistency in his environment to reduce anxiety and agitation.
  2. Support Systems:
    • Utilize community health services, including home visits from nurses or allied health professionals.
    • Engage with disability support services for additional assistance and monitoring.
  3. Access to Care:
    • Evaluate the availability of necessary medical resources and interventions in the community.
    • Consider telehealth consultations for specialist input without needing to transport Mark.
  4. Monitoring and Follow-Up:
    • Implement regular check-ins to monitor Mark’s condition.
    • Schedule follow-up appointments with his GP or specialists as needed.

In the Emergency Department

  1. Urgency of Care:
    • Address acute issues promptly, such as pain, potential fractures, or seizures.
    • Utilize the ED’s resources for comprehensive diagnostics and immediate treatment.
  2. Specialist Assessment:
    • Access to specialists, such as neurologists or psychiatrists, for a thorough evaluation.
    • Perform necessary imaging or laboratory tests that are not available in the community.
  3. Environment Considerations:
    • Be mindful of the potentially stressful ED environment for Mark.
    • Provide a quiet, private space if possible and involve carers to help keep him calm.
  4. Transition of Care:
    • Plan for Mark’s return to the community, ensuring all follow-up care and support are in place.
    • Communicate with his primary care team about the outcomes and any changes in his management plan.

Specialised Services or Personnel for Aboriginal or Torres Strait Islander Patients

  1. Aboriginal Health Workers:
    • Include Aboriginal Health Workers or Liaison Officers who can bridge cultural gaps and improve communication.
  2. Cultural Support Services:
    • Utilize local Aboriginal or Torres Strait Islander health services that offer culturally appropriate care.
  3. Community Elders:
    • Involve community elders in the care process, respecting their input and decisions.
  4. Holistic Health Programs:
    • Access programs that address the social determinants of health, such as housing, nutrition, and social support.
  5. Telehealth Services:
    • Use telehealth to connect with specialists who are experienced in Indigenous health.

Approach to Polypharmacy in Residential Care

  1. Regular Medication Reviews:
    • Conduct regular reviews of Mark’s medications to assess the necessity, effectiveness, and potential interactions of each drug.
    • Involve a pharmacist in these reviews to provide expertise on polypharmacy management.
  2. Minimize Medications:
    • Aim to simplify Mark’s medication regimen by discontinuing any non-essential medications.
    • Prioritize medications that have clear benefits and are essential for his health.
  3. Monitor for Side Effects:
    • Closely monitor Mark for any side effects or adverse reactions to his medications.
    • Educate carers on recognizing and reporting side effects promptly.
  4. Assess Cognitive Impact:
    • Evaluate the impact of medications on Mark’s cognitive function, especially considering his intellectual disability.
    • Adjust medications that may exacerbate cognitive impairment or behavioral disturbances.
  5. Involve a Multidisciplinary Team:
    • Engage a multidisciplinary team, including doctors, nurses, pharmacists, and allied health professionals, to develop a comprehensive medication management plan.
  6. Communication with Carers:
    • Ensure clear communication with Mark’s carers about his medication regimen, including the reasons for each medication, possible side effects, and the importance of adherence.
    • Provide written and verbal instructions to support carers in administering medications correctly.
  7. Individualized Care Plans:
    • Create individualized care plans that consider Mark’s specific needs, preferences, and health conditions.
    • Regularly update these plans based on changes in his health status or medications.

By considering these factors and incorporating specialized services, you can provide holistic and culturally sensitive care for Mark, ensuring his well-being in both community and emergency department settings.

Factors to Consider: Community vs. Emergency Department

In the Community

  1. Continuity of Care:
    • Ensure Mark’s primary care team and regular carers are involved.
    • Maintain familiarity and consistency in his environment to reduce anxiety and agitation.
  2. Support Systems:
    • Utilize community health services, including home visits from nurses or allied health professionals.
    • Engage with disability support services for additional assistance and monitoring.
  3. Access to Care:
    • Evaluate the availability of necessary medical resources and interventions in the community.
    • Consider telehealth consultations for specialist input without needing to transport Mark.
  4. Monitoring and Follow-Up:
    • Implement regular check-ins to monitor Mark’s condition.
    • Schedule follow-up appointments with his GP or specialists as needed.

In the Emergency Department

  1. Urgency of Care:
    • Address acute issues promptly, such as pain, potential fractures, or seizures.
    • Utilize the ED’s resources for comprehensive diagnostics and immediate treatment.
  2. Specialist Assessment:
    • Access to specialists, such as neurologists or psychiatrists, for a thorough evaluation.
    • Perform necessary imaging or laboratory tests that are not available in the community.
  3. Environment Considerations:
    • Be mindful of the potentially stressful ED environment for Mark.
    • Provide a quiet, private space if possible and involve carers to help keep him calm.
  4. Transition of Care:
    • Plan for Mark’s return to the community, ensuring all follow-up care and support are in place.
    • Communicate with his primary care team about the outcomes and any changes in his management plan.

Specialised Services or Personnel for Aboriginal or Torres Strait Islander Patients

  1. Aboriginal Health Workers:
    • Include Aboriginal Health Workers or Liaison Officers who can bridge cultural gaps and improve communication.
  2. Cultural Support Services:
    • Utilize local Aboriginal or Torres Strait Islander health services that offer culturally appropriate care.
  3. Community Elders:
    • Involve community elders in the care process, respecting their input and decisions.
  4. Holistic Health Programs:
    • Access programs that address the social determinants of health, such as housing, nutrition, and social support.
  5. Telehealth Services:
    • Use telehealth to connect with specialists who are experienced in Indigenous health.

Approach to Polypharmacy in Residential Care

  1. Regular Medication Reviews:
    • Conduct regular reviews of Mark’s medications to assess the necessity, effectiveness, and potential interactions of each drug.
    • Involve a pharmacist in these reviews to provide expertise on polypharmacy management.
  2. Minimize Medications:
    • Aim to simplify Mark’s medication regimen by discontinuing any non-essential medications.
    • Prioritize medications that have clear benefits and are essential for his health.
  3. Monitor for Side Effects:
    • Closely monitor Mark for any side effects or adverse reactions to his medications.
    • Educate carers on recognizing and reporting side effects promptly.
  4. Assess Cognitive Impact:
    • Evaluate the impact of medications on Mark’s cognitive function, especially considering his intellectual disability.
    • Adjust medications that may exacerbate cognitive impairment or behavioral disturbances.
  5. Involve a Multidisciplinary Team:
    • Engage a multidisciplinary team, including doctors, nurses, pharmacists, and allied health professionals, to develop a comprehensive medication management plan.
  6. Communication with Carers:
    • Ensure clear communication with Mark’s carers about his medication regimen, including the reasons for each medication, possible side effects, and the importance of adherence.
    • Provide written and verbal instructions to support carers in administering medications correctly.
  7. Individualized Care Plans:
    • Create individualized care plans that consider Mark’s specific needs, preferences, and health conditions.
    • Regularly update these plans based on changes in his health status or medications.

Preventive and population health

How would you ensure your prescribed management plan is adhered to by the group home?

Ensuring Adherence to the Management Plan in a Group Home

  1. Clear Communication:
    • Provide a detailed and clearly written management plan.
    • Use simple language and avoid medical jargon to ensure understanding.
  2. Training and Education:
    • Conduct training sessions for the group home staff on Mark’s specific needs and the importance of adhering to the management plan.
    • Include practical demonstrations if necessary.
  3. Regular Follow-Up:
    • Schedule regular follow-up visits or calls to monitor Mark’s progress and adherence to the plan.
    • Ensure there is a point of contact for the staff to ask questions or report issues.
  4. Documentation:
    • Ensure that the management plan is documented and easily accessible to all staff members.
    • Keep a record of any changes or updates to the plan.
  5. Involvement of a Case Manager:
    • Assign a case manager or coordinator to oversee the implementation of the plan and act as a liaison between the healthcare team and the group home staff.

If Mark were younger and still living at home, how would you help the family to follow your management plan?

Supporting a Younger Mark Living at Home

  1. Family Education:
    • Provide comprehensive education to the family about Mark’s condition and the management plan.
    • Offer practical advice and training on how to implement the plan at home.
  2. Written Instructions:
    • Give clear, written instructions that the family can refer to, including signs to watch for and when to seek further medical help.
  3. Support Services:
    • Connect the family with local support services and resources, such as respite care, counseling, and support groups.
  4. Regular Monitoring:
    • Schedule regular check-ups and follow-up appointments to monitor Mark’s condition and adjust the management plan as needed.

If Mark were younger and planning to remain at home, what are the long-term considerations for both Mark and his carers? How could you support both Mark and his carers?

Long-Term Considerations for a Younger Mark and His Carers

  1. Planning for Future Care Needs:
    • Develop a long-term care plan that anticipates future needs and potential changes in Mark’s condition.
    • Consider the financial, emotional, and physical impact on the family.
  2. Respite Care:
    • Ensure the availability of respite care options to prevent caregiver burnout.
  3. Support Networks:
    • Encourage the development of a support network for both Mark and his carers, including family, friends, and community resources.
  4. Education and Training:
    • Provide ongoing education and training for the carers to equip them with the skills needed to manage Mark’s condition effectively.

In the long term, what role would allied health team members play in this situation?

Role of Allied Health Team Members

  1. Physiotherapist:
    • Help with mobility, strength, and balance training to prevent falls and improve physical function.
  2. Occupational Therapist:
    • Assess and modify the home environment to ensure safety and accessibility.
    • Provide adaptive equipment and strategies to enhance daily living skills.
  3. Speech Therapist:
    • Assist with communication strategies and swallowing difficulties if applicable.
  4. Dietitian:
    • Develop a nutritional plan that meets Mark’s dietary needs and manages any related health conditions.
  5. Psychologist:
    • Offer behavioral therapy and support for both Mark and his carers to manage stress and behavioral issues.

What long-term issues need to be considered as part of Mark’s yearly health assessment (eg falls prevention)?

Long-Term Issues for Yearly Health Assessment

  1. Falls Prevention:
    • Assess Mark’s risk of falls and implement strategies to reduce this risk, such as strength and balance exercises.
  2. Chronic Disease Management:
    • Monitor for chronic conditions such as diabetes, hypertension, and cardiovascular disease.
    • Regularly check blood glucose levels, blood pressure, and lipid profiles.
  3. Mental Health:
    • Screen for mental health issues such as depression and anxiety.
    • Provide appropriate mental health support and referrals.
  4. Medication Review:
    • Conduct regular reviews of Mark’s medications to minimize polypharmacy and manage side effects.
  5. Vaccinations:
    • Ensure that Mark is up to date with vaccinations, including the annual flu vaccine and any other recommended immunizations.

What are some preventive activities that are important to consider in general practice for patients with disability?

Preventive Activities in General Practice for Patients with Disability

  1. Regular Health Screenings:
    • Conduct routine health screenings for early detection of chronic diseases and other health issues.
  2. Health Education:
    • Provide education on healthy lifestyle choices, including diet, exercise, and smoking cessation.
  3. Vaccinations:
    • Ensure patients receive all recommended vaccinations.
  4. Falls Prevention:
    • Implement falls prevention strategies, including home safety assessments and exercise programs.
  5. Mental Health Support:
    • Offer regular mental health assessments and provide access to counseling and psychiatric services if needed.
  6. Oral Health:
    • Encourage regular dental check-ups and good oral hygiene practices.
  7. Social Engagement:
    • Promote social activities and community engagement to prevent isolation and improve overall well-being.

Where would you look for information on referral pathways for patients with disability?

Are there broader systems-based changes you could advocate for in this residential group home to improve patient care?

Sources of Information on Referral Pathways for Patients with Disability

  1. Local Health Networks:
    • Contact local health networks or primary health networks (PHNs) for information on available referral pathways and services for patients with disabilities.
  2. Professional Associations:
    • Consult professional associations such as the Australian Association of Developmental Disability Medicine (AADDM) or the Royal Australian College of General Practitioners (RACGP) for guidelines and resources.
  3. Government Websites:
    • Check government health department websites for information on disability services, referral guidelines, and available support programs.
  4. Community Health Centers:
    • Local community health centers often have information on services and referral pathways for patients with disabilities.
  5. Specialist Disability Services:
    • Engage with specialist disability services such as the National Disability Insurance Scheme (NDIS) for referral information and support options.
  6. Allied Health Professionals:
    • Consult with allied health professionals who work with patients with disabilities for advice on appropriate referral pathways.
  7. Online Databases and Directories:
    • Use online databases and directories that list health services and providers specializing in disability care.

Systems-Based Changes to Improve Patient Care in the Residential Group Home

  1. Staff Training and Education:
    • Implement regular training programs for staff on disability care, behavioral management, and emergency response.
    • Include education on recognizing and responding to signs of acute illness or distress in patients with disabilities.
  2. Standardized Care Plans:
    • Develop standardized care plans for residents with disabilities, ensuring consistency in care and treatment.
    • Regularly review and update these plans based on individual needs and changes in health status.
  3. Improved Communication Systems:
    • Establish robust communication systems between healthcare providers, carers, and family members to ensure coordinated and comprehensive care.
    • Use digital health records to facilitate information sharing and continuity of care.
  4. Enhanced Support Services:
    • Increase access to support services such as counseling, physiotherapy, occupational therapy, and speech therapy.
    • Ensure these services are integrated into the daily routine of the group home.
  5. Regular Health Assessments:
    • Schedule regular health assessments for all residents to monitor their physical and mental health.
    • Implement preventive health measures and early intervention strategies.
  6. Safety and Accessibility Improvements:
    • Conduct regular safety audits of the group home environment to identify and address potential hazards.
    • Make necessary modifications to improve accessibility and safety for residents with mobility issues.
  7. Mental Health Support:
    • Provide access to mental health support services, including counseling and psychiatric care, for both residents and staff.
    • Implement programs to promote mental well-being and resilience among residents.
  8. Family and Community Engagement:
    • Foster greater involvement of family members and community resources in the care of residents.
    • Encourage family participation in care planning and decision-making processes.
  9. Advocacy for Policy Changes:
    • Advocate for policy changes at the organizational and governmental levels to improve funding, resources, and support for disability care.
    • Work with advocacy groups to promote the rights and well-being of individuals with disabilities.
  10. Feedback and Continuous Improvement:
  • Establish mechanisms for regular feedback from residents, families, and staff to identify areas for improvement.
  • Implement a continuous quality improvement process to enhance care and services.

Can your practice software capture information about patients with disability?

How would you ensure recalls for preventive activities are followed through in your software system?

Is your practice ‘disability friendly’ in terms of access, booking of appointments, etc?

Capturing Information About Patients with Disability in Practice Software

  1. Detailed Patient Profiles:
    • Ensure your practice software allows for comprehensive patient profiles that include detailed information about disabilities, including type, severity, and any special requirements.
    • Use customizable fields to capture specific information relevant to each patient’s condition and needs.
  2. Health Summaries:
    • Maintain up-to-date health summaries that include all relevant medical history, current medications, allergies, and care plans.
    • Include information about assistive devices or technologies used by the patient.
  3. Care Plans and Progress Notes:
    • Use the software to document individualized care plans and progress notes, ensuring all healthcare providers have access to consistent and up-to-date information.
    • Record any modifications or updates to care plans promptly.
  4. Communication Preferences:
    • Document preferred methods of communication for patients with disabilities, including whether they require communication aids, interpreters, or other support.
  5. Emergency Contacts and Consent:
    • Record emergency contacts and details of any legal guardians or substitute decision-makers.
    • Ensure consent processes are documented and easily accessible.

Ensuring Recalls for Preventive Activities

  1. Automated Recall Systems:
    • Use the practice software’s automated recall system to set reminders for preventive activities such as vaccinations, health screenings, and regular check-ups.
    • Schedule recalls based on the recommended intervals for each preventive activity.
  2. Customizable Alerts:
    • Set up customizable alerts within the software to notify staff when a patient is due for a preventive service.
    • Ensure alerts are visible during patient appointments and when accessing patient records.
  3. Patient Communication:
    • Utilize the software’s communication features to send reminders to patients via SMS, email, or phone calls.
    • Ensure reminders are accessible and easy to understand, especially for patients with disabilities.
  4. Follow-Up Tracking:
    • Track follow-up appointments and ensure that patients who miss recalls are promptly contacted and rescheduled.
    • Document all attempts to contact patients and follow up on recalls.

Making the Practice ‘Disability Friendly’

  1. Physical Accessibility:
    • Ensure the practice is physically accessible with ramps, wide doorways, and accessible restrooms.
    • Provide clear signage and consider installing automatic doors.
  2. Appointment Booking:
    • Offer multiple ways to book appointments, including online booking, phone calls, and in-person visits.
    • Allow for longer appointment times for patients with disabilities who may require more time.
  3. Staff Training:
    • Train staff on disability awareness and how to provide supportive, respectful care to patients with disabilities.
    • Include training on the use of assistive devices and communication aids.
  4. Flexible Scheduling:
    • Provide flexible scheduling options to accommodate the needs of patients with disabilities, including home visits if necessary.
  5. Assistive Technologies:
    • Ensure the practice is equipped with assistive technologies such as hearing loops, speech-to-text software, and visual aids.
    • Offer materials in alternative formats, such as large print, Braille, or audio.
  6. Patient-Centered Care:
    • Foster an inclusive environment where patients with disabilities feel welcome and valued.
    • Involve patients in their care planning and respect their preferences and choices.
  7. Feedback Mechanisms:
    • Implement a system for patients to provide feedback on their experience at the practice, including accessibility and service quality.
    • Use this feedback to make continuous improvements to the practice’s disability friendliness.

if consent is appropriately gained but the patient is not particularly compliant, what steps are involved in performing a finger prick glucose test and venesection for bloods?

Strategies in the Community or Primary Care Setting

  1. Calm Environment:
    • Ensure the environment is calm and free of distractions to reduce anxiety and agitation.
  2. Involve Carers:
    • Engage with carers or family members who the patient trusts. They can help comfort and reassure the patient.
    • Sometimes familiar faces can help in reducing the patient’s anxiety and improve cooperation.
  3. Distraction Techniques:
    • Use distraction techniques such as talking, playing music, or providing a favorite toy or item.
  4. Behavioral Approaches:
    • Implement behavioral strategies such as positive reinforcement or rewards for cooperation.
    • Use a step-by-step approach, explaining each step briefly and clearly before performing it.
  5. Minimal Restraint:
    • If necessary, use gentle physical guidance or holding techniques to prevent sudden movements and ensure safety. Avoid forceful restraint whenever possible.
    • Any physical assistance should be done by trained personnel to ensure the safety and comfort of the patient.

Consideration for Sedation or Referral to ED

  1. Sedation:
    • Sedation should be considered only when all other methods have failed and the procedure is essential for the patient’s health.
    • Sedation should be administered by trained medical professionals and is usually done in a controlled environment such as a hospital or specialized clinic.
  2. Referral to Emergency Department (ED):
    • If the patient remains non-compliant despite all efforts and the procedures are urgent, refer to the ED.
    • In the ED, there are more resources and personnel to safely manage the situation, including the use of sedation if necessary.

Guidelines in Australia

  1. Guidelines and Ethical Considerations:
    • The use of restraint and sedation must comply with legal and ethical guidelines in Australia. The National Disability Insurance Scheme (NDIS) and other relevant authorities provide guidelines on managing non-compliant patients.
    • The principle of the least restrictive option should always be followed, prioritizing the patient’s dignity and autonomy.
  2. Informed Consent:
    • Ensure that consent is properly documented. In cases where the patient cannot give informed consent, a legal guardian or authorized representative must provide it.
  3. Professional Consultation:
    • Consult with specialists in disability care, such as developmental disability health teams, for additional strategies and support.

How would you access additional support/advice about managing this presentation?

  1. Consult Specialists:
    • Developmental Disability Health Teams: Contact specialized health teams that focus on developmental disabilities for tailored advice and support.
    • Neurologists or Psychiatrists: Consult relevant specialists for input on managing patients with complex needs.
  2. Professional Networks and Associations:
    • Professional Associations: Reach out to associations such as the Australian Association of Developmental Disability Medicine (AADDM) or consult resources from the Royal Australian College of General Practitioners (RACGP).
    • Local Health Networks: Engage with local health networks or primary health networks (PHNs) for guidance and referral options.
  3. Multidisciplinary Team Meetings:
    • Organize case conferences with a multidisciplinary team including doctors, nurses, allied health professionals, and carers to discuss and plan management strategies.
  4. Online Resources and Helplines:
    • Utilize reputable online resources and helplines dedicated to disability support and healthcare.

Some patients with disability have limited communication. How would you recognise a significantly ill patient if this were the case?

What modes of clinical handover might be essential? How would this change in a rural location?

How would you ensure Mark is followed up?

Recognizing a Significantly Ill Patient with Limited Communication

  1. Behavioral Changes:
    • Observe for sudden changes in behavior such as increased agitation, lethargy, withdrawal, or unusual aggression.
  2. Physical Signs:
    • Look for signs of distress, pain, or discomfort such as grimacing, moaning, or guarding a specific area.
    • Check for obvious physical symptoms like fever, rash, swelling, or difficulty breathing.
  3. Vital Signs:
    • Measure vital signs including temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. Note any deviations from the patient’s baseline.
  4. Input from Carers:
    • Ask carers about any recent changes in the patient’s behavior, appetite, sleep patterns, or activity levels.
  5. Use of Pain and Discomfort Scales:
    • Utilize non-verbal pain scales or discomfort assessment tools like the FLACC scale to evaluate pain or distress levels.

Modes of Clinical Handover

  1. Verbal Handover:
    • Structured Approach: Use structured handover tools like ISBAR (Introduction, Situation, Background, Assessment, Recommendation) to ensure comprehensive and clear communication.
    • Face-to-Face Meetings: Whenever possible, conduct face-to-face handovers to allow for questions and clarifications.
  2. Written Handover:
    • Detailed Documentation: Provide detailed written handover notes that include the patient’s medical history, current medications, recent changes, and any ongoing concerns.
    • Care Plans: Include updated care plans and specific instructions for ongoing management.
  3. Electronic Health Records:
    • Shared Access: Use electronic health records (EHR) to share patient information securely with relevant healthcare providers.
    • Updates: Ensure that all updates and changes in the patient’s condition are promptly entered into the EHR.

Handover in a Rural Location

  1. Telehealth:
    • Utilize telehealth services for remote consultations and handovers with specialists and other healthcare providers.
    • Conduct virtual multidisciplinary team meetings to discuss complex cases.
  2. Communication with Local Providers:
    • Establish strong communication channels with local healthcare providers, including GPs, nurses, and allied health professionals.
    • Ensure they have access to all necessary information and resources for managing the patient.
  3. Transport Arrangements:
    • Plan for transport arrangements if the patient needs to be transferred to a larger facility for specialized care.

Ensuring Follow-Up for Mark

  1. Scheduled Follow-Up Appointments:
    • Book follow-up appointments in advance and provide clear instructions to the carers about the schedule.
    • Use reminders via phone calls, SMS, or emails to ensure appointments are not missed.
  2. Regular Check-Ins:
    • Arrange for regular check-ins, either through home visits or telehealth, to monitor Mark’s condition and progress.
  3. Involvement of Carers:
    • Educate carers on the importance of follow-up and how to recognize signs that may require immediate attention.
    • Ensure carers have a direct line of communication to the healthcare team for any concerns between scheduled visits.
  4. Use of Care Coordinators:
    • Assign a care coordinator to oversee Mark’s follow-up care, ensuring all aspects of his health and well-being are addressed.
    • The coordinator can help navigate between different services and ensure continuity of care.
  5. Documentation and Communication:
    • Maintain thorough documentation of all follow-up visits and communications.
    • Share updates with all members of the healthcare team to ensure everyone is informed about Mark’s ongoing care needs and any changes in his condition.

By employing these strategies, you can effectively manage Mark’s care, ensuring he receives the necessary support and follow-up to maintain his health and well-being.

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