Stop Look Care

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. 

It can lead to shock, multiple organ failure and even death if not recognised early and treated promptly. Screening, early intervention and immediate treatment saves lives.

Symptoms of sepsis - NHS

If the person looks unwell or their clinical condition changes for the worse, follow the steps 1 to 3 below.

STEP 1: Could this be due to an infection?

For example:

• Chest or lung infection
• Water, bladder or kidney infection
• Does the person have new tummy or belly pain
• A new severe headache or neck pain 
• A new red rash or swollen joint

STEP 2: Any RED flags present?

• Objective evidence of new or altered mental state 
• Unable to stand or they have collapsed
• Unable to catch breath or barely able to speak
• Very fast breathing (more than one breath every 2 seconds) 
• Unable to feel a pulse at the wrist 
• A fast heartbeat or palpitations (heart rate greater than 130 per minute)
• Not passed urine in 18 hours 
• Non-blanching rash or mottled or blue skin

STEP 3: Any AMBER flags present?

• New confusion or is difficult to wake up
• Fast or irregular breathing
• A fast heartbeat or palpitations (heart rate 91-130 or new dysrhythmia)
• Not passed urine in 12 to 18 hours
• Temperature less than 36˚C

If any RED or AMBER flag is present

This is a time critical condition, immediate action is required:

• Call 999 and seek advice
• Inform ambulance call taker if the person has ‘Red Flag Sepsis’
• Tell the paramedic team about any allergies the person may have (especially antibiotic allergies)

If time allows:

• Find all the person’s medication they currently take and give them to the paramedic
• Inform next-of-kin what is happening and where the patient is going

Before you initiate CPR, ensure that there is not a decision regarding ‘Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR)’ in the person’s Advance Care Plan (see relevant section of this webpage).

Familiarise yourself in advance with the location of the nearest Automatic External Defibrillator.

Rescuers who have not been trained to give rescue breaths using a face shield or pocket mask should do compression only CPR as this can still help save a life. 

Rescuers who have been trained should perform chest compressions and rescue breaths. This can provide additional benefit for children and those who have sustained a cardiac arrest due to not being able to breathe e.g. airway obstruction, choking, drowning and depressed respiratory drive.

First aid - CPR - NHS

 

Urinary Tract Infections (UTIs) affect the urinary tract, including bladder, urethra or kidneys.

Sometimes, a UTI can develop into a severe infection that can cause people to become very ill and may then need to go to hospital.

Complications of a UTI are not normally common but can be serious for older people and can lead to kidney failure or septicaemia. Complications can affect people with pre-existing health problems, such as Diabetes or weakened immune system.

Urinary tract infections (UTIs) - NHS

Dehydration occurs when our bodies don’t have enough water.

Water helps to lubricate the joints and eyes, aids digestion, flushes out wastes and toxins, and keeps the skin healthy.

Dehydration can directly contribute to:

• Increased risk of Urinary Tract Infections (UTls)
• Feeling lightheaded which might cause the individual to fall
• Confusion and irritability 
• Constipation

Dehydration - NHS

Eating a healthy, balanced diet is an important part of maintaining good health, and can help you feel your best.

This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight.

• Eat well - NHS
• The Eatwell Guide - NHS
• Eating a balanced diet - NHS
• Water, drinks and hydration - NHS

Managing your weight

Get information and advice about how to manage your weight if you're overweight or underweight.

• Obesity - NHS
• Managing your weight - NHS
• Unintentional weight loss - NHS

Swallowing difficulties (also sometimes known as “dysphagia”) can be common in people with frailty, neurological conditions, head and neck cancer, respiratory and other conditions. 

Some signs and symptoms of swallowing difficulties include:

• Wet or ‘gurgly’ sounding voice during or after eating or drinking 
• Food, drink or saliva spilling from the mouth
• A feeling of food sticking in the throat 
• Discomfort during eating/drinking 
• Holding food in the mouth
• Coughing during or after eating/drinking 
• Choking (airway blocked by food)
• Recurrent chest infections
• Unintentional weight loss

Swallowing difficulties may impact on the amounts of food and drink that people can manage. 

This can lead to malnutrition, dehydration and reduced quality of life.

A person with swallowing difficulties may experience food, fluid or saliva entering the airway. If the person is unable to effectively clear this, some may enter the lungs, this is called ‘aspiration’.

People who have associated risk factors such as not being mobile or poor oral health may be vulnerable to Aspiration Pneumonia (chest infection).

Some swallowing difficulties and aspiration occur silently, potentially without any of the above signs. They may be detected by unexplained recurrent chest infections.

Dysphagia (swallowing problems) - NHS

Supporting people with swallowing difficulties

Being able to eat and drink safely is fundamental to maintaining health and wellbeing.

Support workers and Carers are in an ideal position to identify concerns about people’s difficulties with eating and drinking and to use first-line safer swallowing strategies to help improve comfort and safety. Some people will require a specialist assessment of swallowing by a Speech and Language Therapist. 

Following specialist Speech and Language Therapy assessment, some individuals may require changes made to the texture of their diet or drinks to make them easier to manage. This is called a modified diet or fluid. Examples of a modified diet might include food being pureed or thickeners being added to drinks. The changes are described using the International Dysphagia Diet Standardisation Initiative descriptors.

It is important to follow a Swallowing Management Plan to reduce the risk of serious complications.

What to do if someone doesn’t want to follow the Swallowing Management Plan:

• Explain why the recommendations have been made.
• Discuss with your supervisor and ensure that the Speech and Language Therapy Team are contacted for further advice / support.

Green flags

• Person is able to swallow with no identified problems.
• Monitor for any change.

Orange flags

• Person is managing mild swallowing difficulties by using First-line Safer Swallowing Strategies.
• No concerns about chest infection, dehydration, weight loss or swallowing has been assessed by a Speech and Language Therapist and specialist recommendations are in place.
• Monitor for any change.

Red flags

• First-line Safer Swallowing Strategies or Speech and Language Therapy guidelines are not helpful or person has new difficulties and is at high risk such as being susceptible to chest infection.
• Seek specialist support as appropriate.
  • Contact the GP if person unwell or at high risk of potential harm.
  • Refer to Speech and Language Therapy.

Good oral health care enables people to eat, speak and socialise. Carers play an important role in supporting people to maintain good oral health. Carers are ideally placed to monitor changes in an individual’s mouth and refer on as appropriate.

Gum disease and poor oral health may increase the risk of all kinds of other health complications, including:

• Lack of appetite
• Malnutrition
• Heart disease
• Diabetes
• Pneumonia

Green flags for mouth care

• Mouth is healthy, clean and moist
• Teeth and dentures are clean and not painful
• No further action required

Orange flags for mouth care

• Mouth is dry, food and bits remain around teeth
• Teeth and dentures are broken or dirty
• Monitor, document and support individual with mouth care, if needed, and explain the importance of mouth care to the individual

Red flags for mouth care

• Mouth is inflamed, dry and sore or ulcerated
• Teeth are painful or very mobile
• The face is swollen
• Seek additional support on day identified from GP or their own Dentist and document

Supporting someone with their mouth care

• Oral health for adults in care homes - NICE
• Caring for my teeth and gums - Oral Health Foundation

Explain how you are going to support them, as some people can feel anxious. Encouraging individuals to look in the mirror whilst being supported will enable them to see what is happening. It can be easier for the carer to stand slightly behind, or to the side, when supporting individuals with oral health care.

Ensure the person is comfortable and ensure that you are not rushed. Remember you may not be able to support brushing the person’s whole mouth in one go.

Support the person twice a day to clean their teeth. Replace the tooth brush every three months or sooner if required (eg. when the bristles are splayed).

Dentures which do not fit well can affect eating, drinking and speaking and can be uncomfortable.

Some individuals’ gums may bleed when brushing, this is a sign that their gums are unhealthy. The only way to improve gum condition is to gently brush the bacteria away. Teeth should be brushed in a circular motion with a small ‘pea sized’ amount of toothpaste.

Encourage people to spit out after brushing and not to rinse. It is better to leave a little toothpaste residue in the mouth to maintain fluoride concentration levels.

The frequency and amount of sugary food and drink should be reduced and where possible, kept to mealtimes.

Frequent oral health care is important for those who are unable to take any food or drink orally. It is important to minimise oral bacteria that might enter the airways or lungs, as well as optimising oral comfort.

Ensure dentures are labelled in a denture pot, as these can go missing when individuals are admitted to hospital. Loss of dentures may cause great distress and can be expensive and time consuming.

Support individuals with false teeth to clean them daily. Dentures should be removed and cleaned at night. Consult their dentist regarding the need to soak them in plain water overnight or not.

Ensure when the person’s dentures are removed, they do not have any residual food left in their mouth.

Maintaining good skin condition is really important; pressure damage can have a huge impact on an individual’s wellbeing, causing pain and distress.

Carers are ideally situated to monitor an individual’s skin condition. The parts of the body that are at higher risk of developing pressure damage are:

Shoulders or shoulder blades

• Elbows
• Back of the head
• Rims of the ears
• Knees, ankles, heels or toes
• Spine
• Tail bone (the small bone at the bottom of the spine)

Wheelchair users are at risk of developing pressure damage on:

• Buttocks
• The back of arms and legs
• The back of the hip bone

Pressure ulcers (pressure sores)

Supporting and encouraging a person with regular changes of position is important to prevent and maintain good skin condition. 

They may need prompting to do this and may need your help or further assistance. 

How often to reposition either in bed or in a chair/ wheelchair is based on individual assessments. Ask if you are not sure.

If the person has pressure-relieving equipment, check it. If you have any concerns or if it is not working or damaged, contact the equipment store where it was delivered from. Equipment should be regularly serviced. 

Remember, individuals with Alternating (Air) Mattresses still need regular repositioning.

If the person does not have pressure-relieving equipment and you have concerns about them refer to their GP for signposting.

If pressure relieving equipment has been provided but not used appropriately and this results in a pressure damage consider a safeguarding referral.

What to look for

Green flags

• Skin intact and good colour
• No further action required, follow skin-care guidance above.

Orange flags

• Skin is painful, swollen, discoloured (for a short time only and returns to normal quickly) or sweaty.
• If the individual has reduced mobility or is unwell or has very thin skin or poor nutrition or hydration, they are at increased risk of pressure damage. This can be permanent or temporary.
• Follow skin care guidance above.
• Refer on for further support, monitor and document as needed.

Red flags

• If you see discoloured skin that does not turn white when pressure is placed on it or any of the signs below, the person could be starting to develop pressure damage.
• Skin is red, blistered or broken or open.
• Seek additional support on day identified from GP, or community nurse if known to them and document.

Skin excoriation tool

Healthy Skin

• No evidence of tissue damage, no erythema (redness).
• Skin can be cleaned with mild soap and water, soap substitute or skin cleanser. Apply small amount of moisturiser to keep skin healthy and hydrated.
• No further action required, follow skin-care guidance on previous pages

Mild Excoriation

• Erythema (redness) no broken skin.
• No moisture lesions but area may be uncomfortable to clean and apply creams.
• Clean area gently with soap substitute or skin cleanser.
• Apply thin layer of Medi Derma-S every 12 hours. Allow it to absorb.
• Consider the cause.
• If erythema is diffuse and satellite lesions present, consider fungal infection and treat accordingly.
• Consider allergy or contact dermatitis.

Moderate Excoriation

• Extensive erythema with diffuse broken skin and moisture lesions.
• Moderate exudate and may bleed on contact.
• Painful to clean and apply cream.
• Gently clean with soap substitute or skin cleanser.
• Apply Medi Derma-S film/ Cavilon Barrier spray once every 48 hours. Allow ir to absorb. Do not rub vigorously.
• Consider causes such as fungal infection, allergy, continence issues and pad absorbency.
• Refer to district or community nursing team if not improving.

Severe Excoriation

• More than 50% broken skin and moisture lesions.
• Bleeds easily.
• Extremely painful on movement, passing urine or faeces, when cleaned and creams applied or exposed to air.
• Gently clean with soap substitute or skin cleanser.
• Pat dry as much as possible.
• Apply Medi Derma-S / Cavilon Barrier Film spray once every 48 hours or apply a liberal layer of Proshield Plus to the excoriated skin at every toileting session.
• Allow to absorb. Do not rub vigorously.
• Consider a faecal management system and/or short term urinary catheter.
• Consider causes such as fungal infection.
• Refer to district or community nursing team.

Mobility and prevention of falls is fundamental in supporting people to retain their independence.

Falls can have a significant effect on people’s health.

Keeping people mobile can reduce the incidence of infections and pressure damage.

It is important that people seek early intervention from specialists to maintain mobility. A fall may affect confidence levels; it may also increase anxiety and reduce mobility levels.

If the answer is yes to any of the 3 questions below, consider a referral to your local Falls Service Team:

1. Has the person fallen in the last year?
2. Do they have problems with their strength and balance when walking?
3. Do they have a fear of falling?

Falls - NHS

NHS advice on exercises for older people, which can be undertaken in the home including exercising when seated and exercises to improve balance, flexibility and strength.

Physical activity guidelines for older adults

Green flags

• Mobility
  • Independently mobile with or without aids
  • No further action required
• Falls Risk
  • Good mobility, good mental status and good confidence
  • No further action required
• Encouraging people to increase their strength and balance through exercises will help maintain mobility and reduce the risk of falls. Consider introducing the Get up and Go Booklet and signposting to local exercise groups.

Orange flags

• Mobility
  • Needs assistance beyond their usual level
  • Monitor and document, consider further advice and support
• Falls Risk
  • Near misses, unsteadiness, reduced confidence
  • Monitor and document, consider further advice and support from GP, or Community Nurse/Physiotherapist or Community Falls Service Team.

Red flags

• Mobility
  • Can no longer move independently when could before Seek additional support and advice on the day identified and document
• Falls Risk
  • Recent falls, falls causing injury, dementia or medication affecting balance and coordination
  • Seek additional support and advice on the day identified from GP, and document. Consider 999, if fallen and injured

Falls prevention

Preventing falls among adults is a crucial aspect of safeguarding their well-being, particularly as they age. 

One of the primary strategies is to conduct a comprehensive assessment of their living environment. Identifying and rectifying potential hazards within the home, such as loose carpets, cluttered walkways, or inadequate lighting, significantly reduces the risk of falls.

Falls - Prevention - NHS

Follow the guidance below to help prevent a fall.

Environmental

• Keep rooms and stairways lit, using the brightest bulb available, try low energy light bulbs to reduce bills, but remember they take a minute or two to warm up.
• Remove clutter, trailing wires and frayed carpet.
• Mop up spillages.
• Use non-slip mats and rugs, or ensure they are tacked down or removed.
• Make sure there are suitable grab rails around the house if needed.
• Ensure easy access to a commode or toilet. Ensure appropriate clothing to ease independence.
• Use a nightlight.
• Try not to rush around in the home.
• Make sure cats or dogs have bright collars or bells to help prevent tripping over them.

Impaired sight and hearing

• Support those who wear glasses to keep them on or have them close by; Make sure they are clean and in good condition and are the right prescription.
• If vision seems to be deteriorating, check they have had a recent eye test. If not, refer to optician.
• As a minimum, you should have an annual eye test.
• Is hearing reduced? Check hearing aids for wax, check for cleanliness. Do they need a hearing test?

Mobility and balance

• Walking aids: Provide and encourage the consistent use of assistive devices like walking sticks or zimmer frames to enhance stability and mobility, making sure they are identifiable, accessible and well maintained. 
• Refer to a physiotherapist if there are concerns with mobility.
• Promote physical activity and mobility. Encourage participation in tailored exercise routines that focus on improving strength, balance, and flexibility, as well as walking and dancing. These can significantly reduce the risk of falls.

Confusion and cognitive impairment

Dementia can affect the signals the brain receives therefore people with Dementia can be particularly at risk of falls. 

Contrasting colours on rails, in bedrooms, stairs, bathroom doors/baths can help as well as visual cues/pictures on doors and personalising resident walking aids.

Feet, footwear and clothing

• Check the condition of feet; check for pain, problematic bunions or toenails. If necessary seek the advice of a podiatrist.
• Check that footwear is suitable, fits well, is in good condition and supports the ankle.
• Ensure shoes and slippers have non-slip soles.
• Ensure that clothing allows the person to move their legs and feet freely. Encourage people not to wear clothes that are too tight or too loose-fitting. Trailing clothes might trip them up.
• Use footwear with Velcro or laces, so they can be adjusted if feet swell.

Illnesses and medication

• If known to have low blood pressure when standing (Postural Hypotension), advise to stand for 10-12 seconds before walking.
• If complaining of dizziness, ensure eating and drinking adequately. You may need to seek support from a Community Nurse, GP or Pharmacist.
• Ensure proper management of medication. Have regular medication reviews to check for side effects and interactions that might contribute to dizziness or instability.
• Medications may cause imbalance. Be aware if taking four or more medications or starting new medication. Seek support from a Pharmacist.
• Those who are over 65 years should have an annual medication review.

Hydration and nutrition

• Promote a healthy diet and sufficient hydration.
• Nutritional deficiencies and dehydration can significantly contribute to weakness, constipation, lack of energy, low blood pressure and therefore an increased risk of falls.

Frailty varies in severity; people should not be labelled as ‘frail’ rather described as living with frailty. It is important to establish their baseline functioning in terms of frailty.

Signs of frailty can include:

• Falls - collapse, legs giving way
• Immobility - sudden change in mobility
• Delirium - sudden change in levels of confusion
• Incontinence - change or worsening in continence 
• Medication - change or increase in side effects

People living with frailty can have a fine balance between vulnerability and resilience. Encourage people to:

• Maintain physical activity can improve strength and balance.
• Eat a healthy diet, and drinking enough fluids can help minimise the impact of frailty. Carers should check how much fluid people have had, particularly those dependent for support.

Although these symptoms can indicate frailty, there can sometimes be a straightforward explanation with no further problems. It is always best to get the person reviewed by a GP, if concerned.

Green flags

• Person fit and active, independent with most activities of daily living, washing, dressing, provision of food.
• No further action required.

Orange flags

• Person less fit and active, requires some support with activities of daily living, monitor and support in a person-centred way.
• Document as this enables better detection of increased frailty.

Red flags

• Change in person’s level of independence; appears frailer.
• Seek additional support and advice from GP or Community Nurse on the day identified and document.

Personalised Frailty Assessment

You may wish to use the Rockwood frailty scale to measure a person’s clinical frailty.

This scale has only been validated in older people over 65 but not for individuals with learning disability or people with stable long-term disability such as cerebral palsy.

Rockwood frailty scale - NHS

There are a number of different respiratory problems which can affect people, these include:

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Fibrosis 

People with respiratory problems can require extra time support and patience with their activities of daily living, particularly activities which may cause them to become breathless. Breathlessness can increase anxiety in people, so being calm and understanding can help.

People will generally know what is normal for them. People can present as anxious, and more confused if breathless.

People should be using their oxygen as per their prescription, this should be written in their yellow folder in the oxygen section. If in doubt, phone and check with the respiratory team.

Green flags

• Breathing at a normal rate and depth for individual.
• No further action required.

Orange flags

• Know how to support individuals with inhaler or nebuliser if needed.
• Monitor and document

Red flags

• Breathing is abnormal for the individual — above 20 or below 10 breaths per minute or the person could have blue lips/nails.
• Seek additional support from GP or Community Respiratory Team, if known.
• In a emergency, call 999 and document.

Inhalers and nebulisers

People may use inhalers, nebulisers and/ or oxygen to support their breathing.

Correct inhaler and nebuliser use can prevent complications, for example chest infections, which can potentially cause admissions to hospital.

Nebuliser maintenance as per manufacturer's instructions is essential, otherwise they can lead to complications.

It is important the devices are for a named person and not shared in a care environment.

Using the correct inhaler technique with the right inhaler device is vital for disease improvement and management.

How to use your inhaler | Asthma + Lung UK

Green flags

• Person competent and able to use inhaler correctly.
• No further action necessary.

Warning flags

• Person requires some support to use inhaler or nebuliser correctly.
• Consider further training requirements for the person or the carer from either Practice Nurse or GP or Respiratory Team.
• Monitor and document.

Reg flags

• Person unable to use inhaler and has no support in place to help them using their inhaler.
• Seek additional support and advice on day identified and document.

Problems with continence both bladder (urine) and bowels (faeces) are relatively common; however, embarrassment can often cause people to not ask for help. 

Carers are in a perfect position to support and refer people on for help and advice.

Urine

People generally go to the toilet to pass urine four to seven times in a day. However, some people may develop incontinence; some of the common signs that indicate people may need to have a proper continence assessment include:

• Leaking urine when exercising
• Leaking amounts of urine when sneezing
• Leaking amounts of urine when laughing
• Leaking urine when lifting objects
• Described as having a sudden urge to pass urine and often described as unable to get to the toilet in time
• Going to the toilet frequently, either during the day or overnight
• Leaking urine on the way to the toilet

Urinary incontinence - NHS

Bowels 

Different people have different bowel habits. Most people have a bowel movement more than 3 times a week and pass good textured faeces (not too hard or soft) without straining. 

Since it can be hard to state what is normal and what is abnormal, some health professionals use a scale to classify the type of stool passed. 

• Bristol Stool Chart - NHS
• Bowel incontinence - NHS

It is important that people with diabetes receive regular check-ups to help manage their condition. Supporting people to keep their blood glucose, blood pressure and blood fat levels under control will greatly help to reduce the risk of developing complications in diabetes.

Short-term complications can include:

• Low-blood glucose (Hypoglycaemia)
  • Signs: Feeling shaky, short-tempered, pale, sweating, tiredness, lack of concentration.
• High-blood glucose (Hyperglycaemia)
  • Signs: Feeling thirsty, tiredness, headaches, passing more urine.

Long-term complications can include problems with:

• Vision
• Heart (cardiovascular disease)
• Kidneys (nephropathy)
• Nerves and feet (neuropathy)

Green flags

• No diagnosis of diabetes - follow health lifestyle, eat a varied diet and exercise regularly.
• No further action required.

Orange flags

Diagnosed with diabetes – well controlled and managed with no problems.

• Monitor, document and support individual and if concerned, refer to the GP or practice nurse.
• Additional steps to take when you are sick even if blood sugar readings are within target range:
  • Continue taking insulin and diabetes pills as usual
  • Test blood sugar every four hours and keep track of the results
  • Drink plenty of water to prevent dehydration
  • Try to eat as you normally would

Red flags

Diagnosed with diabetes – poorly managed or declining treatment, presenting unwell or with hypoglycaemic (low blood glucose) or hyperglycaemic (high blood glucose) episodes.

• Seek additional support on the day identified from the GP, practice nurse or community nurse and document.
• In an emergency, dial 999.

Advice and guidance

• Diabetes - NHS
• Diabetes and feet | Foot problems | Diabetes UK

For Residential Care Homes

If you are assessing a new resident for your service, consider whether they have any potential district nursing needs - for example, insulin administration. If they do and before you accept new individuals, you need to consider making a referral to the relevant district nursing team in your area, to ensure they have capacity, before any agreement on admission is made. 

Managing medicines for someone you look after can be a challenge, particularly if they are taking several different types.

Medicines can legally be administered by anyone, as long as it has been prescribed by an appropriate practitioner.

Medicines need to be stored appropriately and safely so that the products are not:

• Damaged by heat or dampness
• Mixed up with other people’s medicines
• Stolen
• Posing a risk to anyone else

Administration of medication

Remember the ‘Eight Rights’

• Right person
• Right medicine
• Right route 
• Right dose 
• Right time
• Right to decline
• Right information 
• Right documentation

Classifications of Medication

• P - Pharmacy 
• POM - Prescription only medication
• GSL - General sales list 
• CD - Controlled drugs
• Homely remedies (vitamins, herbal) have no legal classification.

Levels of support with medicines

• Level 1 - Assist (Prompt, Pass, Prepare under supervision, Open but not give)
• Level 2 - Administer (Prepare unsupervised, Give, and Apply)
• Level 3 - Administer by specialised techniques (Rectal or Vaginal medicines, PEG, RIG, Injections, Nebuliser, Oxygen canister changing, Buccal Midazolam)

Ask a pharmacist for advice if you have a medication related query. They are usually best placed to respond to queries.

Tip: Write the telephone number of the patient’s pharmacist on the medication chart or care plan along with the GP surgery in case of any queries.

Key tasks to be carried out during medicines administration by care workers

• Confirm that the medication and dose is correct; on the MAR chart and the medicine label
• Confirm it is the right person
• Ask whether the person wants the medicine
• Make sure that no-one else has already given this dose to the person
• Prepare the correct dose for the time of day, ensure medication is appropriately spaced-out following directions
• Give the medicine to the person and also offer a drink of water
• Sign the administration record

Advice for carers

Advice for carers who support with medication:

• Always read the instructions on the packaging or Dosette box before giving medicines to anyone. They should always be given either according to the instructions or as advised by whoever prescribed them.
• Instructions for when and how to give medication should be clear. If you are experiencing any problems, ask a doctor, nurse or pharmacist to explain.
• It is important to give medicines at the recommended time of day. Not doing this can make them less effective. You also need to know whether or not the medicines should be taken before food, with food or in between meals. 
• Please ensure that you follow your employing organisation’s medicines policy, which may have information regarding what you can and cannot administer after appropriate training. 

Medication for people with a learning disability

Stopping over medication of people with a learning disability and autistic people (STOMP) is a national NHS England work programme to stop the inappropriate prescribing of psychotropic medications.

People should only be given psychotropic medication for the right reasons, in the lowest dose, for the shortest time.

The impact of any side effects of psychotropic medication should be regularly weighed against the potential benefits of treatment. To ensure continued prescribing remains appropriate, people should receive regular, person-centred, holistic and structured medication reviews from professionals who understand people with a learning disability and autistic people.

From the age of 14, people with a learning disability are entitled to an annual health check, and this includes a holistic, structured medication review.

Tip: If a person with a learning disability is anxious about being in a healthcare setting when having immunisations, you may need to provide them with reassurance. 

Green flags

• Person competent and able to take their own medication with no problems.
• No further action required.

Orange flags

• Requires support taking medicine.
• Assist in a person centered way.
• Monitor and document.

Red flags

• Problems with taking medication i.e. swallowing difficulties.
• Seek additional support and advice from Pharmacist, GP or Nurse on the day identified and document.

Adult social care refers to a person’s ability to manage their own personal needs and environment in order to live their lives in a comfortable and safe manner.

Some people require additional practical and physical help to maintain their wellbeing due to additional needs, such as mental health, physical health, learning disabilities, older age and frailty.

A person who provides a significant level of support to another person in their day-to-day life is usually considered as a Carer. This is not the same as a person who provides care in a professional or paid capacity. Carers may also be able to have support to help them take a break.

When might a person need support with social care?

Sometimes day-to-day tasks can become difficult and a little extra help may be required. Some examples are doing the shopping, cooking meals, cleaning the house, managing finances, laundry, having a wash, getting dressed or getting out into the community. Help is available for these types of tasks from various community sources.

Here are some ideas of where to get additional support or advice: 

• Family and friends
• National charities
• Local charities
• Care agencies
• Church group
• Community groups
• Cleaning services
• Meals on Wheels
• Dial a Ride
• Day centres
• Local council for telecare
• Carers Groups

Social Care Assessment or a Carer’s Assessment

Sometimes people are not able to manage their own social care needs or require additional, professional support from a Social Care Worker. 

Everyone is entitled to a Social Care Assessment or a Carer’s Assessment, as outlined in the Care Act (2014).

This can be completed by your local Social Care Team who will consider the following factors in relation to eligibility:

• The adult’s needs for care and support arise from or are related to a physical or mental impairment or illness and are not caused by other circumstantial factors.
• As a result of the adult’s needs, the adult is unable to achieve two or more of the outcomes specified in the Care Act (2014); examples include unable to manage personal care, nutritional needs or accessing the community.
• As a consequence of being unable to achieve these outcomes, there is, or there is likely to be, a significant impact on the adult’s wellbeing. 

Similar eligibility criteria exist for Carers. If you feel a Social Care Assessment would be of benefit, please contact Surrey County Council.

Green flags

• Person’s needs are met through their available support networks - for example family and friends. 
• No further action required.

Orange flags

• Person is having social care difficulties that cannot be managed by family or friends.
• Person can access support from various community sources listed above.
• Consider whether a Social Care Assessment would be of benefit.
• Monitor, document and escalate to local Social Care Team if appropriate.

Red flags

• Person is struggling with daily tasks to the point they are putting themselves at risk, or there is a high risk of Carer burnout.
• Contact the local Social Care Team to request a Social Care Assessment.

What is adult safeguarding?

• Protecting an adult’s right to live in safety, free from abuse or neglect.
• Promoting the wellbeing of the adult.
• Showing regard of the adult’s views, wishes, beliefs and feelings when deciding an action.
• Providing support and interventions for adults who have experienced or are experiencing abuse.
• Learning how to support and protect people from abuse and harm.
• Strategies to prevent abuse and harm occurring.
• Partnership with other agencies and professionals.
• Avoiding blaming and taking responsibility within our roles.
• Reflection and learning on our work practice.

Safeguarding concerns

You must raise a safeguarding concern if you are working with an adult who:

• Has care and support needs, and
• Is experiencing, or is at risk of, abuse or neglect, and
• Is unable to protect themselves because of their care and support needs.

Report a Safeguarding Concern

 

Mental capacity is the ability to make a decision.

It can vary over time.

It can vary depending on the decision to be made.

Physical conditions and location can affect a person’s ability to make decisions.

• Mental Capacity Act - Social care and support guide - NHS
• 5 Principles of the Mental Capacity Act 2005 - SCIE

Green flags

• Person has capacity to make their own decisions.
• No further action required.

Orange flags

• Person has fluctuating capacity or is unable to make some decisions.
• Take steps to maximise their ability to make the decisions for themselves, such as using pictures and familiar objects.
• Re-assess their capacity, monitor and document.

Red flags

• Person lacks capacity to make serious decisions such as managing their finances, moving house.
• Contact a Best Interests assessment.

Best Interest

There is no single definition of best interests. Instead, the Mental Capacity Act 2005 (MCA) sets out a checklist of factors to be considered when making a best interest’s decision.

Best interests are not just medical best interests. You must consider the person’s welfare in the widest possible sense, and consider the individual’s broader wishes and feelings, and values and beliefs.

Once you decide that a best interest decision is required, remember that the best interests assessment process will depend upon what is reasonable, practical, and appropriate in each case.

Best Interest checklist

• Take all reasonable steps to permit and encourage the person to participate or to improve their ability to participate in the decision.
• Take account of the person’s past and present wishes, feelings, values and beliefs where those are known or can be reasonably ascertained.
• The fact that a person lacks capacity does not automatically mean that their views can be excluded or discounted in the decision-making process. The person lacking capacity should participate as fully as is possible in any decision affecting them.
• Those involved in caring for the person, or interested in their welfare, must be consulted about their views on the person’s best interests, and the person’s past and present wishes, feelings, beliefs and values.
• Ensure they have all the information in their preferred format to help them participate as much as possible is essential.
• Ensure you have a proportionate approach to decision–making and the least restrictive intervention.

Who is responsible for a best interests assessment

Best interests assessments are the responsibility of everyone involved in caring for the person. The approach to decision-making should be multi-disciplinary and seek to involve and hear from all members of the care team who can contribute. 

Where a decision involves the provision of medical treatment, the doctor or other member of healthcare staff responsible for carrying out the particular treatment or procedure is the decision-maker.

Advance decisions to refuse treatment (ADRTs)

• Sometimes a person will have made a valid and applicable advance decision to refuse treatment (ADRT), which applies in the person’s clinical situation. 
• Here the person has already decided to decline a certain treatment and that decision must be respected, as if it were a person with capacity making it.

Court-appointed deputies

• In some cases, the Court of Protection may have appointed a deputy to make welfare and healthcare decisions for someone who lacks capacity. 
• The decision to appoint (and who to appoint) is to be taken in the best interests of the person, taking into account their wishes and feelings, and also the principle that the appointment of a deputy is not necessarily less restrictive of a person’s rights and freedoms than the normal decision-making process of the MCA.

Lasting power of attorney (LPA)

• Some people have made a lasting power of attorney (LPA) appointing a health and welfare attorney. 
• Where a person has the appropriate powers (including, in the context of decisions about life-sustaining treatment, the power to consent to or refuse such treatment), and the LPA has been registered with the Office of the Public Guardian (OPG), the health and welfare attorney is the lawful decision-maker.

Independent Mental Capacity Advocate (IMCA)

• Provides independent safeguards for people who lack capacity and, at the time the decision needs to be made, have no-one else to support or to represent them.

Remember: The MCA established the Court of Protection to make a decision or to appoint a decision-maker on someone’s behalf in cases where there is no other way of resolving a matter affecting a person who lacks capacity. This may arise because there is disagreement.

A learning disability affects the way a person learns new things throughout their life.

A learning disability is different for everyone. No two people are the same.

A person with a learning disability might have some difficulty:

• understanding complicated information
• learning some skills
• looking after themselves or living alone

Learning disabilities - NHS

Annual health checks

Anyone with a learning disability who is aged 14 or over and on their doctor's learning disability register should be offered a free annual health check.

Annual health checks can identify undetected health conditions early, ensure that ongoing treatments are appropriate and establish trust and continuity of care.

Clinical evidence shows that annual health checks can promote health.

Learning disabilities - Annual health checks - NHS

Health action plan

As part of the annual health check for someone with a learning disability, GP practices are required to produce a health action plan. A health action plan:

• Identifies what is important to the person, what their health goals are and what outcomes they would like.
• Identifies the person’s health needs.
• Identifies what needs to happen to manage each of their health needs.
• Identifies who will take the action i.e. is the person able to do it or would they require support, if so, who will support them?
• Identifies when their health condition needs reviewed and by whom.

GPs should work with the person and / or their carer to develop and agree their Health Action Plan following their annual health check.

Health action plans should include health promotion activities, eye checks, dentistry monitoring, referrals to community and acute health services, pain management etc. and link to advanced care plans as appropriate.

Learning disability liaison nurses

Learning disability liaison nurses are nurses that help people with learning disabilities who are aged 18 or over access health services. There are learning disability primary care liaison nurses and acute liaison nurses.  

Acute Hospital liaison nurses work across Surrey's five general hospitals, to help acute staff identify adults with a learning disability and make sure they are offered reasonable adjustments when they go to acute hospitals for emergencies, planned admissions and outpatient appointments. The nurses also provide learning disability specific training to hospital staff and support them to create and use easy read information.

Primary Care liaison nurses help GPs identify people who have a learning disability. They can also provide additional support, such as helping to arrange appointments for people with special requirements and giving people access to easy read resources to help them understand procedures and communicate their needs.

• Liaison Nurses: Surrey and Borders Partnership NHS Foundation Trust
• Learning disability liaison service: NHS Frimley Health Foundation Trust
• Liaison Nurses: Royal Surrey NHS Foundation Trust
• Liaison Nurses: Ashford and St. Peters Hospitals
• Liaison Nurses: Surrey and Sussex Healthcare NHS Trust

Epilepsy is a common condition that affects the brain and causes seizures. 

Seizures are bursts of electrical activity in the brain that temporarily affect how it works, so the brain’s messages become mixed up. They can cause a wide range of symptoms.  

Epilepsy is more common in people with a learning disability, with 20-25% of people with a learning disability also suffering from epilepsy.  

There are many different types of seizure, and what happens to someone during a seizure depends on which part of their brain is affected. During some types of seizure, the person may remain alert and aware of what’s going on around them, and with other types they may lose awareness. They may have unusual sensations, feelings or movements. Or they may go stiff, fall to the floor and jerk. Different people also have different things that trigger their seizures.  

Epilepsy - NHS

If you support someone with epilepsy, then you should ensure that you are familiar with the persons epilepsy guidance/care plan, and have the appropriate knowledge and training required.

Green flags

• The person’s seizures are what is normal for them. They are well controlled and health is good.
• No further action.

Orange flags

• Monitor closely during a seizure. 
• Ensure the person is appropriately supported during and after the seizure. 
• Ensure all seizure details are recorded. 
• Check that there are no underlying health issues, such as infection.
• If the person is known to have epilepsy, follow their Epilepsy Care Plan.

Red flags

• Seek medical support if a person’s seizures are not what is normal for them.  
• In an emergency, call 999 for an ambulance if someone: 
  • is having a seizure for the first time 
  • has a seizure that lasts more than five minutes 
  • has lots of seizures in a row 
  • has breathing problems or 
  • has seriously injured themselves 
• If you require buccal midazolam, please tell the call handler to enable the right trained staff to be dispatched.

Autism Spectrum Condition (ASC) is not a learning disability. 

It is a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how people make sense of the world around them. 

People with a learning disability are more likely to have autism (20-30%, compared to 1% of general population).    

Autism - NHS

People with ASC may have difficulties in areas specified below; the level of difficulty in each section may vary:

• Social communication
• Social interaction
• Highly-focused interests
• Sensory sensitivity
• Repetitive behaviour or routines

Supporting people to manage their Autism

Autistic people may experience over or under sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain.

There are many simple adjustments that can be made to make environments more autism-friendly:

• Sight: reduce fluorescent lighting, provide sunglasses, use blackout curtains.
• Sound: use visual supports to back up verbal information, shut doors and windows to reduce external sounds, provide ear plugs and music to listen to.
• Smell: If under-sensitive, create a routine around regular washing and using strong-smelling products to distract them from inappropriate strong-smelling stimuli (like faeces). If over-sensitive: use unscented detergents or shampoos, avoid wearing perfume, and make the environment as fragrance-free as possible.
• Touch: warn the person if you are about to touch them - always approach them from the front.

When caring for a person with ASC, use the communication tips from the following list: 

• Always use their name 
• Make sure they are paying attention before you ask a question or give an instruction
• Use their hobbies or interests to engage them
• Say less and say it slowly
• Use specific key words, pause between words
• Don’t use too many questions, keep them short and structured
• Use less non-verbal communication
• Use visual supports, if appropriate
• Be aware of the environment (noisy or crowded)
• If appropriate, give them a visual help card to use to ask for help
• Be clear (avoid irony, sarcasm and rhetorical questions)
• Use a behaviour diary to work out if the behaviour is a way of telling you something
• Offer other ways of expressing “no” or “stop”
• If there is a safety issue, look at ways of explaining danger and safety instead of just saying “no”
• Set clear boundaries and explain why and where it is acceptable and not acceptable to behave in certain ways

It is estimated that around 1 in 3 people with learning disabilities will display behaviours of concern at some time.

The term challenging behaviour is often used to describe these behaviours. It is important to note that this term is used to describe how the behaviours affect us, how we are challenged by these behaviours. It is not a label for people, for example, people do not have a diagnosis or label of challenging behaviour.

All behaviours happen for a reason. People with a learning disability often learn fewer behaviours. If a person hasn’t learned an effective behaviour to achieve something, or they are not understood, this might be distressing for them.

It is important to understand a person’s communication. It may also be that the behaviour is understood, but we find it challenging so we either ignore it or try to stop it. Instead, we should be trying to understand and respond to the behaviours and teaching more effective ones to get their needs met.

How to deal with challenging behaviour in adults - Social care and support guide - NHS

Positive Behaviour Support

If we focus on helping people achieve the purpose of their behaviour, we can avoid restrictive approaches or practices. This approach is called Positive Behaviour Support (PBS). PBS focuses on understanding the purpose that the behaviour of concern is serving for the person within their environment.

PBS focuses on identifying the person’s strengths, areas for skill development, and making changes to the person’s environment to help make communication and interaction easier for them.

The six “Ps” of PBS

1. Person-centred: ensuring the person is always at the centre. 
2. Partnership: working closely with the person and their supporters to shape the process. 
3. Planned: creating a clear and positive Behaviour Support Plan (BSP) to ensure shared understandings and accountability. 
4. Positive: focusing on being preventative, not just reactive. 
5. Purposeful: using a Functional Assessment to know the reason for the behaviour. 
6. Process driven: following a process of identifying, assessing, planning, implementing, monitoring and evaluating data. 

The main feature of PBS is the use of a Behaviour Support Plan (BSP) based on a Functional Behavioural Assessment (FBA) developed by a Behaviour Support Practitioner.

Restrictive approaches

In some instances, restrictive approaches or practices may be used. These include: 

• Physical restraint: using ourselves to hold people
• Chemical restraint: using medication to sedate people 
• Mechanical restraint: using clothing, or equipment (such as belts or splints) 
• Environmental restraint: using the environment (locking doors, placing obstacles)

There may be times when restrictions are needed, but this should always be detailed in a support plan, the least restrictive approach possible, and used for the least time possible. There should also be a restraint reduction plan in place.

Adverse mental health affects one in four of us in any one year.

Mental health conditions - NHS

Carers are in an ideal position to identify and signpost any concerns they have, in relation to the individuals they support.

Carers can help by supporting individuals with personalised care, assisting individuals to feel empowered and in control. Your attitude can impact both positively and negatively when supporting a person with mental health conditions. It is important to give people time and space to talk about how they may be thinking and feeling.

To help mental health and wellbeing, some people may like to connect with activities. These can include music, singing, creative activities, gardening, learning something new or spending time outside.

Early detection of concerns about mental health is important to ensure that people are supported in the correct way.

Legislation

Legislation that you as a Carer need to have a basic understanding of: 

• Mental Health Act 1983
• Human Rights Act 1998 
• Data Protection Act 2018 
• Mental Capacity Act 2005

Identifying people who may be at risk of suicide

There's no such a thing as a suicidal personality which leads someone to take their own life, but certain factors can increase the risk.

People who feel suicidal often express feelings of hopelessness, humiliation or depression. Some will have a mental illness, but for many the distress may be temporary and linked to life events. 

However, life events do not necessarily need to be of a serious nature to trigger emotional or behavioural distress. The distress may develop as a result of a number of risk factors in the individual’s life. For example, previous traumatic experience, mental health issues, lifestyle, employment or relationships. This may have been in the immediate past or longer standing such as in a persons childhood.

Being subject to repeat victimisation may also increase a person’s risk of suicide especially in circumstances where the victim feels a sense of resignation that nothing will be done to alleviate the issues they are enduring.

Suicide is often the end point of a complex history of risk factors and distressing events. Careful assessment must be made of every individual’s level of risk, both in terms of the likelihood of harm and the severity or impact of such harm. 

If the person you are caring for has suicidal thoughts or feelings, it is important for you to engage and support them and escalate accordingly.

Help for suicidal thoughts

If you or someone you know is experiencing poor mental health or is in a mental health crisis, there is help and support available.

Call 999 immediately if you or someone you know is in a life-threatening situation.

Call 111 if you urgently need medical help or advice but it is not a life-threatening situation.

Help for suicidal thoughts - NHS

Dementia is an umbrella term for a number of conditions that affects thinking skills, such as memory, language, object perception, attention and the ability to plan and organise.

The most common types of dementia are Alzheimer’s Disease, Vascular Dementia, Lewy Body Dementia, Fronto Temporal Dementia and dementia in Parkinson’s Disease.

Dementia is a progressive illness. An early diagnosis of dementia can help planning for the future. This would include conversations around Lasting Power of Attorney and end of life wishes whilst the person still has capacity. In some cases, an early diagnosis of dementia can improve access to certain types of medication, which may support the person.

A person-centred and individualised approach is needed for all people with dementia. The approach needs to change as the condition develops for each person.

People can live well with dementia. If individuals are showing signs of distress, then they may have physical or mental health issues that can be managed. Pain, infection and delirium are common underlying causes for changes in presentation or behaviour.

Changes in behaviour or a person displaying behaviours that challenge can be helpfully understood as a communication of unmet need. For example, around occupation, over or under-stimulation, sense of safety (for self or others), connection with others, sensory needs, pain or physical comfort. Adopting a Positive Behaviour Support approach can help consider and proactively address these needs.

Dementia - NHS

Green flags

• Person has a diagnosis of dementia.
• Support in a personalised way and follow care plan.

Orange flags

• Person is showing some changes in their behaviour.
• Inform the GP or mental health team if known.
• Monitor and document.

Red flags

• Sudden or serious change in presentation.
• Urgently contact the GP surgery or mental health team if known to document concerns.
• Refer and seek advice.

Delirium is a common, serious but often treatable condition that starts suddenly in someone who is unwell. 

It is a serious condition that is sometimes mistaken for dementia. 

The symptoms of delirium will start suddenly and may come and go over the course of the day. They can be worse in the evening or at night. 

A person with delirium will show some of the following changes.

• Rambling speech
• Showing changes in behaviour
• Having disturbed patterns of sleeping and waking
• Being prone to rapid swings in emotion
• Experiencing hallucinations
• Having abnormal or paranoid beliefs

Many people living in care homes will be at risk of delirium. Care staff have an important role to play in looking out for any changes and providing support to reduce the risk of delirium occurring and act quickly if they suspect.

Types of delirium

• Hypoactive Delirium is when delirium can cause an individual to be abnormally withdrawn and sleepy. It can easily be missed or mistaken for depression, even by a health professional.
• Hyperactive Delirium is when delirium can cause a person to become abnormally alert, restless or agitated, and possibly even aggressive. The person may have hallucinations (seeing or hearing things that aren’t really there) or delusions (strongly believing things that are not true, for example that others are trying to harm them).
• Mixed Delirium is when individuals can also alternate between hypoactive and hyperactive delirium over the day. 

Sudden confusion (delirium) - NHS

Green flags

• No evidence of risk factors which cause Delirium, individual is acting and responding normally for them. 
• No further action required.

Orange flags

• Monitor the person carefully if they have any of the risk factors for Delirium.
• Be observant for the signs and symptoms of delirium. 
• Report to their GP and document any deterioration in physical or mental health.

Red flags

• If someone develops an acute confusion, seek additional support and advice immediately, they need to see a doctor.

 

Assessing pain and communicating it to the healthcare team will be one of the most important things you can do.

As carers, you get to understand a person really well and can read both the verbal and non-verbal signs.

Types of pain

There are different types of pain: 

• Acute pain starts suddenly and is short-term.
• Chronic pain lasts for a longer period of time.
• Breakthrough pain often happens in between regular, scheduled painkillers.
• Bone pain happens when cancer is affecting a bone.
• Soft tissue pain happens when organs, muscles or tissues are damaged or inflamed.
• Nerve pain happens when a nerve is damaged.
• Referred pain is when pain from one part of your body is felt in another.
• Phantom pain is when there is pain in a part of the body that has been removed.
• Total pain includes the emotional, social and spiritual factors that affect a person’s pain experience.

Assessing pain

When assessing pain, you need to take into consideration the person’s ability to express their pain.

The numerical Pain Scale is often used and is very effective in describing pain. Asking the person their score and assisting them to keep a pain diary while doing various activities means that they can get the best treatment.

The Distress and Discomfort Assessment Tool (DisDAT) was designed to help identify distress cues in people who because of cognitive impairment or physical illness have severely limited communication.  It is NOT a scoring tool; it provides a record against which subtle changes can be compared.

It can be difficult to assess a person’s pain if they are unable to verbalise it and/or unable to use a numerical Pain Scale.

People can react in various ways to pain: some get louder and seek support while others will get quieter and want to hide or not let others know. There are some signs and symptoms that a person may exhibit if they are in pain that can clue you in:

• Facial grimacing or a frown
• Writhing or constant shifting in bed
• Moaning, groaning, or whimpering
• Restlessness and agitation
• Appearing uneasy and tense, perhaps drawing their legs up or kicking
• Guarding the area of pain or withdrawing from touch to that area

Green flags

• To support anyone with pain discomfort or distress, ensure a personalised pain assessment has been completed. 
• Consider using the tools in previous page.

Orange flags

• If they are experiencing pain, follow their pain management protocol.
• If they do not have one in place, contact their GP.

Red flags

• If you think the person you care for is experiencing a level of pain that is distressful for them, seek medical assessment and/or advice.

Advance care planning refers to a whole range of ways a person can work with their care teams and discuss, document and communicate their wishes about how they would like to be cared for in the future.

Why plan ahead? - NHS

Anyone can start advance care planning at any stage in life and is something that can be reviewed and updated.

It is particularly important for people who are at risk of deterioration, are frail or have long term conditions.

Ensure the content of any advance care plan is known about by the whole care team and store any written plans in familiar and accessible places.

Common things Advance Care Plans cover and aim to prepare for include:

• Details of the person’s current health and care needs and what care issues might be expected to happen to them in the future based on their conditions.
• Information about the person’s general likes and dislikes which affect their quality of life.
• Religious, spiritual, cultural beliefs or traditions.
• Naming those they would like to be involved in their future care.
• The overall approach they would like e.g. focus on life-sustaining care. For example, operations, chemotherapy, admission to hospital or focus on quality of life over quantity and less invasive tests.
• The place they would like to be cared for in, including where they would like to die.
• Care after death, organ donation, and funeral plans.
• Anything else the person would want the care team to know if for whatever reason they were unable to express it in the future.

There are three main types of plans made:

1. Person-made description of the nature of the care they would like to have in the future based on their wishes, values, feelings and beliefs about their future care. Not legally binding but guides overall approach and goals of care.
2. Person-made specific refusals of certain treatments in a legally binding manner known as Advance Decisions to Refuse Treatment (previously a Living Will).
3. Clinician-made, but person involved decisions about which treatments are clinically appropriate to offer to someone - such as whether or not to attempt cardiopulmonary resuscitation.

ReSPECT: Recommended Summary Plan for Emergency Care and Treatment

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a personalised recommendation for your clinical care in emergency situations where you are not able to make decisions or express your wishes.

ReSPECT for patients and carers - Resuscitation Council UK

 

Everyone should be able to die as well and as comfortably as possible.

Recognising that someone is dying usually involves decision making from a clinical team. Decisions will acknowledge that there are no reversible causes to be addressed, documentation and communication to allow natural death These decisions will look at a persons wishes via a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) or Advance Care Plan request. They will involve conversations with the dying person and all those important to them, including carers.

Once this is agreed the focus can be moved from life sustaining (often more invasive care), to prioritising comfort, wellbeing, dignity and doing our best to respect their wishes. Though it can be difficult to be certain someone is dying, raising the possibility enables the whole team to work together to establish the right goals of care for the person.

We don’t always like to talk about death even though it will happen to us all. Research has shown most people know when they are dying. They prefer to talk about it if asked, and loved ones tend to experience regret after a person’s death if we do not talk about it openly.

The national framework to support caring for dying people is called the Ambitions for Palliative and End of Life Care.

End of life care - NHS

Bereavement support

Losing someone can be very difficult.  It can impact everyone, families, friends, other residents and staff members.

If you feel that you require bereavement support, you can speak to your GP or local hospice.

• Grief and bereavement - Healthy Surrey
• Dealing with bereavement and support with grief - Mencap
• Bereavement support for people with learning disabilities - At a loss