Authors (including presenting author) :
Dr LAU CHI CHEUNG MICHAEL(1)(2)
Dr KWAN YIU KEUNG(1)(2)
Dr CHAN NGAI HO TONY(1)(2)
Ms LEE MAN MAN(1)(2)(3)
Affiliation :
(1) DEPARTMENT OF MEDICINE AND GERIATRICS
(2) TUEN MUN HOSPITAL
(3) COMMUNITY NURSING SERVICE
Introduction :
Most of the very frail elderly patients in Hong Kong are cared in Infirmary. Because of the long waiting time, some of these elderly have to be taken care at home. However, the care givers are facing lots of problem and stress. They have difficulities to arrange transportation to escort their elderly for regular medical follow-up. They also have difficulties in finding medical support in case the elderly have acute illness. Currently they can only call ambulance to the Emergency Department, leading to repeated and unnecessary admissions. From February 2018, Geriatrics team, Tuen Mun Hospital and the community nursing service have collaborated to start up a new programme, Infirmary Care At Home(ICAH), to provide onsite integrated medical care, including regular medical follow up, nursing intervention, paramedical support and ad hoc medical consultations
Objectives :
To report the characteristics of these patients
To report the ad hoc medical consultation outcomes
To report the feedback from care giver of this programme
Methodology :
individual case study from CMS
Result & Outcome :
From February 2018 to November 2018, there were total 11 patients(including 3 male and 8 female) with mean age of 85(62-96) were recruited. All patients were non-communicable and bedridden because of dementia(6), recurrent stroke(4) and hypoxic brain damage(1). Ten of them were on waiting list for infirmary care and one for nursing home care. While 4 of them on Ryle's tube feeding and 4 of them had stage 3 or above pressure injury. The mean attendance of Emergency Department and the mean admission in the past one year before the programme were 3.2 times and 2.8 times respectively. During the ten months study period, The total regular medical consultations were 46 times, while the total ad hoc medical consultations were 19 times. Most of the ad hoc medical consultations were fever, pain control for pressure injuries and chest symptoms including cough sputum and shortness of breathe. The Ad hoc medical consultations were provided when care givers noted symptoms of their elderly, and would contact the community nurse in charge. Ad hoc onsite nursing consultations would then be provided, assessment of the clinical conditions and clinical photos(if any) would be sent through HA chat to the Geriatrician. Adjustments of medical as well as prescription of medications could be arranged and the community nurse would review the conditions afterwards. There were 4 admissions were sent to emergency department and admissions arranged after initial ad hoc treatment given. During the study period, 3 patients were recorded death. Questionnaire were conducted to their carer givers. A "pre-test" vs. "post-test" were employed. The Relatives' Stress Scale(RSS) was used to meansure the care stress of the care giver before and after the programme. Significant reduction in the mean score of pre-RSS was 33.00 versus post-RSS score 18.36(p<0.000) In conclusion, Infirmary Care At Home(ICAH)programme which provided onsite medical services to those frail elderly with chronic and severe disabilities. This was important to provide support to these patients with unstable medical conditions who were cared at home during the period of the service gap. The programme could also reduce the carer stress with the results showed a significant reduction in using RSS.
Co-location with:
