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Emergency healthcare plans

In my last four years spent working as a community matron, and in previous nursing roles in both the hospital and the community, I have been privy to, and part of healthcare increasing integration. The aim is to offer the best care for each individual patient, at the right time and place for them. Achieving this means professionals from across different organisations, working more closely together, and at the forefront of this is having in place up to date patient documents and records.

The emergency healthcare plan is part of the national Deciding Right document which is produced by the Department of Health and links to end of life care. The plan outlines what an emergency might be and is a guide to what a care giving professional should do in these circumstances. The plan escalates a care at home package to prevent a hospital admission. The plan would come from the GP, the community matron, or district nursing sister and would be agreed with the patient and their family. If it's someone with a long-term condition it could be decided that sending them into hospital might not be in their best interest, so care at home can be offered. The plan is used by all partners, for example if paramedics were contacted out-of-hours because a patient feels unwell they would already have the plan to work with, so what could be a difficult decision for them has already been addressed.

One thing that might be included in the plan could be administering subcutaneous or 'subcut' fluids, this is done to prevent dehydration and avoid an admission to hospital. Intravenous fluids are administered by continuous infusion through a needle sited just under their skin so we don't need to use a pump anymore. Another procedure included in the plan might be giving antibiotics intravenously at home to prevent hospital admission or aid early discharge. 

We have a nurse led admissions register in our area, it is quite unique as we don't have any hospice beds in local hospices. If someone has a life limiting disease like cancer and they are reaching the end of their life they can be put on the register. This covers three local community hospitals, so if a patient has a symptom that can't be controlled easily at home or the family are struggling to cope, rather than them going through A&E or the palliative care units, they can go straight to one of the three community hospitals. It is a very supportive nurse led service that is liked by patients as it keeps them closer to home. This is possible because we have close working relationships with our community hospital colleagues. We are in and out of the hospital regularly so we are able to discuss progress of our patients on the admissions register and flag up when patients may be heading towards an admission.

Record keeping is important and we use audits to improve our practice, with an ongoing audit of both our electronic and patient held records to ensure they are complete. We ensure all the demographics are provided including patient's contact details, their next of kin, ethnic origin, religion, whether they smoke, what their allergies are. This is all from a safety point of view, so we know what they are allergic to, and it is also important for our colleagues in other services. For example if an out of hours doctor visits the house they can look at a comprehensive document and see exactly what has been happening with the patient and what their care plan is. There is also the quality control aspect for the Care Quality Commission monitoring.

I ask our staff nurse to do a monthly audit, so it's peer to peer. The importance of accurate record keeping has become a more of a priority as our electronic record becomes more integrated with other professional groups, such as GPs, occupational therapists and specialist nursing services.