The Falls Care Pathway within the Ambulance Service - Essay Example

?INTRODUCTION About our care pathway: Our care pathway is very basic and leaves a lot of decisions to the professional. If a patient takes the decision of not travelling to hospital or has no injury then a full set of baseline obs must be taken and recorded. They must fall within normal parameters. The patient must have a full explanation of the referral to the falls team and consent must be gained. Referrals are made to the clinical hub. Patient details are handed over and the patient will be contacted within 2 hours. A copy of the patient report form is left with the patient with a non transport form. Patients referred must be over 18 years of age, referred after a trip or fall Patients who cannot be referred are under 18, under effects of alcohol or drugs, acutely ill with psychiatric problems and maternity patients. The falls team prevents unnecessary admission, provides fast multi professional assessments and the provision of enabling care, focus on rehabilitation and return to previous level of independence, provides full generic urgent multi disciplinary assessment and treatment, refers to appropriate health and social care professionals, manages bowel and catheter problems, supports patients with uti, chest infections, copd and diabetes, and provides palliative care. The importance of our chosen pathway: Emergency medical services include both hospital and non hospital services. They are a very important part of any health system. Emergency medical services are essentially very important for most health authorities in countries where morbidity and mortality rate due to injury is high. F alls present a huge problem for the health and independence of older people. Having a fall as one ages is not evitable, however the associated mortality and morbidity from a fall is high. Individual consequences range from distress, pain, physical injury and loss of confidence to complete loss of independence. There are many strategies for those who have already had a fall or fracture. The falls care pathway within the Ambulance service makes a very significant impact on the number of people who have become victims of the attack. The falls care pathway that I have chosen is very beneficial and fruitful for the injured people by falls. The scheme is beneficial for both patients and those in need of ambulance. This is why we have chosen this particular pathway. Under this pathway it is assumed that patients who have become victims of fall injury are likely to become fall victims again. This immensely increases the risk of their injury, and gives them broken bones and reduced quality of life. Additionally the health care falls prevention team analyses the needs of fallers in our pathway. They are well directed and provides them with additional support and equipment so that their risk of falling down again is minimized. Our pathway will ensure that the best possible service is provided to patients who are suffering from injuries. The pathway that we have chosen is beneficial because it involves engaging people in targeted and evidence based prevention ; management programmes that improves their overall fitness, health and ability to comply with medical regimes. It will provide them with the opportunity to live a life with high confidence and free from disability; the working environment is conducive to team work and beneficial for it. (ICPUS ) The issues that we encountered: The issues that we encountered: This is an emergency based work in which we have to be on our toes at all time. There I a different care every other day. For instance we encountered a case related to Maria who is a 73 year old woman working in a factory ; and she came to the attention of the health service in October 2001. During the last two years she has experienced memory troubles and behavioral changes, resulting in loss of self-determination in her daily life (CIRS severity: 2.6/5; CIRS co-morbidity: 5/13; MMSE: 14/30; Cornell scale: 19/38; NPI: 69/144).Maria has severe problems with mobility that led to falls and accidents and she couldmt intake food without help/ Following a clinical examination, Maria wa diagnosed with serious vascular dementia (according to the NINDS-AIREN criteria) and waprescribed medication to handle her associated behavioral problems. Maria lives at home with her daughter, who works full-time during the day. She is also back up by an informal network of people. Neighbors help with meals and therapies, but she is alone at home for the most of the day Her daughter is concerned about this, whose working performance and relationships have been influenced Maria's low income does not permitted for private home assistance or temporary admittance to a nursing home, and social services are neglected of her case. Her daughter feels that her mother should stay at home with her. Social services are contacted to value the family's income and inquire the possibility of home care support. They arrange for her to receive home help.By January 2002, Maria demonstrated a development in her attention capacity (MMSE 17/30). Her behavior has also corrected Her daughter reports a decrease in the number of confused episodes and neurological and psychological anxiety, and Maria is sleeping throughout the whole night/. Aspects of Maria's ailment die hard, but there are improvements in eating independently, due to socialization interference. Her mobility problems last out, but she has not had any falls since the process started and there have been good improvements in her daily living activities and environmental aspects (CIRS severity: 2.6/5; CIRS co-morbidity: 5/13; CDR: 3/5; SOB: 15/30). Her daughter expresses an improvement in her worth of life too (CBI: 56/96). The therapy remains unchanged. By July 2002, Maria makes more improvements (MMSE: 19/30; Cornell scale: 6/38). Her behavioral changes have vanished (NPI: 14/144), although her loss of autonomy remains (ADL: 2/6, IADL: 0/8, CDR: 3/5; CIRS severity: 2.6/5; CIRS co-morbidity: 5/13). The daughter feels less concerned (CBI: 37/96). As a result of comprehensive cohesive care combining medical, pharmacological, nursing and social support, Maria's situation has immensely improved. This particular treatment is considered complete and will be replaced with a new care idea. (Emergency care practictioner) (Health, 2007) There are different cases every now and then and the nature of each case varies tremendously. According to DH, older people are a bigger issue for mot pathways. So Is the case with our pathway. Older people tend to be a bigger issue than most A and E Accident and Emergency departments. There is a lot of under reporting where black out and fall of older people is concerned. The DH finalize that more than one third of falls tend to go un-reported in the computerized records. This leads to other pitfall such as a major chunk of prevention being omitted. NICE and NSF guidance: The NSF guidance is of the view that the fall call care pathway should not risk the lives of people who have fallen or are expected to fall. Their work should be prompt and on the spot. All issues should be taken care of; and multichannel and an individualized intervention for falls prevention. The NICE guidline for on falls haul older people who reside in communitie, or at home, in residential and nursing homes in a retirement complex. Under this guideline an older person is someone who is above 65 years or more. There are not stipulations in the guideline for people who are hospitalized, and bed bound if their reason for such limitation is not treatment after fall. There are no guidelines for medication anthritis. (Health, Domicilary Care National Minimum Standard Regulations. Care Standards Act 2000, 2000) Working in Multi Disciplinary Teams: Teams play a very important role for the overall development and functioning at the care pathway. A synergy of worker and worker idea and proceedings can be thus formed. The teams can be used to communicate effectively within the pathway. The open area is very important because this introduces the new team members, which in this case would be the Working Better group. When we work in this area, we are at our best and also productive. The open arena is actually seen where good cooperation and communications occur. Also when different teams are grouped, the size of the open area can be expanded horizontally into the blind space so that individuals can learn more about themselves. This can be done by seeking and actively listening to feedback from other people. This can be done by anonymous slips so as to ensure privacy. This cannot be done immediately until or unless the people actually get to know each other first. I didn’t come across many communication issues just a few minor ones. We have not been provided with pagers to communicate so sometimes it would be difficult to communicate with team players who would be in areas where there would be no coverage or where they would be out of reach. Teams helped produce a major synergy of ideas. Tasks could be effectively managed and handled hassle free. There has been a lot of coordination and rapport between the team members since then. Decision Making Processes: Given the nature of this drastic work, we are confronted with in-numerable type of decision to make every other day. We have to reach work in completely. It would be very important for the employees to reach the work place charged. Smoking and drinking would be strictly prohibited. As it is not just one person who is put at stake when one smokes or drinks. (Care Ambulance) There would be different circumstances and issues that we would be subjected to on the site of the incident. We need to take care of the sensitivity of the situation and make the best possible decision in this regard at every site. Understand that when we arrive on scene there may be different things going on that could compromise our safety and the safety of our partner. Scene overview should be the first important that needs to be taken care off. This overview hits off fleetingly as soon as the run snaps in. some of the things that need to be considered before making the right decision include road conditions, weather conditions, road construction and traffic flows. Hazardous scenes need to be peculiarly well taken care off. When we run into hazardous scenes, strict attention and care has to be taken to ensure that the sensitivity of these scenes is taken well care off. We need to be aware of everything around us. For instance there could be fuel leaks, there could be broken power lines, building collapses debris etc. In each of these circumstances the correct decision need to be taken. Watch out for things that are more risky for our partners, the patients and identify ways to rapidly move things. Similarly decisions in violent scenes have to be taken according to the nature of that scene. When responding to violence, care needs to be taken regarding the appropriate measures taken at the violent scene. We need to ensure that we are sitting at a hand’s dance from the site of the incident till the police arrive and secure it. Ensure that we are at a safe distance till the police directs clear signals at us. As soon as the police grants a clear signal and sound return, we need to rush to the sight scene. We need to make sure that we never follow the police car to the scene. It would be very dangerous incase the authorities insist on drawing weapons. This will then put them in the line of fire. If it’s a very intense wild scene then a safety gear has to be worn at all times. Helmets, gloves, safety vests, EMS turnout gear and safety equipment are some of the safety equipment that need to be kept in for protection at all times. No item should be taken for granted. The items are there to curb injuries and put a limit on chemical exposures and exposures to pathogens born out of blood. Gears will help prevent the transmission of diseases and exposure to hazardous material for our loved ones. We need to ensure that while driving the driver takes the correct decisions. There can never be any apologies, none what so ever for the danger we inflict upon ourselves and those at stake with s. we need to make sure that driving decisions are taken very swiftly and accurately. We don’t have to run the risk of other accidents and injuries at the cost of rushing to the site or hospital. We need to exercise complete caution while driving. Ensure that we don’t drive too fast on wet floors, when the conditions are snowy and foggy. We need to pay attention to the weather and road conditions and check how swift there. Placement of our ambulance at dangerous scenes, such as auto accidents, is eminent. Place it in a manner that allows us rapid access. The car needs to be parked atleast 200 feet in front of an accident spot. The decision regarding where the car should be parked should be carefully evaluated. It must be remembered that the most important people on the scene can obtain high quality care that they need. Thus a buffer distance needs to be maintained at all times. (Services) Reflection of my development: Working for the falls care pathways has been a tremendous working experience for me. It helped me provide secure employment in the Ambulance service, A career in the Ambulance Service provide secure employment, promotion prospects ,continuing professional development, splendid terms and conditions as well as a gateway to other roles in the NHS. The Trust is actively attempting to recruit people from all cultures, regardless of gender, race or disability giving me an opportunity to work in diverse environment. The ambulance service copes with emergency and non-emergency healthcare. Staff working in addition, as part of an ambulance crew, there is also a team of people with different roles who provide the essential back-up. There is a diversity of different opportunities for us to work within the ambulance service. It also helped inculcate in me the skills of being compassionate. I became more social in the process, possessed superior driving skills, had a very critical approach and became ever willing take on challenges and tasks. It helped develop in me excellent organizational and time management skills. I am better and more organized now. I have inculcated within me the capacity to work hard and in teams. I am more tolerant of other’s views and opinion and have the emotional and physical stamina to take on challenges. This work has instilled within me the confidence to deal with any kind of situation. I have become a pro at handling nervous situations and patients. My spoken and written skills have improved tremendously in the process. I have become self possessed and have developed the aptitude to work with a myriad of skills and people across the board. I have a desire within me to go out there and help people. I have also become capable of handling pressure and am sympathetic of others related to confidentiality. There are other monetary perks associated with this work. The pathway worker can easily earn between 13, 500 and 16, 500. As we gain experience in this field, the perks can rise up to 18,200 and further allowance maybe given to workers who are sent to remote geographical place at odd hours. All in all, it is a very pleasurable experience. CONCLUSION: Being a paramedic is an insolent fulfilling and rewarding career. Having the capability to help people in times of work and need makes a difference. It is a very vigorous work. It gives one a very soothing experience and helps them save lives. This is a very challenging job and the task very humane. Every day I am compelled to think outside the box. The variety of work that I am exposed to is tremendous. The tasks are intense, there is brilliant support around me and I am given frequent training in the process. It has also helped me develop a strong network with my friends and peers with an ever changing outstanding work environment. . Care pathway provides better opportunities and practices, based on pragmatic testimony on outcomes, such as health, activities of daily living (ADL), mobility, quality of life, well being, cost-effectiveness, quality of life and respect for the person and their rights. Continuity of care to make sure the quality of life for the careers, providing added value to informal care Standards of care and expenses becoming explicit to clients and their careers: Increased client involvement Improved communication. Clarity about what benefits and risks can be expect Care pathways operate the needs of professionals and managers through: Standards of care and expenses becoming explicit, justifying professional activities and the means that are required Better value of care and worth of life for the client and her/his family, which may add to professional demand Support to staff in daily decision-making Enhanced collaboration and decision-making Participation of all professionals and managers in improving care Unreadable roles, responsibilities and actions to be taken that are amenable to education and training Effective use of resources Easier audit by variance-tracking instruments, which manage whether interventions have been carried out Better understanding of the demand of clients and their careers, as well as shortcomings of the systems (or the care pathway) by evaluate variations in practice. Works Cited Emergency care practictioner. (n.d.). Retrieved jan 13, 2010, from Career Opportunities: http://www.londonambulance.nhs.uk/working_for_us/career_opportunities/ambulance_staff/emergency_care_practitioners.aspx Health, D. o. (2000). Domicilary Care National Minimum Standard Regulations. Care Standards Act 2000. London. Health, D. o. (2007). Urgent Care Pathway of Older People with Complex Need. London: DH. ICPUS . (n.d.). Retrieved Jan 12, 2010, from Integrated Care Pathway: www.icpus.ukprofessionals.com/ICPs.html Care Ambulance. (n.d.). Retrieved Jan 13, 2010, from Care Ambulance Service: http://www.careambulance.net/home1. Emergency care practictioner. (n.d.). Retrieved jan 13, 2010, from Career Opportunities: http://www.londonambulance.nhs.uk/working_for_us/career_opportunities/ambulance_staff/emergency_care_practitioners.aspx Health, D. o. (2000). Domicilary Care National Minimum Standard Regulations. Care Standards Act 2000. London. Health, D. o. (2007). Urgent Care Pathway of Older People with Complex Need. London: DH. Services. (n.d.). Retrieved Jan 13, 2010, from Care Ambulance Service: http://www.careambulance.net/services.asp Read More