Since 2012, a group of staff at the James Paget University Hospital have been working together to ensure that patients with Learning Disabilities/Autism/Dementia who are coming in for elective procedures and operations are cared for in a way that combines compassionate care and reasonable adjustments with pre-operative planning and pathways.

The group of staff is made up of:

• Person and Carers

• Anaesthetic secretaries

• Anaesthetist

• Clinical Lead, Senior Operating Department Practitioner

• Learning Disability Liaison Nurse

• Dementia Liaison Nurse

• Sister on the Day Care Unit

From the moment a person is identified at clinic, the team will set up and plan every part of the person’s admission to hospital and discharge home.

See Case Study 1. Communication with the families’ carers and care homes is vital to assess the level of support a person will require including family carers attending the anaesthetic room to ease anxiety of the person. Families, carers and care home staff are invited to attend a pre-operative planning meeting were they get the opportunity to meet the staff involved in the operation and ask questions. Staff are able to find out more about the person, their additional needs and what measures can be used to reassure the person. Desensitisation kits are made available which include: green scrubs, mask used to receive anaesthesia, cannulas, a photographic pathway to aid understanding and wrist bands. These have proved hugely successful and some patients with learning disabilities have chosen to arrive wearing the scrubs. The person’s GP will also be involved if any additional changes to the person’s standard care and medication are required. We routinely complete multiple procedures under single anaesthetics for patients as it is the least restrictive option.

Case Study 1 75 year old gentleman, with history of advanced dementia, resident of local Care Home. His wife is still very involved in the care planning of her husband; she understands his dementia fully and is able to comfort him in time of distress. The Care Home had arranged a dental appointment as it appeared that he had broken & damaged teeth. Dentists who saw patient recommend dental examination /extraction under General Anaesthetic.

Dementia related anxieties relevant to admission.

• Unable to wait, becomes anxious & agitated

• Was not able to tolerate a recent x-ray

• When anxious will push staff away.

• Is unable to walk any distances and is only able to take a few steps when fully support by care staff (due to his vascular dementia).

• Patient is not aware of his limited mobility and when distressed or agitated will try to stand and walk away, which results in him being at a very high risk of falling.

• May be able to attend pre op if needed. Wife will support him attending the clinic. Reasonable adjustments to be made on day of admission

• Cannot wait, gets agitated: wife will stay with him & can settle him.

• Will not lie on a bed or trolley unless very tired and wanting to sleep- gets onto bed once had pre-med.

• Will drink a liquid pre medication of Paracetamol & Midazolam.

• Would be O.K. in a bay with other patients.

• Awakes late morning,: would suit PM admission.

• Needs to be 1st on theatre list

• Not to undress into a gown, Keep own loose fitting clothing on.

• Member of staff from care home & wife to come and stay with patient on day of admission.

• Carer or wife has option to go into anaesthetic room & recovery if needed

• Ok to talk about his teeth & dental extraction, he understands he has dental pain.

• Interest’s and subject to talk about; was previous a very active & fit man, loves swimming, Holidays with his wife & music

This elective pathway for vulnerable adults has led to this group of people receiving the best standard of care and ensuring good surgical outcomes. At James Paget University Hospital we are proud to deliver patient centred care at its best.

For further information please contact

[email protected]


[email protected]

About the Author:

Joan Pons Laplana
Transformation Nurse at James Paget University Hospital.

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