For the sake of confidentiality I’m going to call the patient Jimmy. We went into Jimmy’s room, the staff did an extremely thorough, professional and caring examination ruling out a head injury and checking Jimmy was neurologically stable. On our way to Jimmy’s home the team explained that Jimmy was well known to the service and they had visited him several times previously because of his long term condition which was COPD. When the team examined Jimmy and took his observations he was tachycardic with high resps and oxygen saturations in the low to mid 90’s.
Because the team knew Jimmy and had access to his medical records they knew this was normal for him. Whilst there we all chatted to Jimmy about football and he spoke about his love for a drop of cognac which his wife brought to him regularly. We watched him stand up on his own and with the help of a zimmer frame walk independently around his room and sit down. We wished Jimmy well and left.
Why such a caring act then? Let me explain what could have happened and what can happen elsewhere. Jimmy will slip and bang his head. The unsupported care home staff will call 999 and an ambulance will arrive. They examine Jimmy and see no signs of head injury but the breathlessness and observations cause them to take him to ED. In ED the medical teams, under time pressures and without prior knowledge of Jimmy admit him under the medical team with exacerbation of COPD. He will get into a hospital bed and at that point start deconditioning physically. He is likely to lose independent mobility as he is treated for his condition and as various assessments are undertaken to ensure a care home is the right place for him. During this time Jimmy could develop a chest infection on top of his COPD and die in hospital.