Timely care for people with learning disabilities
A clinical placement with the intensive health outreach team helped nursing student Moses Dube understand the importance of timely interventions, as well as accurate documentation, in ensuring people with learning disabilities get the care and treatment they need.
A clinical placement with the intensive health outreach team helped nursing student Moses Dube understand the importance of timely interventions, as well as accurate documentation, in ensuring people with learning disabilities get the care and treatment they need
During my second year of training I was on a placement with the learning disability (LD) intensive health outreach team (IHOT) when I responded to an emergency call to a care home for people with learning disabilities and complex health needs.
A healthcare assistant was concerned about the clinical observations of a patient, who I will call John, whose national early warning score (NEWS) was five.
John had a urinary tract infection (UTI) and urinary retention, and had not been taking adequate food or fluids. The NEWS score of five meant his health was declining significantly.
Under the supervision of the IHOT LD nurse, I carried out John’s clinical observations using the SBARD tool – situation, background, assessment, recommendation and decision. This enables clinical concerns to be escalated effectively and in a timely way, alleviating further risks to patients.
I did John’s clinical observations every ten minutes. These produced a NEWS score of seven, meaning his condition had deteriorated further, and a call was made to the emergency services. When the paramedics arrived, I gave them a detailed handover and John was taken to hospital.
As John had a learning disability, a staff member went with him to support him, and the necessary documentation was provided, including John’s hospital passport identifying his health, communication and social needs. The hospital LD liaison nurse was informed of his admission.
I felt proud of what I and the care home staff had achieved. Through our observations, interventions and assessment, John received the health services he required in a timely manner.
This experience made me aware of how prevalent health inequalities are for people with learning disabilities, and that it is essential for reasonable adjustments to be made so care can be improved and people can access the health services they need.
People with a learning disability do not always know when they are unwell, or can find it difficult to communicate their health needs, causing them unnecessary suffering. Informing the LD liaison nurse of their admission, and providing the hospital passport as we did with John, helps facilitate effective continuity of care.
The introduction of annual health checks for people with a learning disability has also played a significant role in improving health by providing routine screening and health promotion activities, helping with early detection of ill health.
John’s annual health check had already been undertaken – with the information forming part of his documentation on admission to hospital – contributing to a shorter hospital stay.
This identified his unmet health needs, with the physical health examination providing baseline findings to help clinicians ascertain whether John’s health was deteriorating further or whether he was recovering and fit for discharge.
Moses Dube is a third-year learning disability nursing student at the University of the West of England