Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective

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Nursing staff, due to their close proximity to patients, are likely to be the first to detect early signs of deteriorating health and to respond accordingly to minimise the level of intervention required. In the hospital setting, early warning systems help to recognise physiological changes, signalling a problem, and a response team can be activated. For nurses working in nursing homes, the challenges of identifying and managing a deteriorating resident are similar, but the system for recognition and response may be absent or not clearly defined. Detection in this setting is further tested by the fact nursing home residents are typically frail and have complex health needs associated with at least one chronic condition 1. Signs and symptoms of an acute exacerbation can be subtle or difficult to detect and interpret in this population 2. Delays in recognition can lead to hospitalisation for a problem that could have been managed in the nursing home if detected early 3. But the capacity for nursing homes to manage and treat certain conditions varies, as nursing homes are not ‘miniature hospitals’ 5. Hospital avoidance programmes in the nursing home setting have the potential to address this gap by facilitating a more coordinated approach to the recognition, response and management of the deteriorating resident.
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