Acute patient pathway | Right Decisions

Pre- admission/ pre appointment

Provide the patient with full clear information about their hospital visit/ appointment.
All information should be provided in an appropriate format - this may be easy-read/ words and pictures format. To request translation of information into easy read or any other format, contact ggc.clear.toall@nhs.scot
All information should include an explanation of processes and medical terminology. Explain clearly what the patient can expect to happen during their appointment or hospital stay. It should also, where possible, include routes to buildings/clinics from point of arrival at the hospital. If there is sufficient advance notice of the admission, offer the opportunity for a pre visit or additional information to reduce anxiety levels about the experience. This will also aid staff understanding of what is required to improve a patient’s journey.
If it is an outpatient appointment, try to give the patient an appointment for late morning or early afternoon. Many people with a learning disability may take longer to get ready and leave the house in the morning. This is particularly true for people who have additional support needs and are supported by a carer.
As soon as possible, staff should find out the capacity status of the patient and, if applicable, ensure legal guardians are consulted in treatment consultations. Patients may also require a Section 47 Certificate of Incapacity
Consider contacting the local LD Nurse Team and find out if they can provide additional support or advice for staff.

Admission for inpatient or day procedure

Prior to admission, staff should find out the capacity status of the patient and, if applicable, ensure legal guardians are consulted in treatment consultations. Patients may also require a Section 47 Certificate of Incapacity.
When the patient comes in, ask them if they have all of the support they need. If required give further information or support regarding what is going to be happening during the appointment.
If there has been no opportunity to chat or answer questions prior to admission, staff should take extra time to ensure the patient (and where relevant their family/carer/partner) has understood what is happening. Speak clearly, giving the patient time to process the information. If someone is non-verbal do not assume that they do not understand what is being said.

During outpatient appointment or day surgery

Prior to admission, staff should find out the capacity status of the patient and, if applicable, ensure legal guardians are consulted in treatment consultations. Patients may also require a Section 47 Certificate of Incapacity
Explain any examinations or processes to be undertaken during the stay. If the patient has a carer with them, find out how they might be able to provide support during this conversation.
Any changes which need to be made should be clearly explained to the person as soon as possible. This will give time for the patient to process the changes and feel more comfortable.
Ensure that the patient is aware of the position of other relevant facilities such as toilets (Accessible toilets if necessary).

During ward stay

When the patient is admitted, make sure that the What Matters to Me board or form is completed. Where appropriate, involve carers and family.
Find out what the patient’s support needs are during meal times and when being given medication. Again, carers/ family should be involved as much as appropriate.
Ensure that the patient is aware of the position of other relevant facilities such as toilets (Accessible toilets if necessary).
Support prior to operation/ procedure - make sure that the patient is fully aware and understands what will happen during pre-surgery and any procedures involved in surgery and in recovery.
As soon as possible, staff should find out the capacity status of the patient and, if applicable, ensure legal guardians are consulted in treatment consultations. Patients may also require a Section 47 Certificate of Incapacity
Consider contacting the local LD Nurse Team and find out if they can provide additional support for the patient and for staff. LD nurses can advise acute staff on the most appropriate ways to support patients during hospital stay.

Discharge/ follow up

Before starting discharge process, make sure the patient has all the support they need to fully participate. If relevant, what role can the carer play during this conversation.
Take time to go through any information that the patient may need and ensure that it is in a format which is suitable for them. Go through the information with the person if necessary, ensuring you check their understanding. Take special care to ensure any medical terminology is explained.
Speak with the patient and carer to identify ways in which carers could be involved during aftercare
Consider if the patient is already supported by community LD Nurse service. If not, could a referral or link be made on behalf of the patient? How can an LD Nurse provide support during this stage of patient’s care?