Covid 19 referral Information

Covid 19 Referral Guidance to Complex Care and Dementia Psychiatric Liaison Service

These guidelines apply to ALL acute and community hospitals throughout Cornwall.

The Team

We are a nationally recognised Psychiatric Liaison Accreditation Network (PLAN) accredited service.  The team is based at Royal Cornwall Hospital (RCHT), Treliske.  The service is managed by the Complex Care and Dementia Liaison Service Clinical Lead.  The team will provide a service to all hospital sites Monday to Friday 09:00-17:00hrs excluding bank holidays during the escalation of Covid 19.The multi-disciplinary team comprises Registered Mental Health Nurses (RMNs), Consultant Psychiatrist, Core trainee in Psychiatry and team administration.

What we do

The Liaison Service is an essential component of the Complex Care and Dementia Service line.  We meet patients with many different mental health problems, such as:

  • Being worried about memory
  • Patients living with dementia with complex needs
  • Patients experiencing delirium with complex needs and behaviours
  • Problems with worry, stress or depression
  • Medically unexplained physical health problems
  • Psychosis

The Liaison Service provides comprehensive both telephone triage, advice and support as well as,  face to face mental health assessment of the patient and management advice to the referring team.  We communicate effectively with all those involved in the persons’ care including family members where appropriate to ensure our advice is based upon all relevant information available regarding the patient’s presentation and background history.  This is with a view to:

  • Provide advice and guidance on mental health nursing and care.
  • Provide advice and guidance on treatment options including appropriate use of psychotropic medication, taking into account local policy and only with the support of the Doctors in the multi-disciplinary team.
  • Ensuring that a patient’s mental health issues do not unnecessarily contribute to prolonged hospital admissions.
  • Improving detection and treatment of pain and other physical factors that may contribute to confusion and Behavioural and Psychological Symptoms of Dementia (BPSDs).
  • Offering advice and support to Carers.
  • Contributing to prompt and effective discharge planning for patients with mental health needs in liaison with the Onward Care Team.
  • Legal and National frameworks (Mental Health Act, Mental Capacity Act, including best interests consideration, Deprivation of Liberty safeguards and processes around safeguarding of vulnerable adults).

In providing ongoing assessment and treatment whilst the patient remains in the hospital, we work collaboratively with health care professionals in the general hospital setting to meet the needs of the patient and promote patient centred care.  During this time, the hospital wards clinicians have overall responsibility for the patients’ care until discharge.

The team also support complex discharge planning and where appropriate arrange community follow up.  After discharge the patients GP (and other relevant agencies) will be notified by way of an assessment letter to ensure continuity of care.

CC&D Psychiatric Liaison Service or the medical team can signpost the patient into other appropriate services.

Who we see

  • Patients who are confused due to suspected or known dementia, of any age.
  • Patients with functional mental illness who are 75 years or over.

Who we do not see

  • Patients who are already on the caseload of the Adult Integrated Community Mental Health Team (ICMHT) should be referred to the Adult Psychiatric Liaison Service. 
  • Patients presenting with deliberate self-harm (these patients should be referred for initial assessment and risk by the Adult Psychiatric Liaison service for RCHT patients and CMHT’s with other hospital settings).
  • Patients who are dependent on alcohol or other substances (these patients should be referred for assessment by the specialist Alcohol Liaison team within RCHT).
  • Patients requiring ongoing psychological therapies/interventions.

Referral to the service

We accept referrals from professionals in health and social care.

Referrals to the service can must be completed via Maxims (internal hospital referral system) selecting “Psychiatric Liaison Service” – Complex Care and Dementia.  This is the preferred route.

If refers do not have access to Maxims referrals should be made using the team referral form.  This should be sent to the team’s generic email address – cft.ccdliaison@nhs.net.

We aim to make contact with all referrers to the service for an initial telephone triage  by the end of the following working day.  However we will endeavour to respond to more urgent referrals in particular from the Emergency Department (ED) on the same working day where at all possible.  Urgent enquires can be made via telephone – 01872 252930.

Acute Care at Home East Contact Information

Telephone 01752 679017 or via Bodmin switchboard 01208 251300

Email:  acah.east@nhs.net

Acute Care at Home East

The Acute Care at Home service is a “virtual ward” concept currently consisting of 7 experienced registered nurses plus 1 paramedic and an admin assistant. Our aim is to facilitate advanced nursing care / support to patients in their own homes or alternative care environment,  in order to prevent admission to, or facilitate discharge from the acute hospital.

We can provide treatment up to twice daily.

The service operates from 08.00 until 20.30 seven days a week, 365 days a year

We accept referrals from:

•Acute and community hospitals

•Other community professionals such as:

•Acute GP Service / ambulatory care

•Out of hours service

•Community matrons

•Community nurses

•Home first

•Other allied health professionals

The GP should have assessed community patients within 24 hrs of referral and be prepared to maintain medical responsibility throughout the patient’s treatment, or, in the case of out of hours, until the patient’s own GP is available.

Referral procedure

Community:

Refer direct to Acute Care At Home East co-ordinator on 01752 679017

or, via Bodmin switch 01208 251300

Ask to speak to co-ordinator for Acute Care At Home East to discuss plan of care.

Complete ACAH community drug chart if required and email along with patient profile to acah.east@nhs.net

No FP10 needed.

We would aim to begin intervention on the day of referral and once in receipt of the above documentation.

Acute Hospital

Refer direct to Acute Care At Home East co-ordinator on 01752 679017, or, via Bodmin switchboard,  01208 251300

Ask to speak to co-ordinator for Acute Care At Home East to discuss plan of care.

Complete ACAH community drug chart if required and email with discharge letter if available to acah.east@nhs.net

Medications, diluents and flushes should be prescribed and provided by hospital.

Types of condition that can be managed by the team include:

• Chest conditions such as COPD, chest infections, pneumonia.

• Cardiac monitoring eg.AF, heart failure, IV diuretics for HF.  

• Intravenous fluid replacement, (bolus), subcutaneous fluid replacement.

• Cellulitis.

• Short term provision of nebuliser therapy for exacerbation of respiratory complaints.

• Postoperative infections.

• Treatment of post-operative patients requiring IV antibiotic therapy.

• Sepsis screening, full set of observations at each visit.

The team can provide intensive nursing support at home including:

• Cardiovascular and respiratory examination

• I.V therapy, including antibiotics, anti-emetics and diuretics.

• Management of midlines, PICC and implanted ports.

• Cannulation and phlebotomy.

• Blood sampling where results may be required urgently in order to guide or instigate a particular treatment plan.

Advantages of using the service for the patient

• The patient’s recovery rate is improved by being in their own environment particularly the elderly and confused.

• More cost effective.

• Patient satisfaction.

• Social support networks are maintained.

• Rapid commencement of treatment.

Advantages of using the service for the G.P

• More cost effective

• Team will liaise with other services such as Home First, Community Matrons, to ensure a seamless journey for the patient.

Limitations of using the service

• The patient must be agreeable to staying at home.

• The patient must be over 18 years old

• Patient must have access to a telephone

General information for referrers

Please ensure the patient meets the above criteria; please contact us with any queries.

A nurse will visit the patient to undertake a full and complete assessment either in the hospital prior to discharge, or in their own home if referred via GP.

Throughout the patient’s treatment the team will liaise with you re any changes or concerns.