EC11L Investigate and diagnose an unwell older person presenting for emergency assistance

Overview

This standard covers the formation of a justifiable diagnosis of an unwell older person presenting for emergency assistance.  The standard involves the collection and systematic, balanced analysis of information to arrive at a diagnosis. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. the complexity of determining the individual’s capacity for decision making and the variable nature of understanding and decision making in some individuals
2. the anatomy and physiology of the human body
3. aging processes and their presentation
4. the value and uses of different sources of information in reaching a diagnosis
5. the importance of a systematic and logical approach to information use and analysis, and the risks associated with jumping to a premature conclusion
6. why it is important to ensure that all information is taken into account in reaching a diagnosis and why you need to be prepared to review that diagnosis in the light of emerging information
7. the processes that should be gone through to arrive at a justifiable diagnosis for an older person presenting with unclear or conflicting symptoms
8. the steps you should take when unable to arrive at a satisfactory diagnosis
9. the importance of clear communication in clinical situations
10. the importance of communicating with the older person in a manner which:
1. is consistent with their level of understanding, culture, background and preferred ways of communicating
2. acknowledges the purpose of the communication
3. is appropriate to the context
4. encourages their participation
5. responds to communication of any kind from them
11. the importance of maintaining confidentiality during communication, consistent with legislation and the employer’s policies
12. the importance of recording information clearly, accurately and legibly
13. the differentiating features that can be used to develop a diagnosis of health problems in an acutely ill older person
14. health problems which may present with similar symptoms and how to differentiate between them
15. the causes and contributing factors to commonly occurring health problems in an acutely ill older person
16. clinical norms with regard to typical conditions presenting as a clinical emergency in relation to an acutely ill older person
17. the complicating factors that can make diagnosis difficult in relation to the acutely ill older person
18. the different investigative procedures that can be applied to enable a diagnosis of commonly occurring health problems in an acutely ill older person to be reached, and how and when to call for each
19. the baseline observations used in diagnosing commonly occurring health problems in an acutely ill older person
20. the further investigations required to diagnose commonly occurring health problems in an acutely ill older person
21. where further investigations can be carried out, who undertakes them, how to request them, the timescales involved and any contra-indications of which you need to be aware when deciding to call for them
22. the pathophysiologies and pathopsychologies underlying commonly occurring health problems in an acutely ill older person
23. national, local and organisational procedures for the emergency treatment of the acutely ill older person
24. the organisational policy and practices with regard to the keeping and sharing of clinical records and information
25. organisational procedures on making notes
26. national, local and organisational procedures for requesting investigative procedures
27. the legislation regarding confidentiality and information sharing, the provision of services, the rights of the individual, protection issues, anti-discriminatory practice, informed consent, relevant mental health legislation and care programme approach
28. how to interpret and apply legislation to the work being undertaken
29. the ethics concerning consent and confidentiality, and the tensions which may exist between an individual’s rights and the organisation’s responsibility to individuals
30. the importance of gaining assent from individuals who lack capacity to consent
31. circumstances when further investigations, including child protection procedures, can be carried out, in line with organisational and national protocols and guidelines

Performance Criteria

You must be able to do the following:

1. establish the older person’s capacity for comprehension and decision-making with regard to what has happened to them and what is now required
2. use discretion and respect throughout, balancing the rights and capabilities of the older person with their significant others
3. explain clearly to the older person and any carer with them:
1. your own role and its scope, responsibilities and accountability
2. the information that is needed and who might have access to it
3. what is involved in the investigation process
4. obtain informed consent from the older person or any carer with them if the older person’s capacity for comprehension and decision making is reduced
5. discuss and agree with colleagues:
1. who is responsible for aspects of the assessment and how this will be managed and reported
2. needs and risks and how these can best be addressed
6. ensure you obtain a complete and accurate history of the presenting older person
7. accurately and promptly identify the additional information which you need to make a differential diagnosis
8. follow the appropriate procedures and protocols to arrange for any investigations or observations needed to provide you with relevant information
9. review all the available information, noting and taking account of any conflicting, confounding or unusual aspects
10. recognise accurately and promptly the differentiating features of commonly occurring conditions presenting in unwell older people
11. recognise promptly the need for, and obtain, any additional information needed to clarify or confirm your analysis
12. identify and make use of relevant research and findings from evidence based practice to inform your interpretation
13. promptly seek additional views and advice from relevant others when your interpretation produces unclear results.
14. develop a diagnosis which is:
1. justifiable given the information available at the time
2. likely to result in the optimum outcome for the older person
15. balance any additional or unusual aspects of the older person’s presenting features against their overall presentation, acknowledging any uncertainties and conflicts
16. recognise accurately potential signs of abuse and report them promptly to the appropriate person, in line with national and organisational policy
17. form an accurate and justifiable identification of:
1. the nature and severity of the older person’s condition
2. the likely causes of the older person’s health problems
3. the implications of pre-existing and other medical problems which the older person may have
4. the prognosis for the older person
5. the older person’s related needs
6. risks to the older person’s health and well being in the short and longer term
18. form a working diagnosis as quickly as possible
19. seek additional support and advice from other practitioners as necessary to arrive at a satisfactory working diagnosis
20. re-evaluate and adjust, if necessary, your initial diagnosis in the light of emerging symptoms and/or the results of investigations
21. determine and confirm when death has occurred, within the limits of your own role, accountability and scope of practice, or inform the appropriate other of the need for them to make this confirmation
22. maintain full, accurate and legible records of your diagnosis and any assumptions made and make these available for future reference in line with organisational practices.
23. initiate symptomatic treatment at the earliest opportunity in a manner which is consistent with:
1. evidence based practice
2. your own scope of practice
3. legislation and national guidelines and protocols
24. initiate action which provides the best possible outcome for the older person
25. advise the older person and any significant others of the diagnosis:
1. at the earliest opportunity
2. in a manner which is sensitive to their concerns
26. provide opportunities for the older person and significant others to ask questions and develop their understanding of the diagnosis
27. identify and share with colleagues relevant details of the diagnosis you have reached and its implications for further action

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning