Meet Marjorie• Marjorie lived in her own home and was able to  care for herself and make all of her own decisions.  She ha...
• Marjorie became unwell and was admitted to  hospital having had been unwell. Prior to her  discharge an assessment was c...
• Marjorie has become worse and is in  hospital. She is now steruggling to breathe  and isunable to swallow safely. The  c...
• Marjorie had not given her son or daughter  power to consent or refuse treatments with a  PWLPA.• Marjorie had never had...
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Breakout 4.4 Meet Marjorie - Les Storey

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Breakout 4.4 Meet Marjorie - Les Storey
Consultant Respiratory Physician, Whittington Health & NHS Islington
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine
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Breakout 4.4 Meet Marjorie - Les Storey

  1. 1. Meet Marjorie• Marjorie lived in her own home and was able to care for herself and make all of her own decisions. She has a son and daughter who are both married and they have their own grown up children and they all live locally. Marjorie visits her surgery once a month to see the practice nurse for a respiratory screening and blood tests due to her breathing problems.• Q. What could be introduced to Marjorie at this time.• 1
  2. 2. • Marjorie became unwell and was admitted to hospital having had been unwell. Prior to her discharge an assessment was completed and Marjorie made the decision to move into Leafy Green Care Home(N) because she wouldn’t be able to manage at home and she didn’t want to be on her own anymore, her son and daughter both worked full-time.• Q. While Marjorie was in hospital what other documents could be considered.•• Marjorie lived in Leafy Green Care Home for three years, she enjoyed the company of the other residents and she had taken an active part in the life of the home, being chair of the residents committee for the last year.• She had told the home manager and her GP in the previous year that if she had problems breathing or swallowing she did not want to have any feeding tubes as she loved her food and would not want to live without being able to eat and drink normally.• Q. What documents should be in place for Marjorie at this point in time, and what documents should have been sent into hospital with her. 2
  3. 3. • Marjorie has become worse and is in hospital. She is now steruggling to breathe and isunable to swallow safely. The consultant does not know whether she will be able to regain her ability to swallow and advises that she may die without artificial hydration and nutrition.• Q. What assessment/document should be completed at this stage.• Marjorie doesn’t appear to be able to understand and is unable to communicate her needs and wishes with her family or the staff.• Her daughter is very upset and wants the consultant to put in a feeding tube. Her son isn’t certain whether this is the right thing to do.• Q. Is Marjorie’s daughter able to make this decision.• Q. What documents should be discussed/completed to assist in the decision making process. 3
  4. 4. • Marjorie had not given her son or daughter power to consent or refuse treatments with a PWLPA.• Marjorie had never had any conversations with her family about what she would want if anything like this happened to her.• Q. Should the care home/GP have discussed their conversation about artificial hydration and nutrition. 4

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