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36
Psychiatric Care in the Community
Two district nurses who are also psychiatric qualified were
appointed to visit and nurse patients who need specialised psychiatric
care. This involved giving support and also supervising the medication
ordered by the consultant psychiatrist. These patients were usually
referred back to their own doctors.
The nurses attended the special sessions held in Kenley Ward
at Kingston Hospital for group and case discussion.
They are also involved with the care of psycho-geriatric
patients in the community, who often require additional support from
the district nurses who also have knowledge of the facilities available
to help both patients and relatives.
Geriatric At Risk Register
With the consent of the general practitioner involved, several
elderly patients, who have deteriorated either physically or mentally,
have been entered on the "at risk" register after referral by home nurses
and health visitors and surveillance has been kept by special visiting,
including seven day a week coverage when the other services were not
available.
Where further deterioration has taken place, the senior medical
officer makes a domiciliary visit and advises on action to be taken.
The maintenance of the register and regular discussion with the
workers involved has helped in preventing more patients being removed to
hospital under compulsory removal orders under Section 47 of the National
Assistance Act.
Special consideration has been given to prevention of hypothermia
in the elderly and emergency kits have been maintained for this purpose.
Communications with Hospitals
As a result of a combined study day for district nurses, health
visitors and ward sisters, it was agreed that the service to the patient
could usually be improved by better links in communications. A revised
form was introduced for a trial period to the staff of two wards at the
hospital for completion by the ward sisters when the patients are being
discharged.
This confidential report gives detailed information on each
patient and an assessment of his ability on discharge, and this is proving
to be very helpful to the district nurses and also to the patients' general