Case study'' Redwood Ward

1
Case study.. Redwood Ward

• Introduction.
• Background and care.
• Challenges.
• Learning.

2
Background and care.

• 40 year old lady.
• Diagnosis of Downs Syndrome with severe learning
  disability,frontal lobe atrophy and registered
  blind. Not able to speak. Communicates pleasure
  and displeasure non verbally.

3
Contd...

• Admitted to Redwood Ward under Section 2 of the
  Mental Health Act. Later converted to Section 3.
• Steady deterioration in mental state over a
  number of months, characterised by increased
  irritability, tearfulness and reduced enjoyment.

4
Contd..

• Pinching and kicking at people.
• Picking at skin below and behind her ears,
  causing ulcerated wounds and risk of infection.
• Accommodation issues.. first floor bedroom,
  increasing quantity of p.r.n.
• One previous admission. Had been heavily sedated
  to allow for wound healing. Very sensitive to
  side effects.

5
Care.

• One carer from MDLP working with A each shift.
  Purpose to engage and distract.
• Often 21 observations when A distressed in order
  to deflect her hands.
• P.R.N. of no benefit in addressing agitation.

6
Contd.

• Periods of extreme agitation, scratching herself
  and others.
• Evidence of development of rapport with familiar
  people.
• Consideration of the use of arm splints to reduce
  scratching at her wounds. Nursing staff
  uncomfortable initially.

7
Contd..

• Support from MLDP O.T. re splints. Guidelines and
  careplans developed.
• Initially splints unsuccessful as huge increase
  in distress and ease of A removing them. Increase
  in assaults on staff.. Kicking, punching and
  scratching.
• Increase in use of physical restraint as damage
  to face increasing .

8
Contd..

• Stressful time for ward staff- increase in
  assaults and inconsistency in the attendance and
  quality of care staff.
• MLDT helpful and available for advice and
  support.
• New splints arrived and uncomfortable.

9
Contd.

• Increasing amounts of time out in public areas,
  both inside and out.
• Negotiation with MLDP re provision of 24 hour
  carers. Observation levels reduced to 11.
• Splints remodelled and comfortable. Reduction in
  A distress.
• Discharged after 6 weeks. No reduction in
  attempts to scratch self or others.

10
Challenges.

• Communication with A.
• Restraint issues.
• Joint working.
• Working outside scope of practice.

11
Learning.

• Increase in confidence, skills and ability.
• Joint working.
• Dr. Jenkins phone number!!

12

• Thank you.
• Any questions ?