Using the SBAR4 model for Management of a Patient with Complex Comorbidites in the Nursing home - A case study

ABSTRACT

Singapore faces a rapidly ageing population. By 2030, 19 percent of the population will be aged 65 years and older. The rise of the dual-income family, the decline of extended families, as well as the increase in age-related degenerative disorders consequent to increased expectancy of life, create challenging situations. Families which are manpower and expertise challenged will find it difficult to look after their elderly infirm at home, especially if the elderly members are frail, functionally dependent, and prone to falls. Such families will increasingly look to the nursing home as solutions. To aid in allocation to nursing homes, elderly patients are classified into 4 categories by the Resident Assessment Form Category I patients are physically and mentally independent; Category II patients are semi-ambulant; Category III patients are wheelchair-bound or bed-bound; and Category IV are highly dependent. Categories I and II are primarily admitted to sheltered homes, while the limited nursing home places are mainly reserved for Category III and IV patients. The SBAR4 Tool is useful for clerking nursing home placement applications for placement decisions; for admission clerking; and for follow-up assessments and interventions. A case study of a patient who became bed-bound after hospitalisation for pneumonia due to deconditioning is used to illustrate the use of the SBAR4 Tool in a patient admitted to a nursing home, in implementation of recommendations, and in follow-up review of this patient a year later.