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Pathways and Processes in services for patients care in Acute and Primary…
Pathways and Processes in services for patients care in Acute and Primary Care Settings
Post admission
Services
CREST
PCC teams
Age action
Light home repairs (grab rail, changing light bulbs)
Pulmonary rehab
GRASP
UL neuro rehab class
Meals and wheels
COPE
NCBI
Mental health services
POLAR unit
MDT post amputation service for Cork Kerry
Gait re - ed for anputee
Donning / doffing limb
Crystal service
IWA
Personal assistant hours
Pre Admission
Primary Care Centers Central of co-ordinated approach by MDT
Services
Wheelchair association of Ireland
NCBI
Library
Safety online
knitting
Managing finances
Age Action Ireland
Ambulatory Outreach Team
Pathfinder (MDT new service out of CUH)
Headway
Groups
Activator pole classes
Falls prevention group
MS ireland classes
active retirement
Fatigue Management groups
Probus (limerick)
Sing strong
Crystal project
singing for the brain
memory gym
dementia info sessions for family
Alzheimers cafe
ALONE
Fit for the Future (Cork Sports Partnership)
Mens Shed groups
Smoking cessation classes
Pul rehab
ICA
Staff involved could include
Mental Health
SLT
Physio
Dietetics
PHN
OT
GP
+/- Clinical team meetings
**Preventing admission has impact on various stakeholder: patient, hospital (bed availability etc)
During admission (acute hospital, hospice, CNU)
MDT approach (may be located on one site, may be more efficient for discussions)
Physio
OT
Dietetics
Discharge co-ordinator
Nursing Alcohol liason nurse
Social Worker
Activities team
MDT meetings (rehab potential, identifies pts main problems, discharge planning etc)
Family meeting
Huddle +/- Expected Date of Discharge)
Palliative care
Psychology services
Pharmacy
Audiology
Joint treatment sessions
Frailty Intervention team
D/c routes
SFH
SFU
PCC
Ambulatory outreach team
CNU