Synopsis
Deliver proactive, person-centred medical care in a care home, recognise acute illness against an observed baseline, prevent medicine and transition errors, and coordinate residents, families, care staff, primary care and specialist services around function and goals.
- Know each resident's baseline cognition, communication, mobility, continence, intake, weight, medicines, escalation plan and preferred contacts before illness occurs.
- First-line deterioration assessment uses ABCDE, glucose, observations, 4AT when appropriate and a precise description of what changed from baseline.
- Do not diagnose UTI from confusion plus a positive urine result alone; assess local urinary and systemic infection features and alternative delirium causes.
- NICE SC1 requires accurate medicines records, clear responsibilities, trained administration, timely supply, reconciliation and incident learning in care homes.
- Time-critical medicines need resident-specific administration windows and escalation for delayed or omitted doses.
- Review anticholinergic and sedative burden, falls, swallowing, renal function and treatment goals through regular structured medication review.
- Advance care planning records values and preferred approaches, but no document replaces assessment of a new reversible illness or current capacity.
- A DNACPR decision applies to cardiopulmonary resuscitation and does not mean no hospital transfer, antibiotics, fluids or active symptom care.
- Infection prevention combines vaccination, hand and respiratory hygiene, ventilation, appropriate PPE, device care, cleaning and prompt outbreak reporting.
- Transitions need one reconciled medicine list, baseline and mobility description, capacity and legal information, pending results, equipment and named follow-up.
Key red flags
New oxygen need, respiratory distress, hypotension, mottling, oliguria or reduced consciousness requires emergency medical assessment.
Sudden facial, speech or limb change requires stroke activation even when dementia or prior disability is present.
Fall with anticoagulation, head injury, new pain or lost weight bearing requires urgent trauma assessment.
Fever or hypothermia, delirium and rapid functional decline may signal sepsis despite absent localising symptoms.
Missed insulin, steroid replacement, Parkinson's or antiseizure treatment can cause time-critical deterioration and requires immediate reconciliation.
Unexplained injury, dehydration, weight loss, poor hygiene, fear, controlling visitors or repeated omissions raises safeguarding concern.
Delayed insulin, levodopa, steroid replacement or antiseizure treatment produces predictable deterioration.
The MAR, discharge list, supply and instructions disagree after return from hospital.
Injury, dehydration, fear, missing care or restricted contact is unexplained or recurrent.
Investigation priorities
Define the acute clinical question first line.
Management branches
Care staff identify a new cognitive, physiological or functional change.
- State exact onset and baseline departure and use ABCDE, glucose, observations, delirium and focused examination.
- Treat emergencies, reconcile time-critical medicines and select tests and referral from the clinical syndrome.
- Record treatment, monitoring, escalation and goals in instructions care staff can deliver and observe.