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HOME/Knowledge Base/WDPL/WDPL NHS@Home Step Up process
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WDPL NHS@Home Step Up process

Updated on 9th November 2023

NHS@Home Patient eligibility

  • Eligibility for any NHS@Home pathway requires consideration of both clinical & social/ patient factors. The light blue  referral requirements box below details these further.
  • NEWS scores should generally be 5 or below, but clinical discretion can be applied.
  • Exclusion criteria: New onset chest pain, IV fluids required, Suspected stroke or complex symptomology, major trauma, acute MH crisis at risk to self / others. Pt or carer unable to seek help if required.
  • Further details on interventions offered are available the NHS@Home toolkit page or on Remedy  here

The NHS@Home team will ask further details during the referral process:

  • relevant PMHx
  • the patient's social set up ( ?POC/ housebound)
  • any recent medication changes

Patients and carers must be willing to consider community based care as an alternative to hospital admission.

NHS@ Home Respiratory Pathway Remedy Link

Inclusions : COPD/ Asthma exacerbations, LRTI (eg CURB <2), CV19, IE Bronchiectasis

Exclusions: PE, acute cardiac presentation, Pregnant or 6/40 post partum, Acute confusion/ drowsiness/ too SOB to talk in full sentences. Asthma PEF < 50%

Interventions they can offer: Nebuliser therapy,  airway clearance, weaning /monitoring of respiratory medication to ensure efficacy, access to resp consultants. Bloods. If IV Antibiotics being considered please contact the Resp Clinical Advice line on 0333 230 1471 (between 8am - 6.30pm).

NHS@home - Frailty pathway Remedy Link

Inclusion Criteria : > 65 Years with clinical frailty score of >=5 (clinical discretion allowed).

Interventions: Alongside generic NHS@Home interventions, can undertake comprehensive geriatric assessment with access to consultants with interest in Frailty

Information for Primary Care clinicians

Once a patient has been accepted by NHS@Home, the NHS@Home team become responsible for the plans & decisions in relation to that acute episode of care.  The GP will remain responsible for any long term needs, eg repeat medications.

The NHS @Home is an MDT that includes ACP's, working with consultants from UHBW & NBT.

Patients will have access to a NHS@Home patient line ( 8am-8pm, 7 days a week), and can seek support from 111/ 999 as per usual process outside of these hours.

 

 

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