Clifton Hospital 2023-06-26 Person 1 5 0

They need to address the following failures and eview therapy services, in particular OT and their discharge planning. Poor communication between teams on the ward and discharge team and family No discharge planning Ignored and disregarded information from family Failure to communicate with patients wife on changed discharge date plans Admitted for rehab but discharged more immobile deconditioned institutionalised and dependent on others for all self care. 3 x hospital acquired infections No home visit by OT to assess equipment needs for discharge leading to return to hospital for patient. OT went with patient on day of discharge. As patient unable to get legs on bed said he had to return to ward. This problem was 1 reason for admission, had frequently been reported to them by family. A meeting had been held on ward with family and staff to discuss it. They requested height of the bed which family provided. However failed to identify this as a goal for rehab or work towards it. Then unbelievably they were surprised at discharge home he couldn't do it and had to be readmitted. Patient when eventually discharged needed full assistance mobilising and was still having falls. He was weak and required maximum assistance of 2 to walk and for self care. 2 weeks after discharge with family input and reablement physiotherapy and equipment provided after urgent OT assessment 2 days after discharge he is now independently mobile with frame, self caring and Is able to get on and off bed independently.