Case Studies

Case 7: Hospital admission of a person with a learning disability

Pardeep Singh is a 42-year-old man with a moderate learning disability and he lives in a care home. He is unable to communicate verbally and does not like to be touched. He finds it difficult to be with unfamiliar people.

His current problems are a nasal blockage that is making breathing difficult. He has problems with eating and drinking, has disturbed sleep due to snoring and these things are impacting his quality of life.

Pardeep needs a nasal operation. He arrives at the pre-operative assessment (POA) centre accompanied by a support worker and his parents. POA staff were not informed that he had additional needs when his appointment was made, and so it was not possible to make special preparations in advance. Pardeep had to wait in the waiting room and became distressed and agitated.

• 1. What could the pre-operative nurse do to make Pardeep feel more comfortable in this situation?

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  Correct answer:

  • Because Pardeep is unable to communicate verbally, the nurse could discuss his medical history, medication and allergies with the support worker and his parents.
  • The nurse could talk to Pardeep constantly about what he/she is doing, and could use the support worker's knowledge of Pardeep to help with recording BP, pulse, O2 saturation.
  • Pardeep's physical needs could be discussed with his support worker and parents, as could his requirements on admission.
  • The nurse can request a side room with space to accommodate the support worker and ask for Pardeep to be first on the operation list. Pardeep's case should be discussed with the anaesthetist and a telephone assessment arranged with Pardeep's support worker and the anaesthetist. The nurse could also send a clear letter to ward and admissions regarding Pardeep's requirements.

• 2. What can be done to avoid potential issues in the future?

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  Correct answer:

  • The outpatient department should.
  • Liaise with POA to inform them about a patient with learning disabilities.
  • Contact the Health Liaison Team, so they can support people with learning disabilities prior to and after discharge.
  • Book an early appointment and consider booking a double slot.
  • Liaise with Pardeep's carers so they know what to expect and can prepare him.