Adult Scenario NPR2068

Patient Name        Ethel
Date of Birth10/10/1940 (age 80)
Relevant medical HistoryLeft total hip replacement (10 yrs ago) Osteoarthritis (ongoing) Diagnosed with Alzheimer’s over 5 years ago
Current medicationDonepezil 10mg once a day Amoxicillin 500 mgs TDS Paracetamol PRN
AllergiesNone known
Social HistoryLives alone with a regular carer and daughter Emily pops in regularly to help her
Nutrition historyIs independent at home with help from her carer and daughter
Presenting ComplaintEthel has been admitted to hospital with a suspected urine infection
Scenario informationEthel has been admitted to hospital 3 days ago with a high temperature and a suspected urine infection. She has started on oral antibiotics. Due to the change in her surroundings Ethel has become more disorientated than usual and is confused and agitated.   A capacity assessment has been undertaken and Ethel has been assessed as currently lacking capacity in understanding and taking her physical health medication (this is not normal for Ethel).   Ethel is now refusing her Alzheimer’s medication and also her antibiotics. She continues to have a high temperature and is generally unwell.   You have the opportunity to discuss with your nurse manager your recommendations and rationale for a best interest decision.   What are the ethical and legal considerations in this scenario What would your recommendation be for a “best interest decision” for Ethel’s continued care? What legislation do you need to consider? How would Ethel, her family and the multi-disciplinary team be involved in this decision? What are your responsibilities, limitations and accountability within this scenario?