Handover Document & Brief Management plan and Strategies for Superman

Handover Document & Brief Management plan and Strategies for Superman

Name: Superman

DOB: 07/05/1977

Home Address: : xxxxxxxxxxxxxxxKey Contact Details

Legal guardian office of public advocates

Eldest brother: xxx(estranged from rest of family

Youngest brother: xxxxxxx (lives at family home

Sister: Pxxxx (lives in Melbourne)

GP: xxx 9000 Edgars Road medical Centre (000 Edgars Road, Thomastown 3074)

Support Coordinator:

Support Coordinator :

About Superman

Superman is a 62-year-old man living with a diagnosis of schizoaffective disorder. Superman moved to xxxxxx Support Independent Living Accommodation on the 12 /12/2022 . Superman will be sharing the house with his fellow mates who used to reside with him at the Northern Community Care Unit (NCCU). Superman recently lived at ECCU in Coburd, Victoria and has been living there for the past three years. Prior to living at the ECCU, Superman was an inpatient at a secure extended care unit for one year, related to a hospital admission based on Supermans mental health and psychosocial disability. Prior to this, he lived with his parents for most of his life. Supermans parents are ageing and are no longer able to provide the informal support they were previously able to. Superman shows some fixation on topics such as buying things for his parents, returning to employment as a tradesman, moving out of the ECCU and about feeling as though his diagnoses are incorrect. Superman shows reduced insight into his functional capacity, which is a barrier to his engagement in some services.

Medical history.

Schizoaffective disorder (Primary diagnosis)

Chronic Obstructive Pulmonary Disease (COPD)

Congestive Cardiac Failure (CCF)

Morbidly Obese (BMI 54.83)

Lower Limb Oedema impacting on mobility.

Significant left hip pain which reduces Supermans mobility, domestic activities of daily living (ADL) and safety during self-care tasks.

Heavy smoker, poor sleep pattern, wakefulness, insomnia, increased blood pressure, headaches, fatigue, hypersomnia, rectal pain.

Iron deficiency anaemia

Substance use history:

Heavy smoker smokes around 30 cigarettes per day, discharge from SUMMIT, pre-contemplative stage of smoking cessation

HEALTH MANAGEMENT STRATEGIES.

The Superman Sibling got good engagement from his support staff to involve his sibling so that he would feel the same way

Conflict within the family is a significant issue. Eldest brother John is estranged from family, only maintain contact with Superman. For Superman to be included in the family, he has hidden his relationship with John from the rest of his family. Don't reveal any information without Superman's permission.

In addition to Superman's rectal pain (HX fissure), he also suffers from rectal pain (HX fissure), so if it is his rectal pain, he will benefit from Xylocaine 5% ointment, Proctosedyl, or paracetamol.

As a result of non-compliance with BIPAP usage for severe OSA, Rome might consider using this machine to help with his oxygen saturation and hypersomnia.

Noncompliance with 1.5-liter fluid restriction for CCF: Encourage not to drink too much fluid which might exacerbate his

Congestive heart failure which might lead to hospitalization so, check his weight every 2nd day, if his weight keeps going up 2 times in a row notify his GP

BD OBS TDS o2 sat monitoring weight check every 2nd morning for fluid overload

Acute Observation and response chart (AORC) modification O2 saturation approved > 80%. For transport to ED if O2 sat is less than 80% and cannot be improved: as per GP. Encourage BIPAP use to improve O2 sat normally this does help as per team from NCCU

Regular follow up with GP, aiming towards every 2-3 weeks, last GP appointment on 4/11/2022

Encourage BIPAP use every time Superman sleeps, while using BIPAP machine make sure there is no leak

Experience shortness of breath |(SOB) when walking even short distance, allow him to rest in between

Often falls asleep where seated, so take him to safe area like in couch or bed.

History of inappropriate sexual comment toward female staff, put firm boundaries in place

Smokes 30 cigarettes a day, need to put firm boundaries and support worker need to monitor Superman, so that he does not smoke inside the house

Superman Biggest issue is with noncompliance with medication: As Superman is in Community Treatment order so medication compliance is must: All staff should have uniform answer regarding his medication and why Superman should take medication

Support workers may use terminology such as if you do not take medication, you may never be able to get your license back. As Superman wishes to live a normal life and work as a concrete driver, this may be useful in assisting him with medication compliance.

To encourage medication compliance, Superman loves classical music, so classical music can be played and dance with him in appropriate manner

Superman loves cooking food; staff can build rapport with him through the conversation regarding food and meal preparation which might assist with medication compliance

Metformin: Need to remind Superman that this is not for his diabetes but to assist with weight loss

Furosemide: Need to explain Superman that this medication is get rid of extra fluid from his leg and then you can show his leg and explain to him if he does not take this medication there will be bad consequences for his health

Spironolactone: Explain to Superman that this is potassium sparing water pill which will keep potassium in his body and get rid of extra water from his leg and body

Perindopril 2.5mg; Superman will ask for 10mg. remind Superman that when he went to Hospital last year Doctor reduces to 2.5mg due to Low BP and increase in frusemide dose

Inhaler: Superman prefers to spray more that recommendation dose so, monitor the use and administer only prescribed dose

Vitamin D: Superman believes that there is worm in these tablets: Remind him these are vitamin D prescribe by Doctor as his Vitamin D level is low.

IF Superman persistently refuses medication notify Noogal clinic or his GP and follow the instruction from them.

Establishing rapport and trusting therapeutic relationship

Conduct ongoing risk assessments in collaboration with other stakeholders

To monitor and assess for any deterioration in both mental and physical state as an ongoing process and liaise as necessary

To monitor medication concordance, efficacy, and side effects

Interpersonnel Therapy ; relaxation technique, distraction technique

Psychoeducation

Exploration for greater community links

Regular GP, Psychiatrist checks

If there are behaviours of concern, please refer to the behaviour management strategies below.

Crisis Management

During an emergency, support staff may contact management, the Noogal clinic, triage, ED, police, and ambulance services

GP: Edgars Road medical Centre (223 Edgars Road, Thomastown 3074): Richard Wardlaw 94650088

Brief Management plan and Strategies for Superman

Brief Management plan and Strategies for Superman

Traffic light system, where Superman is able to identify which zone, he is in and informs staff.

Green

Superman is able to express himself in a calm and respectful manner . Focused, happy, relaxed, or ready to learn to engage in different activities like cooking , going out for a short walk , listening to staff instructions , able to take his medication with minimum prompting .

Superman has a great sense of humor and makes jokes and laughs when he is in a good mood. Superman enjoys giving staff nick names and interacting with them on a variety of topics. - NO Action required.

Amber- Superman may become irritable, elevated, and frustrated. Symptoms include Swearing , pacing up and down shouting . At this stage he may also refuse to listen to staff feedback when his mind is fixated on something .

Staff should withdraw from Superman's environment if he displays the above behavior and gives him space to settle down until he is ready to speak.

Response strategies (de-escalation)

.

When he is at the day center, the staff may ask him to take a walk around the grounds and observe from a distance.

Behaviour of concern

These above behaviours may continue to escalate; this me see yelling more, swearing more using words like e.g., F---ng Bi---Ch, punching wall and may even start to break furniture.

There may also be instances in which he lifts his hand as if he intends to strike someone, but there is no evidence that he has struck anyone.

It is at this point that Superman may again walk away and self-isolate, so allow him to do so and observe from a distance. When is safe to do so redirect him to his room or outside for a smoke .

Report the matter to the manager if he does not calm down. Initially, he appears to his brother-in-law xxxx, familiar staff, and individuals he perceives as being in authority.

Superman informed nursing staff that he was on the phone to Centrelink, Centrelink could not understand what he was saying so he slammed the back sliding door. Superman reported that now it was broken. Electrical wiring was exposed and unsafe

Staff found over the counter medication

Hydocortisone 1% cream in his bed room. he also reported purchased Salbutamol MDI and he kept in his jacket. He said he bought the medication at chemist at Northland Shopping centre. Superman purchased medications without consultation with treating team. Superman utilised medication inappropriately

Superman's father (Mario) came to nursing station and informed staff that he does not want to have Superman for overnight leave (ONL) due to disruptive behaviour that causing him to have sleep deprivation. Mario Informed staff that Superman insisted to stay for overnight leave. Mario seek help toward staff to pass the information to Superman. Staff informed Superman that team decision is made that Superman cannot have overnight leave when his parent not approved ONL. Superman became verbally hostile and threatening manner toward staff. Superman stated he can do what ever he wants and nobody can stop him. Superman refused reality feedback.

Reviewed by Consultant and registrar 8/10/18- CPF entry Impression: Given some increase in paranoid thoughts, predominantly of sexual nature, in the period preceding the alleged incident; the vague nature of the complaint; the later denial of the alleged incident; even contemplating that it could be a manifestation of psychosis/ imagination; and seemingly unconcerned attitude towards that, along with circumstantial evidence, all point towards a delusional origin for the complaint. The belief seems to have attenuated now.

Risk towards others in the context of this allegation appears minimal. It appears that while there is now some improvement in the self-important thinking and expansiveness, the mood symptoms, there has been some worsening of psychosis. Incident review outcomes indicate that the allegation is psychotically driven, with consultant review

verbal aggression

Physical Aggression

Property damage

Smoking in the house and sleeping with lit cigarette

Living the gas stove on at night after cooking

Noncompliance of Treatment and medication

Using non prescribed medications over the counter medications

History of inappropriate sexual comment toward female staff

Intervention Management

It is important for support people to look for early warning signs that indicate that Superman is anxious/stressed/angry and intervene then. One or a combination of the following reactive strategies should be used when the pre-cursor behaviour is observed:

Physical and Verbal Aggression

Remain calm and use a low, calm, direct tone of voice

Give Superman personal space

Use the word stop rather than no

Re-direct Superman to a liked activity and give labelled praise if he engages in the activity

Keep instructions simple. Use simple sentences, emphasizing key words

Use previously learned visuals when communicating with Superman

Attempt to solve the problem for Superman. e.g., are you hungry or thirsty? (use .e.g.

Remove other known triggers to Supermans behaviours if possible and appropriate

Play music that Superman is known to enjoy

In addition to the above, one or a combination of the following reactive strategies should be used when

the behaviours of concern are observed:

Physical aggression:

Remove the person who Superman is targeting from the environment

Remove all others from the environment if possible

Stand behind natural barriers such as tables, chairs, benches etc.

Do not physically restrain Superman

Remain calm and use a calm tone of voice

Support Superman to use the toilet if he needs to

Prompt Superman to go to bed or back to his bedroom

LIKES:

Listening to music

Going out for Shopping

Out for a drive

Family visits

Sharing jokes

Cooking

Dislikes

I do not like bossy people

I dont like exercises

I dont like to be forced to do things

I dont like to be told what to do.

I dont like loud and demanding peoplePeople invading my private space

I dont like to run out of money

I dont like missing family visits

Functional Capacity

Superman is reliant on the use of equipment such as a Hilo bed, falls alert alarm, shower chair etc., to support his safe engagement in daily routines.

Superman requires around the clock support to ensure the safety of himself and others. Superman shows a considerable reduction in his insight into his own functional capacity, and experiences delusions and fixations which impact on his safety.

Supermans disability is multi-faceted, across physical, cognitive, and psychosocial domains, and he faces challenges with all activities of daily living in one way or another.

Superman requires prompting to engage in self-care routines and domestic tasks, and it is estimated that without assistance- he would likely see a significant reduction in his engagement in these activities.

Daily Routine

Cooking

Superman enjoys cooking and he often cooks meals for other residents. Superman has sporadic cooking sprees at times; sometimes he cooks late at night or early in the morning. Increased excessive cooking has contributed to an increase in food intake and weight issues. Superman often requires prompt to cook safely and is at risk of leaving cooking utensils (pans/pots) unattended; especially in the context of chronic sleep deprivation and drowsiness/napping and general disorganisation secondary to fatigue. Encourage Superman to use rear hot plates on the stove to minimize the risk of burning himself. Prompt Superman to set a timer when cooking to help stay awake whilst cooking, encourage not to cook when sleepy. In order to minimize fire risk, staff lock the stove and oven overnight, no cooking from 21 07:30hrs. The stove and Oven switch has a lock in the pantry, nursing staff has a key. Staff to check on Superman every 30 minutes whilst he is cooking, lock oven and hot plate after use

Shopping and budgeting

Currently Superman is on a disability support pension and his finances are administered by State Trustees. Superman received a compensation payment related to a permanent physical work-related injury. Superman continues to be preoccupied with his financial matters.

Baseline financial plan: Superman receives $220/week. Divided into two payments: Monday $1 10 and

Thursday $110. Usually, Superman receives payment around 1400hrs. Superman requires support with budgeting skills. He often uses money for cigarettes and take away food rather than more economical

shopping options. Superman might need support to make sure he has enough money to buy food.

Superman is currently experiencing disempowerment with multiple external controls being in place against his wishes. The Financial Independence program by the State Trustees was attempted in March 2021 , however, was not successful. Superman cancelled the trial within 1-2 weeks.

Taking the Webster pack medication on a community outing

Please give midday and/or afternoon medications to take with Superman if out on a planned day leave.

Superman has a supportive family, although a long-standing family conflict exists between Superman's brother John and the rest of the family (excluding Superman). Superman has two brothers and one sister. Superman often contacts his parents and brother John over the phone. Younger brother Osvaldo was released from jail, returned home to live with parents on 26/7/21. Superman's father underwent rehabilitation in the second half of 2021 after suffering from strokes. Superman's father is currently residing at the family home, receiving palliative care. Currently Osvaldo is caring for their father at home.