1. family and parenting
2. eldercare

ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Sample Pack
Daily Reporting &
Communication
Comprehensive
Care Planning System
Optional / Nursing
Information
Jo Turner (Manager) Chester Lodge
Mandatory
Assessments/Records
Less admin more care...
… a comprehensive care planning system, easy for
staff to use … it promotes the opportunity to ensure
that all care plans are individualised and person
centred. During the last three inspections CQC
were happy with every one of our care plans …
the nurse assessors from the local PCT have
commented about the high quality of our care
plans and that all of the information they require
is accurately recorded and easy to find. The
documentation guide helps staff to understand the
relevance of each form and how each can be used to
evidence that the outcomes are being met …
Respite
Contents
ADMISSION
21.076 Pressure Ulcer Assessment
19
21.049 Pre Assessment
4
21.078 Bedrail Assessment
20
21.026 Hospital Transfer Record
5
21.079 General Risk Assessment 21
21.050 Re-Assessment
5
21.080 General Risk Evaluation
21
21.051 Admission
5
Optional / Nursing Information
Assessment & Care Planning
21.081 Pain Chart 22
21.052 Support Plan
6
21.082 Wound Chart
22
21.053 Care Plan
7
21.083 Depression Scale
23
21.054 Care Plan Evaluation
7
21.084 Medication Record 23
21.055 Activity Plan
8
21.089 Dependency Profile 24
21.056 Activity Plan Evaluation
8
21.085 Observations and Monitoring
25
21.057 Social Activity
8
21.086 Diabetic Chart 25
21.058 Social Activity Comments
8
21.088 Fluid Balance 25
21.087 Repositioning Chart
25
21.090 Deterioration Scale 26
Dementia & Mental
Capacity Information
21.059 Personal History
9
21.060 Support Network
9
21.061 Mental Capacity Assessment
10
21.062 Deprivation of Liberty
10
21.063 Lasting Power of Attorney
11
21.064 Future Wishes
11
Day to Day Recording
21.065 Personal Care
12
21.066 Bowel Chart
12
21.098 Bristol Stool Chart
12
21.067 Food Chart
13
21.068 Weight Chart
13
21.069 Body Chart
14
21.070 Epilepsy Chart
14
21.071 Oral Assessment Tool
15
21.072 Record of Behaviour
15
Daily Reporting & Communication
21.091 Keyworker 27
21.092 Communication Sheet
27
21.093 Multidisciplinary Notes
27
21.094 Doctors Notes 28
21.095 Family Communication
28
21.096 District Nurse Notes
28
20.768 Daily Report 29
20.025 Daily Report - Single
29
20.019 Nursing Report 29
Respite
20.929 Respite Booklet
30-31
Mandatory Assessments/Records
21.075 Manual Handling
16
21.074 Falls Risk Assessment
17
21.073 MUST Tool 18
21.097 MUST Poster
18
21.077 Infection Risk Assessment
19
2Email:
[email protected] Phone: 01604 646 633
ADMISSION
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Standex Systems have been providing care planning
systems to the care sector for over 40 years. Part
of an international group with over 18,000 satisfied
clients which includes 2,500 in the UK alone.
Standex in the UK specialise in providing care
planning systems to care homes, nursing homes,
hospices and hospitals.
At Standex Systems Ltd we always strive to be
ahead of your documentation needs. By keeping a
close eye on the requirements of the Care Quality
Commission, we are able to develop and update
care planning systems in line with the regulations.
As a company we provide a wide range of filing and
storage solutions to compliment our care planning
system to create a one stop shop for your care
planning needs.
Assessment &
Care Planning
Company Overview
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
Other product ranges available:
• Files & Storage
• Waste & Laundry
Fax: 01604 644 646
• Treatment Trolleys
• Medication Trolleys
Web: www.standexsystems.co.uk
3
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.049 Pre Assessment
• Demographics, medical history,
medication, allergies, resus status.
• Holistic Assessment (including a section
about whether service user has mental
capacity at time of assessment).
• LPA details if applicable.
• Infection status.
• Reasons for acceptance/
non acceptance.
• This form allows evidencing that the
needs, wishes , preferences and
decisions of the service user are placed
at the centre of assessment, planning
and delivery of care, treatment and
support. Whilst promoting independence.
In line with Outcome 1: Respecting and
involving people who use services.
• The very first form that is used before the
service user has even entered the home.
It evidences that safe and appropriate
care is given because individual needs
are established from when they are
referred. It can be recorded that all
aspects of their individual circumstances,
and their immediate needs are recorded
prior to admission (or non admission as
the case may be). In line with Outcome 4:
Consent to care and treatment
4Email:
[email protected] Phone: 01604 646 633
ADMISSION
Dementia & Mental
Capacity Information
Day to Day
Recording
• Hospital Transfer Record should be used if the service user
is taken into hospital.
• Provides ambulance crew and staff at the hospital with
vital information regarding the service user’s health and
support required.
• The principal concern of the care home is to maintain the
service user’s well-being, provide optimal care during the
transfer period, and to deliver the service user safely to the
receiving unit.
• The care home can keep the top copy for their records,
the 2nd and 3rd copies can be given to the hospital and
ambulance crew for their records.
• You may attach photocopied care plans and the latest
daily report if you feel this will better inform nursing staff of
support required.
• In line with Outcome 6: Cooperating with other providers.
Assessment &
Care Planning
21.026 Hospital Transfer Record
Mandatory
Assessments/Records
21.050 Re-Assessment
Optional / Nursing
Information
• A smaller version of
Pre-Assessment to document
any changes in service user’s
condition on return to the home.
• Can document whether the
home can still cater for service
user’s needs.
Daily Reporting &
Communication
Respite
21.051 Admission
• Service user details on admission.
• Designed to go in front pocket
of the file where it can be seen
quickly and easily.
• Quick ‘at a glance’ view of service
user’s details.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
5
ADMISSION
• Based on Roper, Logan and Tierney’s
Activities of Daily Living with
further categories for a more robust
assessment.
• Any problems trigger a care plan.
• This can be done on a monthly basis
or more frequently if needs change.
Here we have the review section
where the service user/advocate can
sign to say they have been involved in
the assessment.
• The holistic assessment looks at
Cognition, Psychological, Physical,
Social and End of Life.
• Can be used to evidence that the
following outcomes are being met:
• Outcome 1: Respecting and involving
people who use services.
• Outcome 2: Consent to care and
treatment
• Outcome 4: Care and welfare of
people who use services
• Outcome 5: Meeting nutritional needs
• Outcome 7: Safeguarding people who
use services from abuse
• Outcome 9: Management of medicines
• Outcome 10: Safety and suitability of
premises
• Outcome 21: Records
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
21.052 Support Plan
6Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
21.053 Care Plan
Day to Day
Recording
Mandatory
Assessments/Records
• Generated from the Support Plan.
• Looks at need, goal and support required.
• Each plan needs to be person centred
(blank for you to do this).
• Our Documentation Guide gives you
prompts for each area and encourages
staff to think in a ‘person-centred way’.
21.053 Can be used to evidence that the following outcomes are being met:
• Outcome 7: Safeguarding people who
use services from abuse.
• Outcome 8: Cleanliness and
infection control.
• Outcome 9: Management of medicines.
• Outcome 11: Safety, availability and
suitability of equipment.
• Outcome 21: Records.
Optional / Nursing
Information
• Outcome 1: Respecting and involving
people who use services.
• Outcome 2: Consent to care
and treatment.
• Outcome 4: Care and welfare of
people who use services.
• Outcome 5: Meeting nutritional
needs.
Daily Reporting &
Communication
Respite
21.054 Care
Plan Evaluation
• To be used to
document the
evaluation of the
care plans.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
7
ADMISSION
21.055 Activity Plan
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
• To be used as the care plan but
specifically for social activity.
• Useful for use by Social Activity
Co-ordinators.
• To be used to document the
evaluation of the activity plans.
21.057 Social Activity
• Can be used to plot dates
of social activities.
• There is a year on a form.
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
21.056
Activity Plan Evaluation
21.058
Social Activity Comments
• Can be used to write comments
about the social activity in
conjunction with the activity care
plans or on their own.
8Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Mandatory
Assessments/Records
• Personal Story.
• Useful for reminiscence, especially
in those with dementia.
• Person-centred.
Day to Day
Recording
21.059 Personal History
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.060 Support Network
• Quick glance document can be used to
document service user’s support.
• Can be used for any out of hours contacts
such as Macmillan Nurse etc. Therefore
supporting End of Life documentation.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
9
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
• To be used if a service user needs to make a
decision and their mental capacity is in question.
• Assists staff in assessing capacity in line with
the Mental Capacity Act 2005.
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
21.061 Mental Capacity Assessment
21.062 Deprivation of Liberty
• Will assist manager in deciding whether an
application to deprive a service user of their
liberty is required.
• Document the outcome of the decision.
10Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Mandatory
Assessments/Records
• For details of any Written Lasting
Power of Attorney and/or advocates.
• Can document any Advance
Decisions/refusal of treatment if they
become incapacitated (i.e. advance
care planning).
Day to Day
Recording
21.063
Lasting Power of Attorney
Optional / Nursing
Information
Daily Reporting &
Communication
21.064 Future Wishes
Respite
• Looks at wishes of the service user at end of life
(ie advance care planning).
• What is important?
• What would they like to happen?
• What would they not like to happen?
• Worries, concerns and special wishes.
• Also looks at what they wish to happen after death.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
11
ADMISSION
21.065
Personal Care
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
• Used to replace
a bath book.
• Year on a form.
21.066 Bowel Chart
• To record bowel movements
and complications.
• Uses Bristol Stool Chart
(poster provided).
2011 Standex Systems Ltd
DO NOT PHOTOCOPY FOR ANY OTHER REASON THAN LEGAL
39 Charter Gate
Quarry Park Close - Moulton Park Ind. Estate
Northampton - NN3 6QB
Phone (01604) 646 633
Fax (01604) 644 646
Web www.standexsystems.co.uk
System No: 21.120
Respite
Daily Reporting &
Communication
Bristol Stool Chart
The Bristol Stool Chart is designed to classify the form of human faeces into 7 categories.
It was developed by Dr K W Heaton at the University of Bristol (1997)
Type 1
Type 2
Type 3
Type 4
Separate hard
lumps, like nuts
(hard to pass)
Type 5
Sausage-shaped
but lumpy
Type 6
Fluffy pieces with ragged
edges, a mushy stool
Type 7
Watery, no solid pieces
ENTIRELY LIQUID
Like a sausage but
with cracks on its
surface
Soft blobs with clear-cut
edges (passed easily)
Like a sausage or
or snake, smooth
and soft
Type 1 and 2 indicate constipation
Type 3 and 4 are the ‘ideal stools’ especially the latter.
Type 5, 6 and 7 tend towards diarrhoea.
If the service user has a Type 7 stool then a sample should be considered.
Please refer to your homes policy regarding isolation and infection control if the service user has a Type 7 stool
Reproduced by kind permission of Dr KW Heaton, Reader in Medicine at the University of Bristol.
12Email:
21.098
Bristol Stool Chart
• Reference guide for
Bowel Chart.
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
21.067 Food Chart
• Enables detailed recording of food intake.
• Sits above MUST Tool in system.
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.068 Weight Chart
• Can document monthly weight on graph
to show clearly any dips in weight (and
vice versa).
• New version will allow you to monitor as
and when required (ie daily or weekly).
• Year on form based on monthly review.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
13
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
• Can be used to map any bruising or markings that have
no explanation but are a concern to staff.
• Could also be used when service user is admitted to hospital and
on their return as a safeguard for both service user and staff.
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
21.069 Body Chart
21.070 Epilepsy Chart
• Allows recording of seizures.
• An accurate and comprehensive record.
14Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Mandatory
Assessments/Records
• Scoring tool to ascertain condition of mouth.
• Suggested actions on reverse to assist care planning.
• Year on form based on monthly review.
Day to Day
Recording
21.071
Oral Assessment Tool
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.072 Record of Behaviour
• Allows recording of any behaviour that may be
deemed inappropriate and harmful.
• Enables staff to clearly see patterns and triggers etc.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
15
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.075 Manual Handling
• Staff can clearly document which type of
handling is appropriate for which movement.
• Any constraints, environmental concerns etc
can be recorded.
• Year on form based on monthly review.
16Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.074 Falls Risk Assessment
• Has questions and necessary actions to prevent the risk of falling.
• Year on a form based on monthly review.
• In Line with Outcome 4: Care and welfare of people who use services. By identifying
risks staff can then state in the care plans how they will be managed and reviewed.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
17
ADMISSION
• Enables MUST score to
be documented.
• Over two and a half years
on a form based on
monthly review.
University Hospitals of Leicester
NHS Trust by poster
•
Accompanied
Ward:
Site:
with BMI, weight loss
'MALNUTRITION UNIVERSAL SCREENING TOOL' ('MUST')
table and alternative
measurements for quick
Height
Body Mass Index (BMI)
Weight 3-6 months ago
% Weight Loss
reference.
System No.: 20.952
Name:
Hospital No:
kg
m
Measured / Recalled
Measured / Recalled
PLEASE CIRCLE
PLEASE CIRCLE
Change in weight
over last 3-6 months
kg
kg/m2
USE CHART TO CALCULATE FROM
CURRENT WEIGHT
AND HEIGHT (See bottom)
Yes / No / Don't know
Measured / Recalled /
IF YES USE CHART TO CALCULATE %
USING CURRENT AND PREVIOUS
WEIGHT (see bottom)
Don't know
PLEASE CIRCLE
'Malnutrition Universal Screening Tool' ('MUST') Score
Please circle score
A BMI
Less than 18.5kg/m2 = 2
∨
2
2
2
2
*
Order a special diet if appropriate e.g. gluten free, pureed diet
Between 18.5kg/m and 20kg/m = 1
1
1
1
1
*
More than 20kg/m2 = 0
0
0
0
0
Assist with ordering suitable meal choices (suggest high energy/high calorie main courses and puddings and
'Chef's Specials')
than 10% = 2
21.097More
MUST
Poster
Between 5% and 10% = 1
2
2
2
2
*
Encourage the patient to request additional items for snacks between meals
1
1
1
1
*
Encourage milk and milky drinks
Less than 5% = 0
0
0
0
0
*
Offer 1 Build Up drink per day (savoury or sweet) Unless contraindicated e.g. renal disease, lactose intolerant, milk allergy or patients
*
Offer assistance with eating and drinking, when required. Instigate red tray if indicated
*
Treat underlying conditions such as nausea, vomiting, diarrhoea
*
Commence food and drink record charts for all meals and snacks
2
B % Unplanned
weight loss
over last
3-6 months
C
MEDIUM / HIGH RISK
DATE
2
• Reference guide for MUST Tool
Acute disease Patient acutely ill and there has been NO or likely
showing BMI chart, Weight Loss
effect score
to be NO nutritional intake for > 5 days:
table and
alternative measurements.
Total
RISK:
Low = 0
Medium = 1
High = 2 or more
YES = 2
2
2
2
2
NO = 0
0
0
0
0
NO
Please circle
NOT NEEDED
Refer to your ward dietitian if:
*
*
*
*
*
S
I
G
N
Nutritional care plan started?
YES
following low residue diets. Contact ward dietitian for advice
REVIEW INTAKE AFTER THREE DAYS, if intake remains minimal, refer to your ward dietitian
*
Add scores to give RISK
Record total score:
If score 1 or more start Nutrition careplan (see
right). If no improvement or if score > 4 refer to
Dietitian
*
*
'MUST' score is 4 or more
Enteral tube feeding is required
NBM > 5 days
'MUST' score increases or there is no improvement on medium/high risk nutrition care plan
Specialist advice is required following diagnosis, or a full nutritional assessment is required in response to
clinical judgement
Patient requires assessment and provision of a therapeutic diet e.g. allergy, metabolic
Repeat 'MUST' weekly - if weight drops >1kg/week refer to your ward dietitian
WEIGH PATIENT TWICE WEEKLY AND
DOCUMENT ON WEIGHT CHART
The ‘Malnutrition Universal Screening Tool’ (‘MUST’) is reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition). The ‘MUST’ was developed by
2011 Standex Systems Ltd
DO NOT PHOTOCOPY FOR ANY OTHER REASON THAN LEGAL
39 Charter Gate
Quarry Park Close - Moulton Park Ind. Estate
Northampton - NN3 6QB
the Malnutrition Advisory Group (MAG) of BAPEN and first produced in November 2003.
Repeat 'MUST' weekly or if condition changes - using new weight and on discharge as part of discharge care planning
Phone (01604) 646 633
Fax (01604) 644 646
Web www.standexsystems.co.uk
System Number: 21.097
‘MALNUTRITION UNIVERSAL SCREENING TOOL’ (‘MUST’)
'MUST'
TOOL
Estimating BMI category from mid upper arm circumference
(MUAC)
- use if you cannot measure service user’s actual weight or height
Body Mass Index and Weight Loss Table
STEP 1 - Body Mass Index (BMI) Score
Measure height and weight to get BMI and
document score in service user file. If unable to obtain height and weight, use the
A BMIprocedures
scoreshown
(& below.
BMI) Height
(feet and inches)
alternative
Height (feet and inches)
STEP 2 - Weight Loss Score
The Nutrition
screening
tool is based
on and
'MUST'
andscore
reproduced
here
Note percentage
of unplanned
weight loss
document
in service user
file with kind permission of BAPEN (the British Association
for Parenteral and Enteral Nutrition). Further information on 'MUST' is available on the BAPEN website www.bapen.org.uk
B - Weight loss score
SCORE 0
Wt
Loss
SCORE
1
SCORE 2
Wt Loss
Wt Loss
5-10% <5% > 10%
SCORE 0
Wt Loss
< 5%
34kg
36kg
38kg
40kg
42kg
44kg
46kg
48kg
50kg
52kg
54kg
56kg
58kg
60kg
62kg
64kg
66kg
68kg
70kg
72kg
74kg
76kg
78kg
80kg
82kg
84kg
86kg
88kg
90kg
92kg
94kg
96kg
98kg
100kg
102kg
104kg
106kg
108kg
110kg
112kg
114kg
116kg
118kg
120kg
122kg
124kg
126kg
< 1.7 kg
< 1.8 kg
< 1.9 kg
< 2 kg
< 2.1 kg
< 2.2 kg
< 2.3 kg
< 2.4 kg
< 2.5 kg
< 2.6 kg
< 2.7 kg
< 2.8 kg
< 2.9 kg
< 3 kg
< 3.1 kg
< 3.2 kg
< 3.3 kg
< 3.4 kg
< 3.5 kg
< 3.6 kg
< 3.7 kg
< 3.8 kg
< 3.9 kg
< 4 kg
< 4.1 kg
< 4.2 kg
< 4.3 kg
< 4.4 kg
< 4.5 kg
< 4.6 kg
< 4.7 kg
< 4.8 kg
< 4.9 kg
< 5 kg
< 5.1 kg
< 5.2 kg
< 5.3 kg
< 5.4 kg
< 5.5 kg
< 5.6 kg
< 5.7 kg
< 5.8 kg
< 5.9 kg
< 6 kg
< 6.1 kg
< 6.2 kg
< 6.3 kg
1.7 - 3.4 kg
SCORE 1
Wt Loss
5-10%
5st 4lb
> 3.4 kg
SCORE 2
0
Wt SCORE
Loss
Wt Loss
< 5%
>10%
<4lb
The subject’s left arm should
be bent at the elbow at a 90
degree angle, with the upper
SCORE 1
Wt Loss
5-10%
SCORE 2
Wt Loss
> 10%
4 - 7lb
> 7lb
SCORE
SCORE
arm0half parallel
to the1side ofSCORE 2
Wt Loss
Wt Loss
Wt Loss
the body. Measure
the distance
<5%between the5-10%
bony protrusion >10%
on the shoulder (acromiom)
Weight before weight loss (st lb)
Weight (kg)
Weight (kg)
5st 7lb
<4lb
4 - 8lb
kg
> 3.6 kg
>7lb
4lbof-the
7lb
<4lband the point
5st>> 8lb
4lb
34 kg 1.8 - 3.6 <1.70
1.70 - 3.40
>3.40
elbow
5st 11 lb
<4lb
4 - 8lb
8lb
1.9 - 3.8 kg
> 3.8 kg
- 8lb
>8lb
5st> 8lb
7lb
<4lb(olecranon 4lb
process).
6st
<4lb
4 - 8lb
36 kg 2 - 4 kg<1.80> 4 kg 1.80 - 3.60
>3.60
6st 4lb
<4lb
4 - 9lb
kg
> 4.2 kg
>8lb
4lb - 8lb
<4lb
5st> 9lb
11 lb
38 kg 2.1 - 4.2 <1.90
1.90 - 3.80
>3.80
6st
7lb
<5lb
5
9lb
>
9lb
2.2 - 4.4 kg
> 4.4 kg
Mark the mid-point.
>8lb
4lb
8lb
<4lb
6st
40 kg 2.3 - 4.6 <2.00
2.00
4.00
>4.00
6st
11lb
<5lb
5
10lb
>
10lb
kg
> 4.6 kg
7st
<5lb
5 - 10lb
> 10lb
4lb - 9lb
>9lb
6st
4lb
<4lb
kg
> 4.8 kg
42 kg 2.4 - 4.8 <2.10
2.10 - 4.20
>4.20
7st 4lb
<5lb
5 - 10lb
> 10lb
2.5 - 5 kg
> 5 kg
5lb - 9lb
>9lb
<5lb
6st
7lb
44 kg 2.6 - 5.2 <2.20
2.20 - 4.40
>4.40
7st 7lb
<5lb
5 - 11lb
> 11lb
kg
> 5.2 kg
7st 11lb
<5lb
5 - 11lb
> 11lb
5lb - 10lb
>10lb
6st
11lb
<5lb
46 kg 2.7 - 5.4 <2.30
2.30 - 4.60
>4.60
kg
> 5.4 kg
8st
<6lb
5 - 11lb
> 11lb
2.8 - 5.6 kg
5.6 kg
5lb - 10lb
>10lb
7st
<5lb
48 kg 2.9
<2.40>> 5.8
2.40 - 4.80
>4.80
8st 4lb
<6lb
6 - 12lb
> 12lb
- 5.8 kg
kg
>10lb
5lb - 10lb
<5lb
7st
4lb
8st 7lb
>6lb
6 - 12lb
> 12lb
50 kg 3 - 6 kg<2.50> 6 kg 2.50 - 5.00
>5.00
8st 11lb
<6lb
6 - 12lb
> 12lb
kg
> 6.2 kg
5lb - 11lb
>11lb
7st
7lb
<5lb
52 kg 3.1 - 6.2 <2.60
2.60 - 5.20
>5.20
9st
<6lb
6 - 13lb
> 13lb
3.2 - 6.4 kg
> 6.4 kg
5lb - 11lb
>11lb
7st
11.lb
<5lb
54 kg 3.3 - 6.6 <2.70
2.70 - 5.40
>5.40
9st 4lb
<7lb
7 - 13lb
> 13lb
kg
> 6.6 kg
9st
7lb
<7lb
7
13lb
>
13lb
>11lb
6lb - 11lb
8st
<6lb
kg
> 6.8 kg
56 kg 3.4 - 6.8 <2.80
2.80 - 5.60
>5.60
9st
11lb
<7lb
7lb
1st
>
1st
- 7 kg
> 7 kg
6lb
12lb
>12lb
8st
4lb
<6lb
58 kg 3.63.5- 7.20
<2.90
2.90
5.80
>5.80
10st
<7lb
7lb
1st
>
1st
kg
> 7.2 kg
10st 4lb
<7lb
7lb - 1st
6lb - 12lb
>12lb
8st> 1st
7lb
<6lb
kg
> 7.4 kg
60 kg 3.7 - 7.4 <3.00
3.00 - 6.00
>6.00
10st 7lb
<7lb
7lb - 1st 1lb
> 1st 1lb
3.8 - 7.6 kg
> 7.6 kg
6lb - 12lb
>12lb
8st
11lb
<6lbAsk the subject
62 kg 3.9 - 7.8 <3.10
3.10 - 6.20
>6.20
10st 11lb
<8lb
8lb - 1st 1lb
> 1st 1lb
to let arm hang loose
kg
> 7.8 kg
11st
<8lb
8lb - 1st 1lb 9st
> 1st 1lb
6lbaround
- 13lb
<6lband measure
64 kg 4 - 8 kg<3.20> 8 kg 3.20 - 6.40
>6.40
the upper >13lb
arm at
11st 4lb
<8lb
8lb - 1st 2lb
> 1st 2lb
kg
> 8.2 kg
7lb making
- 13lbsure that>13lb
<7lbthe mid-point,
9st
4lb
66 kg 4.1 - 8.2 <3.30
3.30 - 6.60
>6.60
the
11st 7lb
<8lb
8lb - 1st 2lb
> 1st 2lb
4.2 - 8.4 kg
> 8.4 kg
but not tight.
7lbis-snug
13lb
>13lb
<7lbtape measure
11st 11lb
<8lb
8lb - 1st 3lb 9st
> 1st7lb
3lb
68 kg 4.3 - 8.6 <3.40
3.40 - 6.80
>6.80
kg
> 8.6 kg
12st
<8lb
8lb - 1st 3lb 9st
> 1st11lb
3lb
kg
> 8.8 kg
7lb - 1st.0lb >1st.0lb
<7lb
70 kg 4.4 - 8.8 <3.50
3.50 - 7.00
>7.00
12st 4lb
<9lb
9lb - 1st 3lb
> 1st 3lb
4.5 - 9 kg
> 9 kg
>1st
0lb
7lb
1st
0lb
<7lb
10st
72 kg 4.6 - 9.2 <3.60
3.60 - 7.20
>7.20
12st 7lb
<9lb
9lb - 1st 4lb
> 1st 4lb
kg
> 9.2 kg
12st 11lb
<9lb
9lb - 1st 4lb 10st
> 1st 4lb
7lb - 1st 0lb >1st 0lb
<7lb
4lb
kg
> 9.4 kg
74 kg 4.7 - 9.4 <3.70
3.70 - 7.40
>7.40
13st
<9lb
9lb - 1st 4lb
> 1st 4lb
4.8 - 9.6 kg
> 9.6 kg
- 1st 1lb
>1stto1lb
10st
7lb
<7lbIf MUAC7lb
76 kg 4.9
<3.80
3.80
7.60
>7.60
is
<
23.5cm,
BMI
is
likely
13st
4lb
<9lb
9lb
1st
5lb
>
1st
5lb
- 9.8 kg
> 9.8 kg
13st 7lb
<9lb
9lb - 1st 5lb 10st
> 1st 5lb
8lb -2 1st 1lb >1st 1lb
11lb
<8lbbe < 20 kg/m
78 kg 5 - 10 kg<3.90> 10 kg 3.90 - 7.80
>7.80
13st 11lb
<10lb
10lb - 1st 5lb
> 1st 5lb
kg
> 10.2 kg
8lb - 1st 1lb >1st 1lb
11st
<8lb
80 kg 5.1 - 10.2<4.00
4.00 - 8.00
>8.00
14st
<10lb
10lb - 1st 6lb
> 1st 6lb
5.2 - 10.4 kg
> 10.4 kg
is > 32cm,
to be
- 1st BMI
2lbis likely
>1st
2lb
4lb
<8lbIf MUAC8lb
14st 4lb
<10lb
10lb - 1st 6lb 11st
> 1st 6lb
82 kg 5.3 - 10.6<4.10
>8.20
kg
> 10.6 kg 4.10 - 8.20
> 30 kg/m2
14st 7lb
<10lb
10lb - 1st 6lb
> 1st 6lb
kg
> 10.8 kg 4.20 - 8.40
8lb - 1st 2lb >1st 2lb
11st
7lb
<8lb
84 kg 5.4 - 10.8<4.20
>8.40
14st 11lb
<10lb
10lb - 1st 7lb
> 1st 7lb
5.5 - 11 kg
> 11 kg
8lb - 1st 3lb >1st 3lb
11lb
<8lb
86 kg 5.6 - 11.2<4.30
>8.60
15st
<11lb
11lb - 1st 7lb 11st
> 1st 7lb
kg
> 11.2 kg 4.30 - 8.60
15st 4lb
<11lb
11lb - 1st 7lb 12st
> 1st 7lb
8lb - 1st 3lb >1st 3lb
<8lb
kg
> 11.4 kg 4.40 - 8.80
88 kg 5.7 - 11.4<4.40
>8.80
15st 7lb
<11lb
11lb - 1st 8lb
> 1st 8lb
- 11.6 kg
> 11.6 kg
9lb - 1st 3lb >1st 3lb
4lb
<9lb
90 kg 5.8
<4.50
4.50 - 9.00
>9.00
15st 11lb
<11lb
11lb - 1st 8lb 12st
> 1st 8lb
5.9 - 11.8 kg
> 11.8 kg
16st
<11lb
11lb - 1st 8lb 12st
> 1st 8lb
9lb - 1st 4lb >1st 4lb
7lb
<9lb
92 kg 6 - 12 kg<4.60> 12 kg 4.60 - 9.20
>9.20
16st 4lb
<11lb
11lb - 1st 9lb
> 1st 9lb
- 12.2 kg
> 12.2 kg
9lb - 1st 4lb >1st 4lb
12st
11lb
<9lb
94 kg 6.1
<4.70
4.70
9.40
>9.40
16st
7lb
<12lb
12lb
1st
9lb
>
1st
9lb
6.2 - 12.4 kg
> 12.4 kg
9lb - 1st 4lb >1st 4lb
<9lb
13st
96 kg 6.3 - 12.6<4.80
>9.60
kg
> 12.6 kg 4.80 - 9.60
9lb - 1st 5lb >1st 5lb
13st 4lb
<9lb
98 kg
<4.90
4.90 - 9.80
>9.80
9lb - 1st 5lb >1st 5lb
13st 7lb
<9lb
100 kg
<5.00
5.00 - 10.00
>10.00
from ulna
length - use if you cannot
user’s actual
10lbheight
- 1st 5lb >1st 5lb
13stmeasure
11lb service
<10lb
102 kg
<5.10 Estimating
5.10 -height
10.20
>10.20
10lb - 1st 6lb >1st 6lb
14st
<10lb
104 kg
<5.20
5.20 - 10.40
>10.40
10lb - 1st 6lb >1st 6lb
14st 4lb
<10lb
106 kg
<5.30
5.30 - 10.60
>10.60
Measure between the point of the elbow (olecranon process) and the
10lb - 1st 6lb >1st 6lb
14st 7lb
<10lb
108 kg
<5.40
5.40 - 10.80
>10.80
midpoint of the prominent bone of the wrist (styloid process) (left side
10lb - 1st 7lb >1st 7lb
14st 11lb <10lb
110 kg
<5.50
5.50 - 11.00
>11.00
if possible).
11lb - 1st 7lb >1st 7lb
<11lb
15st
kg row<5.60
5.60 - 11.20
>11.20
Find the ulna length in cm in112
the white
in the table below.
11lb - 1st 7lb >1st 7lb
15st 4lb
<11lb
Choose the appropriate height
metres from
the age and
gender
in
114inkg
<5.70
5.70
- 11.40
>11.40
Height (m)
the options above or below116
the white
11lb - 1st 8lb >1st 8lb
15st 7lb
<11lb
kg bar. <5.80
5.80 - 11.60
>11.60
Note: The black lines denote the exact cut off points (30, 20 and 18.5 kg/m ), figures on the
chart have been rounded to the nearest whole number
11lb - 1st 8lb >1st 8lb
15st 11lb <11lb
118 kg
<5.90
5.90 - 11.80
>11.80
11lb - 1st 8lb >1st 8lb
<11lb
16st
120 kg
<6.00
6.00 - 12.00
>12.00
11lb
<11lb
kg 1.89 <6.10
6.101.82
- 12.20
Men (<65 years)
1.94 1.93122
1.91
1.87 1.85 1.84
1.80 1.78>12.20
1.76 1.75 1.73 1.7116st
1.694lb
1.67 1.66
1.64 1.62
1.60- 1st
1.589lb
1.57 >1st
1.55 9lb
1.53
STEP
3
Height (m)
12lb
<12lb
kg 1.82 <6.20
6.201.76
- 12.40
Men (>65 years)
1.87 1.86124
1.84
1.81 1.79 1.78
1.75 1.73>12.40
1.71 1.70 1.68 1.6716st
1.657lb
1.63 1.62
1.60 1.59
1.57- 1st
1.569lb
1.54 >1st
1.52 9lb
1.51
Acutely ill and no nutritional intake or unlikelihood of no nutritional intake for more than 5 days
Note: The black lines denote the exact cut off points (30,20 and
18.5
the nearest
whole number.
STEP
4 kg/m2), figures on the chart have been rounded to Ulna
12631kg 30.5 <6.30
- 12.60
Length (cm)
32 31.5
30 29.5 6.30
29 28.5
28 27.5>12.60
27 26.5 26 25.5 25 24.5 24 23.5 23 22.5 22 21.5 21 20.5
Weight (stones and pounds)
Respite
Current Weight
Weight (stones and pounds)
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
COMPLETE ON FIRST SCREEN - DATE:
Weight before weight loss (kg)
Assessment &
Care Planning
21.073 MUST Tool
2
Add scoresbyfrom
step 1,
2 and 3 Ltd
together
to obtainwith
an overall
scoreHospitals
for risk ofofmalnutrition
“Derived from forms developed
Standex
Systems
in conjunction
University
Leicester”
STEP 5
Use management guidelines and/or local policy to develop care plan
Plate 1
Composite
LEICESTER HOSPITAL
1.51
1.49
1.48
1.46
1.49
1.48
1.46
1.45
20
19.5
19
18.5
Women (<65 years)
1.84
1.83
1.81
1.80
1.79
1.77
1.76
1.75
STANDEX
Phone
· Fax1.58
(01604)
6441.55
646 www.standexsystems.co.uk
1.73 ©2007
1.72 1.70
1.69 SYSTEMS
1.68 1.66 Ltd.
1.65
1.63(01604)
1.62 646
1.616331.59
1.56
1.54 1.52 1.51 1.50 1.48
1.47
Women (>65 years)
1.84
1.83
1.81
1.79
1.78
1.76
1.75
1.73
1.71
1.40
20XXX 07/08/06
18Email:
1.70
1.68
1.66
1.65
1.63
1.61
1.60
1.58
1.56
1.55
1.53
1.52
1.50
1.48
1.47
1.45
1.44
1.42
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Mandatory
Assessments/Records
• Evidences that systems are in place to
monitor and manage infection control.
Day to Day
Recording
21.077
Infection Risk Assessment
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.076
Pressure Ulcer Assessment
•
•
•
•
Waterlow Score.
Body map.
Year on a form based on monthly review.
Waterlow Manual accompanies form.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
19
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.078
Bedrail Assessment
• Asks risk balance questions.
• Staff get a recommendation via
the Risk Matrix Tool.
• Can document your rationale for
using (or not), bedrails.
• Consent signature column.
20Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
21.079 General Risk Assessment
Mandatory
Assessments/Records
• One form per risk.
• Trigger questions regarding level of risk
and actions to be taken.
• In the style of the care plans with tabs.
• Can use evaluation form to evaluate plan
without having to re-write.
Can be used to evidence that the following outcomes are being met:
• Outcome 10: Safety and suitability
of premises.
• Outcome 11: Safety, availability and
suitability of equipment.
• Outcome 21: Records.
Optional / Nursing
Information
• Outcome 1: Respecting and involving
people who use services.
• Outcome 2: Consent to care and treatment.
• Outcome 4: Care and welfare of people
who use services.
• Outcome 7: Safeguarding people who use
services from abuse.
Daily Reporting &
Communication
Respite
21.080
General Risk
Evaluation
• To be used to
document the
evaluation of the
risk assessment.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
21
ADMISSION
21.081 Pain Chart
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
• Numeric Pain Scale (for
those who can verbalise
pain).
• Doloplus2 (for those with
a cognitive impairment,
ie dementia, who cannot
verbalise their pain).
• Can assess acute and
chronic pain.
• Body Map.
21.082 Wound Chart
• One chart per wound for more detailed
documentation.
• Accompanies care plan if one is required.
22Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Mandatory
Assessments/Records
• Questions to ascertain whether service
user has depression.
• Soon to be one for those with cognitive
impairment such as dementia.
Day to Day
Recording
21.083 Depression Scale
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.084 Medication Record
• Document all medication on arrival including short term meds such as antibiotics and any
changes to medications.
• In line with Outcome 9: Management of medicines, where an upto date list of medicines
taken by the service user needs to be documented when they first begin the service.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
23
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.089 Dependency Profile
• Scoring tool to ascertain dependency levels.
• Can be plotted on graph to show patterns of dependency levels.
• Can be used as evidence if applying for continuing healthcare funding (has
the same domains).
• Designed to be a monthly assessment and in line with Outcome 21: Records,
it can be evidenced on that assessments are updated, monitored and
reviewed to ensure records are kept and maintained for each service user.
24Email:
[email protected] Phone: 01604 646 633
ADMISSION
• To record temp, pulse, resps, blood
pressure, fluid intake, output and input.
• Can record any relevant comments.
Day to Day
Recording
• Document time, blood
sugar and insulin given.
Dementia & Mental
Capacity Information
21.086 Diabetic Chart
Assessment &
Care Planning
21.085
Observations and Monitoring
21.088 Fluid Balance
Mandatory
Assessments/Records
• Document intake and
output over 24 hours.
• Two weeks on one form.
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.087
Repositioning Chart
• Document repositioning
of service user.
• Two weeks on one form.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
25
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.090 Deterioration Scale
• Recommended by Dr Jo Hockley in
line with Gold Standards Framework.
• Can be used to record periodic review
of deterioration and required action.
26Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
• Enables keyworkers to
document their notes.
Dementia & Mental
Capacity Information
21.091 Keyworker
Day to Day
Recording
21.092
Communication Sheet
Mandatory
Assessments/Records
• Can be used for general
communication purposes.
• Can be used to replace the
Communication book.
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
21.093
Multidisciplinary Notes
• Enables the multidisciplinary team
to document their notes.
Fax: 01604 644 646
Web: www.standexsystems.co.uk
27
ADMISSION
21.094 Doctors Notes
21.095
Family Communication
• Enables family to document any
concerns they may have and any
communication they wish to get
across to staff.
• Recommended by Dr Jo Hockley.
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
• Enables Doctors to document
the outcome of their visit.
21.096 District Nurse Notes
• Allows District Nurses to document
the outcome of their visit.
28Email:
[email protected] Phone: 01604 646 633
ADMISSION
Assessment &
Care Planning
• Sits at the back so can be
changed very easily.
• A form on which day to
day occurrences should
be recorded.
• A3 in size.
Dementia & Mental
Capacity Information
20.768 Daily Report
Day to Day
Recording
20.025 Daily Report
Mandatory
Assessments/Records
• Sits at the back so can be
changed very easily.
• A form on which day to day
occurrences should be recorded.
• A4 in size.
Optional / Nursing
Information
Daily Reporting &
Communication
20.019 Nursing Report
Fax: 01604 644 646
Web: www.standexsystems.co.uk
Respite
• For use by nursing staff.
• Sits at the back so can be
changed very easily.
• A form on which day to
day occurrences should be
recorded.
• A3 in size.
29
30Email:
[email protected] Phone: 01604 646 633
Respite
Daily Reporting &
Communication
Optional / Nursing
Information
Mandatory
Assessments/Records
Day to Day
Recording
Dementia & Mental
Capacity Information
Assessment &
Care Planning
ADMISSION
ADMISSION
Assessment &
Care Planning
Dementia & Mental
Capacity Information
Day to Day
Recording
Mandatory
Assessments/Records
Optional / Nursing
Information
Daily Reporting &
Communication
Respite
20.929 Respite Booklet
• The Standex System in condensed
format for those who are having
short term respite.
31
Web: www.standexsystems.co.uk
Fax: 01604 644 646
Contact your local business
manager for a no obligation
care planning consultation
for your care home.
For any guidance or advice
on all aspects of care
planning, please contact our
Nurse Advisor, Lucy Caldwell
RGN on 01604 646 633
Lucy Caldwell
Nurse Advisor
Standex Systems Ltd
39 Charter Gate І Northampton NN3 6QB
Tel.: + 44 (0)1604 / 64 66 33 І Fax: +44 (0)1604 / 64 46 46
Email: [email protected]
www.standexsystems.co.uk
The forms contained within this brochure are
protected by english copyright law and should
not be reproduced or copied for any reason
other than legal requirements.
Standex Systems Ltd
39 Charter Gate, Quarry Park Close, Moulton Park
Industrial Estate, Northampton, NN3 6QB
Phone: 01604 646 633 Fax: 01604 644 646
www.standexsystems.co.uk