Jake (not real name) is a 26 year old man with Severe Learning Disabilities and Autism. Jake does not communicate through verbal language but can communicate his basic wants and needs to people who know him well through signing and gesturing.
In November, Jake’s support staff noticed an increase in the frequency he was engaging in challenging behaviour, particularly banging his head against hard surfaces. Jake’s staff worked with the Community Learning Disability Team to explore potential health concerns.
Dentists from the local Health Centre visited Jake at his home to complete a dental check. Jake’s team prepared him for this and supported communication between Jake and the dentist so that a thorough inspection could be undertaken. The dentist identified a broken tooth, and another one with dead root. The dentist’s specialist opinion was that Jake would be in considerable pain and hospital treatment was a priority.
A best interest meeting took place on 01/11/2016, attended by two dentists from the local Health Centre and Jake’s parents, Care Manager, Community Nurse and staff from Jake’s team. Following further inspection there was agreement that Jake required surgery at the hospital and that blood would be taken for the blood test whilst Jake was under General Anaesthetic. Staff stressed to the dental team involved the importance of helping him to keep as many of his teeth as possible as we know historically dentists have removed teeth and we knew this was not in his best interest.
On the 24/11/2016 a planning meeting took place involving Jake’s parents, the Community Nurse and two members of staff from Jake’s team. On the 25/11/2016 a member of Jake’s team met with the dentist to plan what preparation was required prior to the surgery.
On the 28/11/2016 a member of Jake’s team and the Community Nurse visited the hospital to assess the area and further plan for the visit.
Jake would need to wake up at 6am to be at the hospital in time for the surgery and his usual sleeping pattern meant he would typically sleep until 9am. On 29/11/2016 an internal team meeting was held to plan how to support Jake in the weeks leading up to the surgery. The Behaviour Consultant worked with the management and the staff team to plan how to change Jake’s sleeping pattern to effectively support him to attend the hospital.
Working with the night staff, the shift patterns were amended so that the night staff and day staff started their shifts one hour earlier. Night staff prompted Jake to go to bed earlier and day staff prompted him to wake up earlier. Jake’s sleeping pattern and medication time progressively changed and by the end of the first week Jake was going to bed at 9:30pm, waking up at 6:30am and having his medication at 7am and 7pm.
On the day of the hospital appointment (08/12/2016), Jake’s two key members of staff arrived at 6am. Jake was prompted to wake up and have his medication including one additional dose of Clobazam. By 6:30am Jake was awake without any prompting. Jake was supported with personal care and on his way to hospital by 7:05am. Jake’s parents and Community Nurse registered Jake at the hospital and staff were in contact with them throughout the journey to prevent delay on his arrival. When Jake arrived he was supported out of the car by his father and everyone met in the hospital as planned.
At the hospital, they tried to sedate Jake but due to his anxiety he fought against this so it was unsuccessful. Jake wanted to leave the hospital and was continuously signing for his car. Jake’s parents and his staff kept him calm and encouraged him to stay and the hospital decided to admit a further dose of anesthetic medication which was successful in sedating him.
Jake had two infections which were treated, three teeth were removed (two of which were wisdom teeth) and he had nine fillings. When Jake woke up from the anaesthetic he was signing to go to the car and trying to stand up. With support from his staff and parents, Jake was supported back to the car and back home. Within a couple of hours Jake was eating small portions of food and appeared settled.
Jake is a young man with complex needs. Without the collaborative working and continued efforts of all those involved, Jake would have been unable to access the surgery to address his health needs. The Community Nurse was key in coordinating all parties involved and the parents worked with the staff to ensure Jake remained calm and settled throughout the day. The success of this treatment was the result of careful planning and ongoing commitment from Health Care Professionals, family and staff.
Authors: Rani Djebara and Gareth Cox