PERSONALISED PLAN AND EMERGENCY CARE PLAN FOR	
Mr Eric Mouse	

The information included in this care plan is correct as 27-Jun-2024 and should be used as a guide thereafter in your clinical assessment. If any significant changes develop after this date please discuss with the relevant health professional involved in your care.

The purpose of this document is to give you the opportunity to let your doctor and health care team know about your priorities and preferences for your healthcare and how you would choose to be looked after in the future. 

•	The first section is helpful should an emergency ever happen.

•	The second section records your own plans for living with your health conditions.

Please keep this document somewhere prominent in your house for use in an emergency.

IF YOU ARE UNWELL AND NEED ADVICE OR SUPPORT 	
	
If you are unwell	
During office hours
GP practice	01228 603751	
Out of hours contact 
Cumbria Health	0300 30 34 365	

For any other queries, advice or support (during office hours)	
Hilda Ogden  - Care Coordinator	19283377	
Nurse Test 	869437643096 	

In an emergency who would you like us to contact?
Name 	Contact number	
Emergency contact  	Fiona Mouse - Daughter (07777734444)  	
Next of Kin (if different)	Fiona Mouse - Daughter (07777734444)  	
Carer details (if appropriate) 	Fiona Mouse - Daughter  
Has an informal carer - Next door neighbour Betty pops in  	

KEY INFORMATION SUMMARY	
	
WHAT YOU WOULD LIKE PEOPLE TO KNOW ABOUT YOU	
I have a daughter who lives nearby and a daughter in Wales. My family is very important. I want to stay at home and be as independent as possible. I can't always hear very well and don't always remember what people have said, please write things down.   
Occupation history - Joiner  	
	
WHAT IS IMPORTANT TO YOU IN AN EMERGENCY SITUATION	
Please contact my daughter Fiona Mouse. Ask her to look after the budgie.

SUMMARY FROM GP RECORD	

Problems
Active
Date	
Problem	
Associated Text	

18-Jul-2023	
Dementia	

03-Sep-2020	
COPD - Chronic obstructive pulmonary disease	

10-Sep-2014	
Allergy to penicillin	

16-Sep-2010	
Type 2 diabetes mellitus	

 

Minor Past
Date	
Problem	
Associated Text	

25-Sep-1996	
History of road traffic accident	
Back injury	

 	
	
ALLERGIES	
Allergies
Date	
Description	
Associated Text	

10-Sep-2014	
Allergy to penicillin	

 	
	
CLINICAL SUMMARY (including what normal looks like)	
Prone to exacerbations of COPD. High risk of falls. Has type 2 diabetes managed with medicines. Manages well at home with support of daughter and friend for shopping. Mobilises using a stick outside. Likely to be more fatigued in morning.  

FUNCTIONAL INFORMATION	
Vision
	Normal vision -   Wears glasses -   	
Hearing	Hearing difficulty -     Auditory aid - Left hearing aid  	
Oral	Dentures - Top & Bottom  	
Speech	No speech problem -     	
Nutrition	No problem swallowing -   Reduced appetite -   Weight decreasing - 3kg weight loss over last 6 months  	
Continence	Bladder: occasional accident -     Bowels: fully continent -     At risk for constipation - Occasional  	
Toileting	Independent in toilet -       	
Pain	  Chronic pain - Back pain associated with accident when younger  	
Ability to manage medication	  Patient forgets to take medication -     	
Mobility
	Mobile outside with aid - Uses stick outdoors  Uses single walking stick -   
	
Stairs in home	    nil	
Number of falls in the last year	25-Sep-2023 Number of falls in last year : 3  -   	
Toileting	No events found.  	
Bathing/personal care	  Use of bathroom aids - Level access shower and grab rail  Able to perform personal care activity -   	
Dressing	Independent with dressing -   	
Cooking	Independent in cooking -   	
Shopping	Needs assistance with shopping - Daughter does shopping  	
Cleaning	Needs help with housework - Friend helps with heavier tasks such as hoovering  	

		EMERGENCY CARE PLAN	
	
INFORMATION FOR PROFESSIONALS 	
Full name:    Mr Eric Mouse 
Known as:   Eric 	NHS number:  123 765 9876 	
	Date of birth:   01-Sep-1939 	
Telephone numbers: 	
 Home:  01228603000 
 Mobile: 0776578909 
 Work:   01228601111 	Key safe/door access code:
666  	
Communication needs: 
Difficulty communicating -               No speech problem  Hearing difficulty -   	
Language:  
Main spoken language English	Interpreter needed:  
No interpreter needed	
Dependants:  
0  - 	Pets:   
Budgie - Tweetie Pie	
Capacity:  
Impaired cognition - Patient identifies memory concerns	
GP Practice: 
Maglona House, Kingstown Broadway, Kingstown Industrial Estate, Carlisle, Cumbria, CA3 0HA	
	
GUIDE FOR FUTURE CARE & EMERGENCY DECISIONS	
DNACPR:  	12-Jul-2023 Not for cardiopulmonary resuscitation	
CPR discussed: 	25-Sep-2023 Discussion about resuscitation - 
25-Sep-2023 Discussion about resuscitation with carer - Hospital consultant Dr Lung discussed with Fiona Mouse  	
LPA (Health & Welfare):	25-Sep-2023  - Bronwyn Mouse - Daughter who lives in Wales	
Deprivation of Liberty (DoLs) in place:	No record of DoLs in place	
Advanced Decision to Refuse Treatment (ADRT):	No record of ADRT completed	
Emergency Health Care Plan (EHCP):	25-Sep-2023  - Completed for COPD  	
Preferred place of care:	Preferred place of care - home -  
  	
On palliative care register:	 Not on palliative care register  	

WHAT TO DO IF YOUR HEALTH SUDDENLY GETS WORSE	
	
Health issue:	
COPD flare up.  This may be caused by an infection or changes in the weather	
What symptoms or changes should you look for?	
-	More out of breath
-	Chesty cough
-	More phlegm/stickier or different colour phlegm. Look out for phlegm that is dark, yellow or green
	
What actions do you take?	
Speak to Jenny to help me take my rescue medicines. 
More out of breath	
Use reliever inhaler/ blue inhaler more often 	
Salbutamol	

More out of breath even though you are using the reliever inhaler 	
Start rescue pack steroids	
Prednisolone 30mg one per day for 5 days	

More phlegm or change in colour (dark yellow or green)  	
Start rescue pack steroids and antibiotics 	
Prednisolone 30mg one per day for 5 days AND
Doxycycline 200mg one tablet then the 100mg tablet for 5 days	

Chestier cough
1)	keep calm and use ways to control my breathing.  
2)	Breathe in through your nose, breathe in through your mouth.
3)	One of these positions might help:

If I cough up blood at any time, I should contact my G.P.
If I feel very unwell, I should call 999	
Contact person and number if you need this:	
Joanne Smith, community nurse 07654987123	

PERSONAL PLAN	

What issues are important to me or what I want to work on:	
25-Sep-2023 - I want to be able to stay at home and look after myself
1) Keep in contact with family and friends, would like to learn how to use video calling. 
•	I am going to ask my friend Julia to help me set this up and sit with me whilst I do this once a week.
2) To get out more to see friends and be a bit steadier on my feet.
•	To work with the care coordinator to improve my balance when I am walking and I would like to be able to walk to the corner shop on my own again 
•	Grab rail at front door 
•	The care coordinator will ask the lady from Age UK to call me about transport to the local Leek Club

3)  Try to get about 6 hours sleep 
•	I will try the new equipment to see of this helps with my breathing and going to the toilet (back rest and bottle)
•	I will reduce the amount of whisky I put in my hot toddy every night
•	I will try to go to bed at 10pm every night and read if I am struggling to sleep
•	I am happy to meet with Age UK to discuss money and ways to keep warm

4)	Understanding my medicines better
•	I am happy for the community nurse to visit to go through my rescue medications for my COPD and breathing. 
The care coordinator will speak to my daughter and ask if she can sort a container that stores my pills so I know what to take once the doctor has checked if I need to be on different pills	

What my key professional contact will organise for me:	
25-Sep-2023 - Ask community nurses to visit and explain how to use COPD rescue medicines. Ask GP to review medication (falls & drop in BP, pain, diabetes control)
25-Sept-2023- O.T to arrange grab rail at front door, back rest for bed and urine bottle for use at night
Referral made to:
25-Sep-2023 - Referral to Age UK for support around finance and transport to clubs.	
Other Services Involved
Date	
Description	
Value	

25-Sep-2023	
Has spiritual and cultural support	

25-Sep-2023	
Under care of respiratory physician	

25-Sep-2023	
Under care of care of the elderly physician	

 	

My plan was completed with:	Review of plan due:	
Grace Darling 27-Jun-2024 	25-Mar-2024