The Singapore Family Physician

Back to issue Vol 43 No. 3 - Managing Complex Patients in Family Medicine Settings

Using the SBAR4 model for Management of a Patient with Complex Comorbidities in the Nursing Home – A Case Study

Goh Lee Gan
The Singapore Family Physician Vol 43 No 3 - Managing Complex Patients in Family Medicine Settings
16 - 20
1 July 2017
0377-5305
Singapore faces a rapidly ageing population. By 2030, 19 percent of the population will be aged 65 years and older. The rise of the dual-income family, the decline of extended families, as well as the increase in age-related degenerative disorders consequent to increased expectancy of life, create challenging situations. Families which are manpower and expertise challenged will find it difficult to look after their elderly infirm at home, especially if the elderly members are frail, functionally dependent, and prone to falls. Such families will increasingly look to the nursing home as solutions. To aid in allocation to nursing homes, elderly patients are classified into 4 categories by the Resident Assessment Form: Category I patients are physically and mentally independent; Category II patients are semi-ambulant; Category III patients are wheelchair-bound or bed-bound; and Category IV are highly dependent. Categories I and II are primarily admitted to sheltered homes, while the limited nursing home places are mainly reserved for Category III and IV patients. The SBAR4 Tool is useful for clerking nursing home placement applications for placement decisions; for admission clerking; and for follow-up assessments and interventions. A case study of a patient who became bed-bound after hospitalisation for pneumonia due to deconditioning is used to illustrate the use of the SBAR4 Tool in a patient admitted to a nursing home, in implementation of recommendations, and in follow-up review of this patient a year later.