Communicating the Signs that a Person you Care for is Unwell

It is essential that any deterioration in a person’s health is detected and acted upon quickly.

People with learning disabilities, dementia and communication problems are particularly vulnerable because they often rely on others to spot the signs that they are unwell.

Trying to explain why you are concerned to the doctor in the Emergency Department can sometimes leave you a bit bewildered, even though you know the person really well and know they are ‘not themselves’ or ‘not right’.

It is really important that you are able to describe in as much detail as you can what is different about the person.

This will really help the healthcare professional in making a clinical assessment, especially when the person themselves is unable to articulate the problem, or it is difficult to carry out any tests and observations where the person is scared, has sensory issues etc.

Using the SBAR tool overleaf is a good way of describing your concerns to the healthcare staff.

There are some prompts to guide you on the type of information that would be helpful.

Situation

• Who you are
• Who they are
• Explain what your concerns are.

Background

• What has led up to this?
• How long has the person been ill?
• When did their condition change?

Assessment (how are they different?)

• Change in consciousness/awareness – including subtle changes such as increased anxiety, confusion or restlessness
• Change in heart and circulation – changes in heart/ pulse rate, dizziness, feeling faint, chest pain, sweating. High (above 37.5C) or low (35C or below) body temperature, chills or shivering
• Changes in breathing – breath sounds different to usual, using effort to breathe, nostrils flaring when breathing, cough
• Change in skin colour – mottling of skin, rash, pallor, blueish tinge to lips
• Change in bowels – diarrhoea or vomiting, distended abdomen
• Change in urine output – change in quantity, colour or smell of urine (measure urine or weigh pads to check)
• Other changes – such as pain, change in appearance or behaviour. How does the person indicate pain? Remember to bring in medication charts, ‘This Is Me’.

Recommendation (what do you want to happen?)

• Any reasonable adjustments required – what works for the person (e.g EMLA cream for blood tests)
• Do they need sedation for any other investigations?

About this leaflet

Authors: Jo Findlay Learning Disability and Mental Capacity Act Advisor
Written: August 2020
Approved: August 2020
Review date: November 2023
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk