🧠Altered Mental State Pathway
Purpose
This pathway helps care home staff identify, assess and respond safely when a resident’s mental state changes — for example, if they become more agitated, more confused, or more drowsy.
It ensures prompt action and the right escalation to Middlewood or emergency services.
⚠️ Recognising a Change
Look for:
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Increased confusion or agitation
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Drowsiness or reduced alertness
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Sudden behavioural changes
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Concerns raised by carers, family, or staff
If you notice any of the above, start the pathway immediately.
đź©ş Assessing the Situation
Determine how quickly the change has developed and assess the resident’s overall condition:
| Onset | Examples / Notes | Next Step |
|---|---|---|
| Gradual (over months) | Possible dementia progression or depression | Discuss at next weekly ward round |
| Over days | Possible infection, dehydration, or medication issue | Check NEWS score, then contact Middlewood |
| Sudden (hours) | Potential acute illness or delirium | Assess NEWS score and escalate immediately |
🧮 NEWS (National Early Warning Score)
Use the NEWS to guide urgency:
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NEWS 0–3:
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Contact Middlewood GP surgery – 01625 872299, Appointment Line (Option 1)
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NEWS 4–6:
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Contact Middlewood GP surgery – 01625 872299, Health Professionals Line (Option 2)
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Consider contacting the Urgent Care Response Team – 01625 663322 (Option 2)
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NEWS 7 or more, and no “Ceilings of Care” plan stating not for admission:
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Call 999
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🧾 Documentation
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Record observations, NEWS score, and any interventions taken.
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Inform senior staff and update the resident’s notes.
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If escalated, document the name and time of the clinician spoken to.
đź“… Weekly Ward Round
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Residents with gradual or ongoing changes should be discussed at the next Middlewood ward round.
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Bring completed monitoring and notes to aid discussion.
