Middlewood Change in Mental State Pathway

Altered Mental State Pathway for Care Home Staff

Clinical Pathway

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 the following changes in your resident:

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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.

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 score to guide the urgency of your response:

NEWS 0 to 3

Contact Middlewood GP surgery on 01625 872299, select Appointment Line (Option 1)

NEWS 4 to 6

Contact Middlewood GP surgery on 01625 872299, select Health Professionals Line (Option 2)
Consider contacting the Urgent Care Response Team on 01625 663322 (Option 2)

NEWS 7+, AND no Ceilings of Care plan stating not for admission

Call 999

PINCHME Mnemonic

Use PINCHME to help identify potential causes of delirium:

Pain

Infection

Nutrition

Constipation

Hydration

Medication

Environment

Documentation

Record observations, NEWS score, and any interventions taken
Inform senior staff and update the resident's notes
If escalated, document the name and time of the clinician spoken to

Weekly Ward Round

Residents with gradual or ongoing changes should be discussed at the next Middlewood ward round
Bring completed monitoring and notes to aid discussion