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Level 3: Complex Care

Site: OpenLearn Create
Course: Welsh Levels of Care E-Learning Program
Book: Level 3: Complex Care
Printed by: Guest user
Date: Wednesday, 15 April 2026, 12:02 AM

Description

The patient may have a number of identified problems, some of which interact, making it more difficult to predict the outcome of any individual treatment.

Table of contents

Lay Descriptors

  • The patient may have a number of identified problems, some of which interact with one and other, making it more difficult to predict the outcome of any individual treatment
  • The care plan is often multidisciplinary and broken up into smaller goals or steps with ongoing observation and regular review by the multidisciplinary team
  • The patient may have a combination of treatments from more than one traditional pathway, or have phased treatment to overcome short term problems, while planning out care aimed at ongoing rehabilitation or long term support
  • The work to deliver care will have a number of skilled interventions and many tasks, including close personal care for ordinary day-to-day activities, and there is a risk of harm without this intimate support
  • The outcome of treatment could vary considerably and the patient may need close supervision and ongoing assessment from a range of staff to deal with problems, as they arise, and adapt the plan of care

Clinical Descriptors

  • The patient’s condition may be stable but has the propensity to change quickly
  • Multiple co-morbidities requiring frequent interventions or close observation
  • Complex needs, requiring varying degrees of support with majority of activities of daily living
  • Patients who are in a stable condition but are dependent on nursing care to meet most,  or all, of their activities of daily living
  • Facilitating a complex discharge where it is the responsibility of the ward nurse

Nursing Theme 1 - Assessment and Observation

  • Neurological observations 2-4 hourly
  • Fluctuating levels of consciousness
  • Ongoing management of escalating NEWS score
  • Risk of falls requires close supervision

Nursing Theme 2 - Respiration

  • Post 24 hrs following insertion of tracheostomy, central lines, epidural, multiple chest drains, or extra ventricular drains
  • New or increased requirement for less than 50% oxygen
  • Complex management of chest drain
  • Patient requiring non-invasive ventilation or respiratory support requiring close observation for complications
  • Frequent changes to BiPAP or CPAP

Nursing Theme 3 - Personal Care, Nutrition and Hydration

  • Complex wound management requiring more than one nurse, or takes more than one hour to complete, or chronic wound management at least once a day, or requires 2 hourly pressure area care 
  • Mobility or repositioning difficulties requiring the assistance of two people and/or the use of aids
  • Requires assistance with most, or all, activities of daily living, or requires personal care lasting longer than one hour
  • Patients with spinal instability, spinal cord Injury and/or cord compression
  • TPN or requires enteral feeding up to 4 hourly
  • NGT aspiration

Nursing Theme 4 - Cognition and Communication

  • Patient or carers requiring enhanced psychological support owing to poor disease diagnosis or clinical outcome
  • Confused patients who are at risk and may be cohorted in small groups to provide close supervision
  • Patient with an enduring mental health problem requiring intervention from members of the multi-disciplinary team
  • Patient with cognition and communication difficulties experiencing increased anxiety and requiring additional support and reassurance
  • Limited cognition and level of understanding or participation
  • Difficulty with communication
  • Anxious patient requiring support and reassurance
  • Potential for accidental harm
  • Patient requires enhanced support during nursing interventions

Nursing Theme 5 - Medication

  • Complex intravenous drug regimes, including those requiring prolonged preparatory administration or post administration care
  • VAC therapy where ward based nurses undertake treatment
  • Complex medication or IVI regime
  • Patient requires support lasting more than 30 minutes to take medication
  • Blood transfusion
  • New insertion of a central line or Port-a-cath