Wessex PSC is working to implement a standardised common language for managing deterioration across all healthcare settings including the Care Home Sector and this work aligns with the NHSE Enhanced Health in Care Homes initiative.
In the UK, 405,000 older people (aged 65+) currently live in care homes. This represents 16% of older people over the age of 85 (BGS 2020). Within Wessex, there are around 23,500 care home beds in 900 Care Homes (CQC 2020).
Improving Health in Care Homes (Wessex AHSN)
Wessex AHSN is working across a number of our programmes to help improve the health of care home residents. These programmes are listed on our Improving Health in Care Homes webpage which brings together both national and local resources developed by a number of programmes within Wessex AHSN to assist care home managers.
RESTORE2 (West Hampshire CCG & Wessex PSC)
RESTORE2 is a physical deterioration and escalation tool for care/nursing homes co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative and based on nationally recognised methodologies including early recognition (Soft Signs - see below), the national early warning score (NEWS2) and structured communications (SBARD).
More information about RESTORE2 (full) and RESTORE2mini (soft signs) including training videos and downloadable resources can be found on our RESTORE2 webpage
On-line video based NEWS2 and Deterioration training for community and care home staff (HEE)
Wessex AHSN and West of England AHSN have collaborated with West Hampshire CCG (RESTORE2) and Health Education England to produce a series of free videos and e-learning materials to support staff working in care homes to care for residents who are at risk of deterioration.
A series of 14 short videos (around 3 minutes each) describe how to take measurements from residents correctly (such as blood pressure and oxygen saturation), spots the soft signs of deterioration, and prevent the spread of infection.
7 of these videos have been re-filmed specifically to support carers of people with a learning disability. Continuing the concept of short videos (around 3 minutes each) focussed on specific aspects of care these videos are more appropriate for the learning disability care sector.
More information and links about the videos (and other Care Home resources) can be found on our Care Home Training Resources webpage
RESTORE2 and RESTORE2mini Interactive Toolkit and Online Training (South West AHSN)
Soft Signs of Deterioration
Studies have shown that nursing assistants in a care home can spot signs of illness in people 5 days before they were seen in observations. (ref: Boockark1, Brodie HD, Lachs M, Geriatr Soc. 2000 Sept;48(9):1086-91.) The study found that nursing assistants were able to spot behavioural and functional state changes in residents before physiological signs were present.
More information about our Soft Signs projects including Interserve Healthcare's Soft Signs Taxonomy, West Hampshire CCGs RESTORE2 and Southampton City CCGs REACT to Soft Signs are included in a discussion article on Soft Signs by Geoff Cooper, Wessex PSC Programme Lead for Deterioration and can be read on our "Using Soft Signs to identify early indications of Physical Deterioration" webpage.
SBAR communication tool (Situation, Background, Assessment, Recommendation)
SBAR Communication in Care Homes (e-Learning for Healthcare)
Unplanned admissions to hospital result from a patient’s condition changing in such a way that they are no longer safe to be looked after in the care facility in which they live. Hospital often becomes the default location for their care to be transferred to. These patients are often elderly, frail and have complex medical comorbidities. If the deteriorating patient is highlighted earlier to other healthcare professionals, unplanned admissions to hospital can be reduced. Therefore, communicating the correct information about patients to the correct people is imperative and SBAR communication provides a standardized tool to aid this.
This training programme is a collaborative project between Sussex Community Trust and Surrey and Sussex Healthcare NHS Trust and is funded from a grant by Health Education Kent, Surrey and Sussex with the aim of reducing admissions from hospital and improving the quality of care of patients who become unwell in care homes (with and without nursing).
Enhanced health in care homes framework (NHSE)
The EHCH framework (NHSE 29 Sept 2016) lays out a clear vision for working with care homes to provide joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of in reach services.
The framework document can be downloaded from the resources zone on the right hand side of the webpage and more information about the Enhanced health in care homes initiative can be found on the NHSE website.
Version 2 of the framework document (NHSE 31 March 2020) builds on experiences of those who have implemented the EHCH model since 2016 and describes best practice in doing so. It supports the delivery of the minimum standard and should be read alongside the relevant contractual requirements.
Version 2 of the framework document can be downloaded from the resources zone on the right hand side of the webpage and more information about the Enhanced health in care homes initiative can be found on the NHSE website.
A film from NHS England recognises the work and achievements of the six enhanced health in care home vanguards and tells their story so far. Through a series of interviews with staff, residents and volunteers, the film showcases the impact new models of care are having on people's health and wellbeing.
React To Resources
React To is a series of training resources, developed in partnership including East Midlands AHSN & Nottinghamshire Healthcare NHS Trust, specifically designed for care home staff and other healthcare professionals. Although aimed at care home staff these resources are also relevant to other carers and healthcare professionals.
Resources include React to: Dehydration, Dementia, Home Rounds, Infection (Influenza and Norovirus), Falls, Feet, Frailty, Malnutrition, Moisture and Red (Pressure Ulcers).
All of their training resources can be found on the React To website.
Using NEWS2 in Primary Care and Care Homes
Patient Safety resources for primary care (AHSN / NPSC)
Patient Safety Collaboratives (PSCs) identify and spread safer care initiatives in their local health and care systems. As part of our response to the COVID-19 pandemic, here are some information and resources to support people working in primary care.
More information about Patient Safety resources, including some RCGP/AHSN webinars here.
Emergency admissions to hospital from care homes: how often and what for? (Health Foundation 2019)
This Health Foundation briefing presents the results of a national analysis of emergency hospital admissions from care homes across England, to provide insight into how often care home residents are being admitted to hospital and the types of conditions that are causing their admissions.
The second part of the briefing draws on evaluations of four enhanced care packages provided to care home residents. By comparing and contrasting the different elements and contexts of these sites and bringing in other local evaluations of these sites, the report explores the factors that may be most influential in reducing hospital admissions.
The briefing concludes by pointing to the next steps for local health and social care providers and commissioners looking to better understand the quality of care being provided in order that they may improve care further.
The full briefing can be downloaded from the resources zone on the right hand side of this page.
Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study (Devi R, Martin GP, Banerjee J, et al. BMJ Quality & Safety 2022)
A qualitative study exploring the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and reviewing the perceived influences to the sustainability of interventions.
ALERT (Portsmouth Hospitals NHS Trust)
ALERT™ (Acute Life Threatening Events Recognition & Treatment) is a multi-professional course designed to train staff in recognising patient deterioration and acting appropriately in treating the acutely unwell.
ALERT HQ have developed a suite of courses for different care settings including: ALERT (Adult); ALERT Obstetrics; BEACH (for unregistered healthcare staff) plus an ALERT Train the Trainer course.
More information about the ALERT Programme can be found on the ALERT HQ website.
Internet offers to help care homes connect (NHSX / NHSD)
During Covid-19, care providers are using digital technology to protect the health and wellbeing of vulnerable residents. Examples include video consultations with health professionals, ordering prescriptions, and supporting residents to talk with loved ones.
NHSX and NHS Digital have negotiated and published a range of internet connection offers with telecom companies on the NHSX website. This is complemented by two new pieces of guidance: choosing an internet connection for your care home and how to use digital services in your care home.
Further information on this workstream can be obtained from Geoff Cooper (Programme Lead) via email or via the contact link at the bottom of this page.
Resources
RESTORE2 Slide deck for Trainers (v5 WPSC)
RESTORE2mini Slide deck for Trainers (v6 WPSC)
The Framework for Enhanced Health in Care Homes Version 2 (NHSE March 2020)
Enhanced Healthcare in Care Homes Framework (NHSE Sept 2016)
Improving safety in care homes (AHSN Network Report)
Emergency admissions from care homes (Health Foundation July 2019)
Patient Deterioration in non-acute healthcare settings (Interserve & WPSC)
