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.)
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.
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 was co-developed in partnership with the six EHCH vanguards, commissioners, providers and partners across health and social care. It is based on the lessons learned by the EHCH vanguards and highlights the components that have had the highest impact on the resident’s quality of care, which can be adopted to meet the local needs of the population.
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.
Access to out of hours/urgent care when needed (EHCH Sub Element 1.4)
Out-of-hospital services form a vital part of the urgent and emergency care system at all times of day and night. The EHCH sits within a streamlined system of health and social care teams that provide advice and care both in hours and out-of-hours. These teams include GP services, NHS 111, rapid-response health and care teams, and the local ambulance service.
Interacting with the multidisciplinary team helps facilitate prompt hospital admission when indicated but it also helps ensure residents remain in their homes where appropriate. In a study at one hub, over 1,500 calls were received in one month more than half of which occurred out of hours. Of those more than 1,300 resulted in the patients being able to remain in their place of residence.
Soft Signs of Deterioration
An emerging area of interest is the identification and use of 'soft signs' to enable the earlier recognition of physical deterioration in individuals whose physiological signs (heart rate, blood pressure, respiratory rate etc.) are not being monitored.
These soft signs include changes in behaviour, diet and habits etc. and are particularly helpful in home settings, care homes and hospital wards.
SBAR communication tool (Situation, Background, Assessment, Recommendation)
NEWS2 AND CARE HOMES
RESTORE2 (West Hampshire CCG & Wessex PSC)
National ‘Excellence in Primary Care’ Parliamentary Award Winners July 2019 (read more here)
One element of developing an aligned model of care pathways across Wessex includes the application of the Wessex All Cause Deterioration Guidance (see our Deterioration and NEWS web page) to the Care Home setting.
RESTORE2 is a physical deterioration and escalation tool for care/nursing homes (*) based on nationally recognised methodologies including early recognition (Soft Signs - see below), the national early warning score (NEWS2) and structured communications (SBARD).
RESTORE2 was co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative.
It is designed to support homes and health professionals to:
An introductory video can be viewed on this webpage and the RESTORE2 tool, associated resources and training materials can be downloaded from the West Hampshire CCG website.
*Wessex PSC advises that all care providers conduct a robust internal governance review prior to use of any clinical escalation tool, including RESTORE2, to ensure that the clinical thresholds and escalation actions are appropriate for the care settings in their organisation.
A Taxonomy of Soft Signs of Deterioration (Interserve Healthcare & Wessex PSC)
As part of a Wessex PSC Breakthrough Series, Interserve Healthcare identified a number of flags of “soft signs of deterioration” and incorporated them into their organisations care concern reporting system.
A taxonomy of around 120 'soft signs' developed by Interserve Healthcare, and a copy of a presentation given at the national Patient First Conference describing the challenges of identifying “soft signs” of deterioration and raising staff awareness to the need to respond promptly and effectively, can be downloaded from the resources zone on the right hand side of the webpage.
REACT (REcognise and Act) to Soft Signs of Deterioration (Southampton CCG & Wessex PSC)
The Wessex PSC REACT cards are based on a project by Southampton City CCG which prompted staff to look out for 'soft signs' of Deterioration in their residents. Using a deceptively simple question 'Is my resident well today?' the card includes a series of prompts to support staff to consider possible 'soft signs' of deterioration and to suggest actions to take if any triggers are present.
Possible triggers include (amongst others): Breathing difficulties; changes in appetite, mobility, consciousness or confusional state; bowel or urinary tract problems.
Suggested actions include (amongst others): Raising the alert, recording observations (using NEWS2/RESTORE2) and communicating concerns by using the SBARD communication process (more information about SBARD on our webpage here).
Staff are also prompted to ensure that residents personal End of Life care preferences are considered as part of the response process.
The REACT cards can be downloaded from the resources zone on the right hand side of the webpage and further information can be obtained via the contact link at the bottom of this webpage.
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.
The Significant 7 Signs of Deterioration Toolkit for Care Homes (NELFT)
The award winning Significant 7 Signs of Deterioration Toolkit supports care workers to identify the health needs of residents in the care home setting.
The Significant 7 Training Package was developed by North East London NHS Foundation Trust (NELFT) following research with care homes, hospital doctors and local authorities for over six months. It supports staff to identify deterioration earlier, resulting in residents receiving care at home rather than a hospital admission which greatly improves quality of life. Staff also report feeling more confident in their role and residents are treated in the right place and at the right time.
A Powerpoint presentation about the Significant 7 approach can be downloaded from the resources zone on the right hand side of of the webpage.
Stop and Watch Early Warning Tool (Interact)
Stop and Watch is a clinical alert, part of the American INTERACT toolkit, intended for use in nursing homes. The tool is intended for use as a clinical alert to provide early identification of, and communication about, acute changes in the condition of a patient or resident. The Stop and Watch Early Warning Tool can be downloaded from the Interact website.
A presentation about using STOP and Watch across North Cumbria CCG by Director of Nursing and Quality Anna Stabler at the 'Don't let me die too young - Mortality Conference' on 1st March 2019 can be accessed on the NHS North Cumbria CCGs website.
LPZ – improving quality and safety in care homes ( East Midlands Patient Safety Collaborative)
East Midlands Patient Safety Collaborative (EMPSC) have introduced an audit tool to measure the prevalence of common care problems found in nursing and residential homes called the International Prevalence Measurement of Care Problems in Care Homes (Landelijke Prevalentiemeting Zorgkwaliteit, or LPZ for short, in Dutch).
LPZ was developed in the Netherlands to provide a reliable mechanism for measuring the prevalence of common care problems within care homes and provide consistent recording of data to drive, or measure, the impact of quality improvement initiatives in the sector. It is currently used to deliver an annual audit of data for care settings in the Netherlands, Germany, Austria, Switzerland, New Zealand, Indonesia and Brazil.
More information about LPZ and the EMPSC project can be found in the NHSI Atlas Directory.
A ‘NEWS’ system for residential care settings (Sunderland CCG)
A multidisciplinary team from Sunderland CCG have developed and applied an electronic system based on an adaptation of the National Early Warning Score (NEWS) tool to support the monitoring of residents’ health. The system has improved residents outcomes and experience. More information about this project can be obtained from the NHSEs Atlas of Shared Learning.
Living Well Essex (Essex County Council & Healthwatch Essex)
The Living Well website has been created by Essex County Council in partnership with Healthwatch Essex to provide information on services and organisations across Essex. They have signposted two documents of particular relevance to Care Homes on their Care Provider Information Hub.
Copes of these documents and information about the Living Well initiative can be found on their website here.
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.