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.
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.
RESTORE2TM (West Hampshire CCG & Wessex PSC)
National ‘Excellence in Primary Care’ Parliamentary Award Winners July 2019 (read more here)
Full information about RESTORE2TM and RESTORE2 MiniTM including training videos and downloadable resources can be found on our RESTORE2 webpage
RESTORE2TM 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).
A "Soft Signs" only version of RESTORE2TM entitled RESTORE2 MiniTM is now available for Care Homes wanting to use a "Soft Signs" approach as a pre-diagnostic indicator of concern" to facilitate earlier treatment and avoid unnecessary transfers to hospital.
Wessex PSC has developed an aligned model of care pathways across Wessex which includes the application of the Wessex All Cause Deterioration Guidance (see our Deterioration and NEWS web page) to the Care Home setting.
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.
Staff using 'Soft Signs' are also to recognise physical deterioration in individuals before changes in physiological signs (heart rate, blood pressure, respiratory rate etc.) are evident.
These soft signs include changes in behaviour, diet and habits etc. and are particularly helpful in home settings, care homes and hospital wards.
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.
New online video training for care home staff
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.
More information and links about the videos (and other Care Home resources) can be found on our Care Home Training Resources webpage
The list of videos includes:
SBAR communication tool (Situation, Background, Assessment, Recommendation)
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.
Supplied in an "all-in-one" tele-health case WHZAN can be used to measure vital signs, record photos, perform multiple assessments and questionnaires including the Royal College of Physcians' National Early Warning Score - NEWS2 to check health.
Whzan automatically calculates a National Early Warning Score (NEWS2), in use throughout the UK supporting analysis of illness, nutrition, hydration and frailty and other conditions. Includes health and activity pattern recognition.
The Whzan tele-health system can be used to support the care of people with long term conditions such as COPD, asthma, diabetes and heart health, as well as monitoring people with short term needs, post-op & during pregnancy.
Provided in a distinctive Blue Box the Whzan tele-health system is portable with wireless instruments. Authorised carers & doctors can get access to patient results and analysis in real-time through WHZAN's own secure cloud-based portal.
More information about Whzan can be obtained from their website.
Early warning through camera based vital signs monitoring (Xim Lifelight)
Wessex Academic Health Science Network (AHSN is working with Hampshire-based digital innovators xim, and Badgerswood Surgery in Bordon to develop new technology capable of monitoring patients’ vital signs.
The LifeLight® system can check a patient’s vital signs - their pulse, breathing rate, blood pressure and blood oxygen level - by simply sitting in front of a computer screen.
LifeLight® does this by using a standard camera on the screen, which detects very small changes in a person’s forehead skin colour, and may help identify unknown health conditions or underlying problems.
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.