Care Homes Improvement ‘Vanguard’ Project

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East and North Herts Clinical Commissioning Group (CCG) is working with Hertfordshire County Council and the Hertfordshire Care Providers Association on an NHS England Care Homes (vanguard) project to provide planned, proactive and preventative support to elderly care home residents with complex care needs.

We were chosen from 269 other contenders for the project – one of just six in the country – because our approach was considered to be one of the most innovative.

Research shows that care home residents with complex and long-term conditions are often taken to hospital and sent back the same day. This is not only unsettling for the patient, but adds to the strain on the ambulance service and A&E departments.

Our aim is to keep elderly residents living in care homes across east and north Hertfordshire out of hospital through regular visits from a dedicated GP practice, better trained staff, patient record sharing and expert medication reviews.

Better care for care home residents will reduce A&E admissions.

Because they are:

  • much more likely to be taken to A&E than those living at home
  • often taken to hospital and sent back the same day – disruptive for the patient
  • on average taking 7 prescribed medicines – medication errors more common in care homes

The four strands to the project are:

  • CONFIDENT STAFF – upskilling staff to feel more confident about supporting residents’ health and wellbeing
  • MULTI-DISCIPLINARY TEAMS – support and advice from pharmacists, dieticians, geriatricians, mental health professionals, doctors and nurses
  • RAPID RESPONSE – Frailty vehicle delivering expert care/support and teams of community nurses, therapists deployed to care homes within 90 minutes
  • EFFECTIVE TECHNOLOGY – GP access to comprehensive patient information when they visit them

If our project is successful we would expect to see:

FewerMore
  • 999 calls
  • A&E attendances
  • Emergency admissions to hospital
  • Short stays in hospital
  • Calls to the out of hours GP service from care homes
  • ‘Delayed transfers of care’
  • Medication errors and problematic polypharmacy
  • People living healthier lives for longer in care homes
  • Calls to NHS 111
  • Staff, residents and families reporting feeling satisfied with care
  • Care home staff choosing to stay longer in their jobs
  • People dying in their preferred location

Example patient story
When Marie moved to her care home a year ago, she had type 2 diabetes as well as breathing difficulties. During her stay, Marie became increasingly confused.  She was increasingly dependent on staff who were not always informed or confident about caring for her long-term conditions. Marie’s frustration at losing responsibility for her own care led to depression and, without a comprehensive care plan in place, there was little improvement in her weight and mobility. When Marie experienced complications from her breathing problems, care home staff were unsure what to do and called an ambulance to take her to hospital, which Marie found distressing and disorientating.

The same story after the improvements are made
When Marie moved to her care home a year ago, she had type 2 diabetes as well as breathing difficulties.

  • Training means care home staff feel more confident helping Marie manage her diabetes through nutrition with input from a dietician.  Long term conditon training covers respiratory problems.
  • Clinical pharmacists review medication for individual patients, to ensure that medicines provide therapeutic benefit and minimise side-effects.

During her stay, Marie became increasingly confused. She became more dependent on staff who were not always informed or confident about caring for her long-term conditions.

  • Confusion recognised by staff with dementia awareness training and are generally more confident about looking after Marie as a whole person.

Marie’s frustration at losing responsibility for her own care led to depression and, without a comprehensive care plan in place, there was little improvement in her weight and mobility.

  • Input from Community Psychiatric Nurse and multi-disciplinary team (MDT) of therapists, district and commiunity nurses and social care staff, Marie is encouraged to join exercise and social/craft sessions.

 

When Marie experienced complications from her breathing problems, care home staff were unsure what to do and called an ambulance to take her to hospital, which Marie found distressing and disorientating.

  • Care planning becomes a joint responsibility of Marie, her family, MDT and carers in her care home. Breathing complications prompt care home staff to call frailty team. Rapid Response team carries out assessment on Marie, and supports staff to keep her in her care home bed.
HOSPITAL ADMISSION AVERTED

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