Valerie Murray Clinical Nurse Lead - Redbridge

1. Significant 7 Presentation Care Home Forum Valerie Murray Clinical Nurse Lead - Redbridge

2. What’s the story? Judith is 91. She lives in a care home.

3. Our Ambition “We are helping care homes to make sure Judith gets all the support she needs, as quickly as possible”

4. Where has this come from?

5. Our Process – QI Methodology Audit at A&E Conversations with local authorities Vision event with care homes Co-design and testing with care homes Roll out project in WF Fellowship Project in Thurrock Roll out across BHR

6. Our Research • Audited admissions to A&E to understand who ends up there, and why • Met with 10 different care homes to understand the perspective of working in and running care homes • Interviewed each of the BHR local authorities to understand their relationship with care homes • Interviewed hospital doctors, paramedics and GPs to understand how care homes relate to the wider system

7. The insights – Wider System • We learned about the wider system: • Supporting residents is a complex task that is currently carried out by a fairly fragmented system • More than 1/3 A&E admissions could have been prevented at some stage • When residents become more unwell, there is often little that care homes can do

8. The insights from Care Home Staff • We learned about care home staff: • Care home managers work hard to support their staff and manage relationships with a huge array of partners, families and other professionals • Care assistants do great work and are often find themselves under pressure from families, paramedics and doctorsDay-to-day working life in care homes is very demanding with many challenging and complex events occurring simultaneously • Care assistants and managers appreciate the reminders they currently have to manage resident’s care effectively and efficiently • With the workload, paper work often makes the job harder to do well, not better

9. What if we could support care workers to help residents more quickly when they start to deteriorate?

10. Early Signs of Deterioration…… ESD 1 2 3 4 5 6 7 8 9 10 Feeling unwell Admission to A&E

11. The Benefits • Less discomfort for residents • More empowered care workers • Reassurance for families • Less stressful management for care home managers

12. Our Principles • Support care homes to do what they do even better • Build on the qualities and relationships that staff already have • Help care assistants to spot the earliest signs of deterioration and respond to them quicker • Fun, engaging training • Simple, clear visual tools • Clinically safe

14. 1. The Checklist Covers the key areas care assistants need to be aware of.

15. 2. Decision Trees Each of the headings of the checklist has a decision tree aimed at helping care workers take earlier action.

16. 4. The Training Fun, interactive session that helps staff learn how they can incorporate the tools into their daily work

17. Progress so far?

18. Successful Training • Care Support Workers has responded well to training • Greater confidence • Really like the tool • Easy to use • Reduction in A&E admission • Reduction in pressure ulcers in one care home

19. Use of S7 Tool in Practice

20. Impact of Training on Practice

21. Next steps… Project now a CQUIN 2017/2018 in South West Essex Continue to publicise the training Looking to explore this concept for carers and care home agencies Currently testing an app to support the training materials Await to hear from the results in Barrett after 1 project

22. Discussion & Questions

23. Thank you! Please contact us for further information: Geraldine.Rodgers@nelft.nhs.uk