Abstract
Introduction: Unlike nursing homes, which have a qualified nurse on duty 24 hours, residential homes offer a social care model and are managed by a senior care assistant. This may increase the risk of admission to the emergency department (ED).
The 45 bedded residential care home and associated GP medical practice in this pilot reported poorly communicated, inappropriate, and duplicate referrals to the practice, with nearly half of admissions to the emergency department occurring without professional assessment of any kind.
Who is it for? The pilot aimed to enable care home staff to improve identification of residents at risk of deterioration and to make appropriate referrals to GP and other services, and reduce ED admission without professional assessment.
Design, implementation and monitoring of the initiative: The need for change was identified by the selected residential care home and aligned GP practice, who noted several key shortcomings such as ineffectual assessment processes, inappropriate and duplicated GP referrals. The intervention was designed by a project implementation group which included residents, their families, care home managers and staff, GPs and their practice manager, and – from the Northern Health and Social Care Trust - nurses from the Responsive Support, Education, and Anticipatory Care with Care Homes (REACH Team) and a community nurse and Trust pharmacist.
Intervention: A nursing team from the Northern Health and Social Care Trust – the Responsive Support, Education, and Anticipatory Care with Care Homes (REACH Team) – delivered and monitored an educational programme to home staff focused on early detection of decline. This included:
Recording of vital signs.
Recognition of ‘soft signs’ (1) of decline (such as change in diet, reduced mobility, and agitation) using the ‘RESTORE2 Mini’ tool. (2)
Using the Situation, Background, Assessment, Recommendation, Decision (SBARD) structured communication tool when referring residents to the GP or other services.
Results: Over a three-month period:
14 of 28 staff (50%) took part in the training.
43 of 45 residents (96%) were assessed for frailty and also referred to a Trust pharmacist for medication review.
GP anticipatory care plans were completed with 38 of 45 residents.
When residents were referred to their GP using SBARD, approximately 60 % were managed within the home.
63% of admissions to the emergency department (ED) occurred after professional assessment, although the overall attendance rate was not affected.
The intervention was well-received by residents, their families, home staff, and GPs.
Learning and next steps:A short, nurse-led, educational intervention can enable residential care home staff to effectively identify residents at risk of deterioration, improve communication, and make referrals to appropriate health services. This relatively straightforward intervention, using accepted assessment tools and existing resources, would be readily transferrable to many care home settings.
Cooper G. Using Soft Signs to Identify Deterioration [Internet]. 2020 [cited 2023 Aug 30]. Available from: https://wessexahsn.org.uk/img/projects/Soft%20Signs%20White%20Paper%20GC%20WPSC%20Final%201.2.pdf
RESTORE2 [Internet]. 2023 [cited 2023 Aug 30]. Available from: https://wessexahsn.org.uk/projects/329/restore2