Promoting safer provision of care for elderly residents.

Essex County Council is proud to announce that the Health Foundation, an independent charity working to improve the quality of healthcare in the UK, has awarded funding for a social care scheme to improve resident safety across Essex care homes and reduce the number of emergency hospital admissions as a result of falls, pressure ulcers and Catheter & urine infections.The news is also significant because it is the first time a social care organisation has ever received funding from the Health Foundation.

The funding is for a two-year pilot project being developed in partnership with Essex County Council, University College London Partners (UCLP) and Essex Care homes.

Background

A significant proportion of people aged 85 years or older, live in care homes and have complex healthcare needs, as a result of multiple long-term conditions, significant disability and frailty. Seventy per cent of care-home residents have a form of dementia and 30 per cent have advanced dementia. This puts them at particular risk of admission to hospital or significant deterioration in their health and quality of life.

In recent years there has been a focus on gaps in quality and safety within healthcare, but this has tended to focus on hospitals and secondary care, thus excluding a high proportion of our most vulnerable patients – those living in care homes.

This project seeks to improve safety and reduce harm, primarily from falls, pressure ulcers and catheter infections, for care-home residents across north-east and west Essex by building upon the skills of those working in care homes through furthering education, measurement and culture change.

Building on existing work and local networks, the project takes a broad approach in which staff will:

  • Develop quality improvements with residents
  • Implement changes
  • Measure the impact of the changes on safety, in order to ensure a focused approach to reducing harm

By focusing on measuring safety, it will help build a safety culture in the care home.

Project Aims

This project seeks to build upon the skills that are central to delivering improved safety for residents. Its key aim is to improve safety and reduce harm for care home residents across north-east and west Essex.

Under the overall aim, specific objectives are to:

  • Work together with residents and their relatives to find ways of introducing new quality improvement training opportunities which will enable staff to address safety concerns
  • Reduce the percentage of residents that present at A&E
  • Increase the proportion of residents who are ‘harm free’ (as defined by the NHS Safety Thermometer)
  • Reduce the prevalence of falls, pressure ulcers and catheter infections across care homes
  • Iincrease staff understanding of, capacity and capability to create a safe environment for residents
  • Establish an evidence base for the intervention

Activities

The project will consist of 3 interventions:

Building capability in improvement and innovation methodologies

Care homes will develop learning based on observations or experience on an ongoing basis throughout the project – for example:

  • Understanding the starting point
  • Working with staff, residents and their relatives to find solutions
  • Planning and testing those solutions
  • Evaluating their impact and refining them
  • Focused on what is trying to be accomplished
  • How it will be known that a change is an improvement
  • What change can be made that will result in improvement (PDSA Cycle)
  • Supporting adoption and engagement across the broader care home community in Essex and beyond, and across other settings of care

Using the Manchester Patient Safety Framework (MaPSaF) to help understand the safety culture

Developed for use in primary care by Parker and Marshall and the University of Manchester, this tool defines five stages of development within the safety culture of organisations. It seeks to look at areas of practice and record areas where attitudes, values and behaviours about patient safety are likely to be reflected in working practices. It has been piloted and developed for use in acute, mental health, and ambulance settings, and in this project is being adapted, in partnership with care homes, to the care-home setting.

Using the NHS Safety Thermometer to strengthen insight and understanding

Care homes will utilise the NHS Safety Thermometer, a quality improvement and analysis tool that is applicable to any care setting. It aims to collect a minimum data set to support improvement across three domains: pressure ulcers, falls, catheters and urine infection. The project team will work with Care home managers to find non-onerous ways to routinely collect the data needed to complete the information required for the Safety Thermometer. In return, they will receive monthly reports that indicate the frequency of which the conditions included in the data set are being reported.

Together, these three interventions represent a theory and evidence-based approach to change in a complex environment.

The project aims to set up a community of practice to facilitate learning and sharing of best practice, providing Care home managers with a safe forum in which they can discuss and share their experiences throughout the pilot.

If you would like to participate in the project or would like more information please contact Lesley Cruickshank.