CCG introduces a range of initiatives to promote hydration and improve outcomes for care home residents, reducing incidence of urinary tract infections requiring antibiotics or hospital admission

* Please provide a brief outline of your work.

 NHS England 2014 reported that urinary tract infection (UTI) was the condition with the highest emergency admissions rate in 2012/13. A higher than average number of admissions to hospital for UTIs in specific care homes was noted in the Windsor Ascot and Maidenhead CCG area. Upon further investigation care homes were relying on non-clinical signs to diagnose UTIs and not following SIGN 88 guidance (as cited in NICE QS90).

The project, which commenced in July 2016, set out to improve correct diagnosis of UTIs; reduce UTIs through improving hydration in nursing and residential homes and optimise UTI management.

 * Please describe the actions you took to achieve your result.

 The project commenced with a multidisciplinary meeting involving a patient safety manager, care homes support pharmacist and 4 care homes managers to design tests of change to improve outcomes for the residents (150 in total). The care home staff proposed and designed the tests of change and so had full ownership with support provided by the patient safety manager and care home support pharmacist (project leads) and had input from a dietitian.

The five tests of change were:

• Introduction of a poster with importance of hydration and signs and symptoms of a UTI

• Staff hydration training

• Introduction of a 7 structured drinks round

• Residents hydration training

• Food and fluids chart – designed by the care homes.

Carers, nurses, activity co-ordinators, chefs and care home managers all participated in the training which was evaluated at the end of each training session to ensure that care home staff views were heard. It captured the care staff’s thoughts on the project and how it would run/improve.

The food and fluids chart was designed with a senior carer in the nursing home who tested the chart in their unit and shared it with staff. Changes were made from feedback after a month’s trial and it continued to be used effectively. Staff engagement was excellent as they designed something that works for them and is easy to use. In the nursing home, ‘huddles’ were used to communicate hydration information and receive feedback from staff.

Some residents were involved in designing drinks rounds trolleys and helped to choose which drinks to add to the trolleys based on activities to taste different drinks. Residents said they liked trying different things and sometimes even had 2 cups!

The drinks rounds became a highlight for residents and a socialising point.

The average cost of a UTI hospital admission is £1331 (NHS National Tariff Payment System). There has been a reduction of 10 admissions to hospital to date a saving of £13,310.00. Other savings included reduced GP call outs, reduced falls as highlighted by care home managers as well as reduced use of antibiotics (cost and anti-microbial stewardship).

The project has minimal cost implications including decorations for drinks trolleys but sometimes these are supplied by families wishing to take part. Through reducing UTIs in care homes, residents’ health improved and they were more able to participate in activities and social gatherings. Most importantly the project has improved residents’ quality of life.

 * Please list the most significant results

 The overall aim was to reduce UTIs requiring antibiotics or admission to hospital

UTI Admission to hospital 2015/2016 18 2016/2017 12 2017/2018 4 to date of submission

UTI requiring antibiotics The incidence of UTIs has reduced from 1 every 13 days at baseline to 1 every 47 days since the project commenced.

One residential home has been UTI free for 230 days.

Qualitative

One resident with a history of a UTI every 6 weeks used a food and fluid chart to help him increase his fluids. He went UTI free for 8 months and is socialising more and more mobile.

* Describe how your project has spread to other teams, departments or organisations

The simplicity and minimal cost of this project has spread by word of mouth. It has been rolled out to a further 9 care homes in East Berkshire and Oxfordshire (611 beds in total). Presentations/teleconferences have been held at the request of CCGs wishing to undertake something similar (Bedford, Luton, Milton Keynes, Chiltern, Swindon, Vale of York), AQuA and East Anglia University.

There has also been interest from secondary care providers. Project resources are shared online. A grant has been awarded by Health Education England to continue to develop these resources to improve outcomes for the frail and elderly.