Council initiates a project to improve care provided to residents in domiciliary care and care homes, enhancing staff knowledge thereby improving patient safety

Our team analyses information about Residential/nursing care, Domiciliary care and supported living services to identify common themes for improvement and seek to find & develop initiatives which will support improvement in quality of care and patient safety. We instigate partnership working to establish a system approach to patient safety.

Achievements include; Prosper project using Quality Improvement methodology with care homes to reduce falls, Pressure Ulcers and changing culture, GERT suit experiential learning programme on the physical aspects of aging, Leadership programme for Domiciliary Care Managers, train the trainer programmes for Domiciliary care staff, medication and MCA/DOLS workshops for all providers.

Challenges

•Intelligence from CQC inspection reports and ECC quality audits of care providers shows safety issues around medication and a lack of understanding of the Mental Capacity Act and Depravation of Liberty Safeguards.

•Intelligence from Safeguarding concerns showed a lack of care staff understanding in the behaviours of people living with Dementia and the frail elderly.

•The biggest proportion of ambulance callouts to care homes is as a result of a fall and the top 3 reasons for admittance to A&E is pressure ulcers, Infections and Falls.

•Over the last 10 years a lot of work has been undertaken with the Residential care market to assess and improve quality however the Domiciliary care market has largely been left untouched. There is a growing number of small agency start-ups who require support and care staff who are out in the field on their own caring for people who are increasingly frailer with co-morbidities, with a push to support people to live in their own homes for longer the challenges for care staff are increasing.

Actions

•We used the model of measurement and improvement as the basis of our improvement work, first establishing an overview of the quality of the market undertaking an analysis of the data available using sources such as CQC, safeguarding, CCG reports and ambulance call out data to identify the common themes where there are issues across the different care services.

•We devised a programme of initiatives to address the issues which included upskilling care staff from both Residential Care and Domicliary Care, talked to people with Learning Disabilities to find out how we could best support them to attend appointments and approached external funders to support some of the initiatives.

•We approached the CCG’s, Community health providers and Care Quality Commission to work with us and provide the clinical expertise that was required to upskill care staff and we worked with local colleges, voluntary organisations and Fire and rescue services on specific improvement initiatives.

•We included the care providers in the development of the initiatives to ensure it met their needs and had a voice when it came to working out system issues.

•We implemented the programme of initiatives ensuring there were evaluation mechanisms in place to see if the interventions were making a difference.

Significant results

•Prosper project, working with Residential Care and nursing homes on the prevention of falls, pressure ulcers and UTI’s using Quality Improvement methodology, Data for improvement purposes and changing staff culture, achieved a 5% reduction in Falls, 20% reduction in pressure ulcers and 66% change in Staff Culture. Prosper has seen services rated by CQC going from inadequate or requires improvement to Good and is mentioned in the CQC inspection reports as good practice

•GERT age simulation experiential learning with care staff has achieved; 94% increase in understanding of what it’s like to live in an ageing body, 86% increase in understanding the impact the physical effects of aging has on the to complete tasks, 73% increase in understanding on how the environment can impact fatigue and disorientation. A change in care practice with more consideration given to time, patience and surroundings when transferring residents from bed/chair or wheelchair, assistance with walking and considering the impact of colours for residents with differing eye conditions which has resulted in homes thinking about the colour & placement of handrails, toilet seats and even bedroom furniture in relation to the walls and carpets

•Leadership programme for residential care providers has seen services rated by CQC going from inadequate or requires improvement to Good and is mentioned in the CQC inspection reports. Domicliary care providers have said the programme is the best thing Essex County Council has ever done.

•Significant achievement is bringing CQC, CCG’s, Community pharmacists and social services together to support care providers. Mental Capacity and Depravation of Liberty workshops for both Residential and Domiciliary care services saw unprecedented partnership working with CQC and a open and transparent environment where by providers could ask and discuss issues they encounter.

•The video books for people with a learning disability has been developed with Health Access champions who have a learning disability, local college media students some of whom have autism, Acute hospitals and Ambulance services bringing together a wide range of stakeholders to support the improvement.

Value achieved

•The Prosper project has a saving on the cost of falls and pressure ulcers in the range of £86,000 - £143,000.

•Change in care practices, Prosper has seen personalised solutions such as decorating walking frames to make them recognisable by people living with Dementia.

•GERT suit experience has care staff pledging to not rush people, to change environment and colours to make them easier to distinguish and one Domiciliary carer said she now knew why the lady she cares for never ate the biscuit she left on a plate, she couldn’t see it! 94% increase in understanding of what it’s like to live in an ageing body, 86% on impact the physical effects of aging has on the ability to complete tasks and 73% increase on how the environment can impact fatigue and disorientation

•MCA/DOLS workshops have brought clarity, discussing real issues such as the use of bedrails and covert medication.

•Medication workshops have up-skilled care staff on subjects such as inhalers, diabetes and respiratory conditions.

•The Innovation team have created strong relationships with partner organisations which were not evident before and are trusted by the care providers to implement solutions through working with them rather than doing to them.

In detail

The Quality innovation teams ambition was to increase the quality of care services across all specialisms including Residential Care and Nursing Homes, Domiciliary Care providing services to people in their own homes and Learning Dissability Services. Targeting interventions to address the common themes identified in the attached Quality Innovation Strategy for Continuous Improvement 10.11.15. With 65% of services rated as good when the innovation programme was designed. The innovation team consists of 7 staff members split across Residential care, Domiciliary Care and Learning disabilities and over 600 services operating across Essex.

The improvement programme uses the model of measurement and improvement as its basis and seeks to implement Quality improvement methodology of PDSA cycles to bring about improvement. The Quality Innovation team has seen great improvement in Residential Care services following the development and implementation of the Prosper project which trained Care home managers in Quality Improvement Methodology and using data for improvement purposes to prevent falls, pressure ulcers and UTI’s and used the learning from this work to inform the programme for other services such as Domiciliary Care, looking to see what could be transferrable. The teams energy and enthusiasm for improvement has enabled us to engage a variety of key stakeholders to support the work, building trusted links that were previously not evident.

The Innovation team have demonstrated real examples of how the integration of Health and Social Care can bring about enormous benefits to the lives of patients.

The team have devised and developed the following improvement initiatives;

•GERT age simulation experience for care staff – delivered to 503 people including Residential and Domiciliary care staff, CQC inspectors, Health and Social Care students, Essex Search and Rescue volunteers, Apprentices and Scout troups.

•Prosper project focusing on the prevention of falls, pressure ulcers, UTI’S and nutrition/hydration in Care homes and Nursing homes. Six cohorts of 106 homes. Organised 12 Prosper Champion Study days and 7 Community of practice events, published 22 monthly newsletters. Working with CCG’s and Community Health providers across 5 CCG areas to deliver the clinical training on the project.

•Train the Trainer programme for Domiciliary Care agencies on subjects such as Stoma Care, Pressure Ulcer Care, Catheter Care and infection control. Transferring the success of the Prosper Champion Study days to the Domiciliary Care sector. The programme has been developed with Community Health Providers and included managers of Domiciliary care agencies on the implementation project group.

•Medication Workshops working with CCG’s and Pharmacists to deliver a series of workshops aimed at care staff to improve knowledge on MAR Sheets, Diabetes, End of life Care, Respiratory conditions and Inhalers.

•Mental Capacity & Depravation of Liberty workshops devised following a number of inappropriate referrals and a lack of understanding on Mental Capacity. The Quality Innovation team were able to engage CQC in this work who presented at the workshops on what they look for on inspections.

•Video books for people with learning disabilities to prepare them for situations they might find themselves in such as appointments for blood tests, back of an ambulance or the dentists. Working with the Health Access Champions who have a learning disability and media students at the local colleges to produce the videos. Collaboration with the acute hospitals and ambulance service.

• End of Life Care workshop for Residential Care staff working with the local hospice to deliver information on caring for a person at end of life, the end of life register and PPC.

•Dementia Friends, the team are all trained as Dementia Friend Champions and have also delivered sessions to Scout troops who we have then buddied up with care homes, Health and Social Care students & apprentices to help prepare them for their future career in care, care staff and care home relatives groups.

•Leadership programme for Residential care home managers and Domiciliary care agencies. The programme is delivered with the national My Home life programme and we have pioneered the leadership programme for Domicliary Care which has never been done before.

The work the Quality Innovation team have implemented and supported the care providers to implement has seen a reduction in falls and pressure ulcers, a change in staff culture and understanding and there are now 80% of care services in Essex rated as Good or outstanding.

Our work is being replicated in other parts of the country with the Prosper project being implemented in Birmingham and interest from other CCG’s and Local Authorities. The owner of one of our Prosper homes has now implemented the programme in all 7 of their homes, 4 of which are outside of Essex. Attached are examples of the success of our work in the Quality Innovation Newsletter which we use to spread and share the work we do.