Trust in collaboration implements an optical sensor technology to support staff and improve dementia care in mental health wards, reducing A&E demand and saving 8,260 clinical hours

Outline:

Mental Health staff face a quandary: how can they verify that patients alone in bedrooms are safe and at the same time foster rest and privacy? Current standard of care is to risk assess patients and check them in person at intervals: in Mental Health hospitals, these checks are typically every 15 minutes.

Despite best efforts of dedicated ward staff following established protocols, incidents on inpatient wards still occur. For dementia wards, the critical patient safety challenge is falls. Most falls occur in bedrooms and injuries can be life-changing for patients.

CWPT have been working with Oxehealth to tackle the challenge of conducting effective safety observations on Dementia wards to reduce falls and associated injuries. Oxehealth’s technology was installed in 12 bedrooms (50% total) in Manor Hospital (dementia wards).

After 8-months, outcomes for Manor Hospital (24-beds):

- 33% reduction in falls at night

- Significant reduction in fall severity; moderate falls reduced from 8% to 2%

- 56% reduction in demand for A&E services: potential £99k saving per year

- Staff and carers report greater confidence and peace-of-mind

- 460 clinical hours saved per year from reducing falls

- 71% reduction (7,800 clinical hours per year) in enhanced observations; potential £154k saving per year

Challenges:

Mental Health staff face a quandary: how can they verify that patients alone in bedrooms are safe and at the same time foster rest and privacy? Current standard of care is to risk assess patients and check them in person at intervals: in Mental Health hospitals, these checks are typically carried out every 15 minutes.

Despite best efforts of dedicated ward staff following established protocols, inpatient incidents still occur. Patients in dementia wards are at high risk of falls; 50% falls happen in bedrooms, mostly at night, and the injuries can be life-changing for patients. In 2017, 84 falls happened in bedrooms at night at Manor Hospital. Goals focused on quality improvement for patient safety, specifically:

- Reduce falls rates

- Reduce associated injuries from falls

- Positive staff experience in managing patient safety risk

- Positive carer feedback

- Wider NHS benefits Patients can present with behavioural disturbance as a result of a fall may need enhanced observation: constant attendance by staff. This adds substantially, and unpredictably, to workforce costs. We evaluated the impact on clinical time/cost, including enhanced observations.

The study was sponsored at Executive level by Tracey Wrench, Chief Nurse, COO. It was approved by Wales Research Ethics Committee 5.

Outcomes:

Better quality dementia care:

- 33% reduction in falls at night

- 92% staff reported “the technology enabled them to prevent a fall”

- Significant reduction in fall severity; moderate falls reduced from 8% to 2%

- Ability to witness unwitnessed falls, reducing avoidable neurological observations Staff and carers reported greater confidence and peace-of-mind:

- 88% patient consent, representing positive staff-carer engagement

- 92% of staff felt the technology improves patient safety

- 6 carers were interviewed; all carers felt that the system keeps patients safer, all expressed the feeling “puts my mind at rest”

Deputy Ward Manager comments: “I couldn’t imagine not having the system now in place. It’s something that makes us feel more secure and we feel it sets up safety for patients.”

Financial and wider NHS outcomes:

- 56% reduction in A&E demand, up to £99k saving per year

- 460 clinical hours saved per year from reducing falls

- 71% reduction (7,800 clinical hours per year) in enhanced observations: potential cost saving of £154k per year.

Due to the technology supporting ward staff in developing confidence in managing patient risk. CWPT had to mature its approach and governance when introducing new technology to support improved patient care, either through research or quality improvement methods.

Spread:

CWPT and Oxehealth are committed in partnership to improving inpatient safety in Mental Health. In the last six months, Manor Hospital has hosted visits from 6 other Trusts to share learnings and best practice on using the technology to reduce falls. Many are looking to “fast follow” and adopt the technology into their Mental Health dementia wards.

As a result of the outcomes in dementia, CWPT are operationalising the technology at Manor Hospital for sustained service improvement. In addition, the technology has been deployed across the Psychiatric Intensive Care Units, Male and Female Acute and Rehab services at CWPT (total of 77 rooms) - as a clinical study to evaluate outcomes in acute settings.

The project was a finalist in West Midlands Tech Awards. CWPT are releasing a white paper and will share with Nursing and Operational colleagues across Mental Health. CWPT are presenting the paper at the Design in Mental Health conference in May, and will share the outcomes at other relevant forums and networks. Oxehealth had the opportunity to bring CWPT’s work to Matt Hancock’s attention at a no. 10 Downing street breakfast convened to to inform the Government’s Ageing Society Grand Challenge (part of Industrial Strategy).

Value:

Manor Hospital has saved 8,260 (across 24-beds) clinical hours on an annualised basis as a result of reducing falls and enhanced observations. This is a significant clinical time saving: equivalent to 688 individual night shifts per year, and a potential cost saving of more than £154k per year.

Critically, this clinical time saving was achieved with little training burden, and the technology worked within existing ward policies and protocols. Staff in inpatient Mental Health services are scarce: vacancies can be as high as 25%. Using this technology enables CWPT to redeploy their time in the most efficient, effective and evidence-based way to achieve the best possible care for patients.

Involvement:

Ward staff and Pathway Managers were quick to see the benefits and eager to incorporate its use. They engaged positively with carers and family members of patients, addressing their questions and keeping them informed of progress. In addition, they worked in partnership with Oxehealth, raising ideas and improvements, enabling Oxehealth to quickly increase the utility of the technology and ensure it seamlessly “slotted into” existing protocols and routines on the wards.

CWPT’s Executive Team, led by Tracey Wrench, harnessed the team’s energy and enthusiasm, and matured the Trust’s approach and governance to introducing new technology in order to allow staff to codevelop and deploy new solutions without compromising patient safety.

CWPT’s Research & Innovation team, led by Dr Kay Wright, were able to collect data, analyse and evaluate the evidence-based outcomes working in partnership with Oxehealth’s research team. A multidisciplinary team consciously created the project governance framework to enable a smooth graduation from the clinical study domain to the operational domain as efficacy was evidenced.

This framework enabled the Trust to identify and work through the governance, data management and operational policy changes required to operationalise the technology at Manor Hospital.