Organisation introduces a project to improve overall performance of residential homes delivering care to older patients, reducing the number of falls and improving quality of life

Outline:

What exactly do doilies, lasers, snack charts and jelly have to do with improving quality and reducing harm for Older People living in care and nursing homes? The Prosper project is working with homes across Essex, to reduce the number of falls, pressure ulcers and UTI’s using Quality Improvement methodology – not only improving system performance and professional development but also changing behaviours – encouraging creative thinking to tackle problems and using measurement to guide improvement.

With a strategy to keep people living in their own homes for longer, admissions to Residential care have complex needs and high risk of falls. Prosper supports Managers and carers to analyse current practice and identify gaps to improve quality for people living in care. Prosper has not only sustained its work over 5 years but gained momentum with learning spread nationally and internationally.

Prosper is highly respected by Health and Social Care and used as a vehicle to introduce new models of care delivery and now includes Learning Disability & Autism services where changing needs of adults entering older age are often overlooked. Analysis of all Prosper homes CQC ratings, before and after demonstrates an increase in Good or Outstanding from 46% to 82%.

Challenges:

Essex has over 400 independent residential care and nursing homes for Older People. Prosper has little control over how independent organisations run their businesses and must gain support and trust of care providers before it can begin. Analysis of Prosper homes data showed 54% were rated requires improvement or inadequate with CQC prior to Prosper. Hospital admission and ambulance call out data showed falls was a concern for care homes. Prevalence of Dementia in care homes is increasing and challenging for care staff. Goals:

• Improve the quality of life for residents and their positive wellbeing

• To change the safety culture of a home to be proactive, not reactive

• Focus on prevention and enablement

• Challenge the way things are done

• Care staff to think differently and creatively

• Educate not just train – understanding is key, you can learn a task but without understanding it’s meaningless.

• Work in partnership with Care homes, Community Health providers, CCG’s and social care for a system wide approach.

• Reduce financial pressure on homes and health & social care through prevention not reaction

• Support Enhanced Health in Care Homes Balances and measures

• CQC quality ratings

• Monthly data collection on falls, pressure ulcers and UTI’s

• Quality Information sharing meetings

Outcomes:

Prosper has supported homes to improve quality of life for residents, think creatively and be proactive;

• 82% of homes rated Good/outstanding

• Evidenced reduction in falls

• 9 residents in one home increased their MUST score and weight by introducing 100 calorie snack booster chart and snack boxes

• A resident kept falling at night, the home tried a smaller room so she was closer to the toilet

• one home tried sensor toilet bowl lights and found one particular colour helped the resident find the toilet and reduced falls.

• Chair sensors to alert staff when residents are getting up and need assistance

• Increased hydration with jelly drops, using smaller red cups, hydration games

• created several lounge/diners so residents didn’t have so far to walk.

• Gave relatives the good slipper guide resulted in 60% of residents getting new slippers at Christmas. See Prosper uploaded document for more outcomes and data

Difficulties include:

• Changes in managers and having to start methodology from scratch, we try to encourage champions and work with them as well as managers

• Data collection- suspicious of why the LA wants data, work with managers to show how data is for improvement not performance.

• Making links with many CCG’s and health services

Spread:

The Prosper model and tools are widely shared at a local, national and international level.

• Enquiries from Australia interested in falls reduction.

• Community health providers use Prosper tools as part of work with care homes eg. prosper Catheter Care Management training is now used by care home practitioners in West Essex. • Prosper toolkit is available online.

• Prosper has had papers published, 2 in the BMJ and 1 in Journal of the Royal Society of Medicine.

• Prosper has two articles published on ULCPartners website this year.

• The Prosper team have presented at National conferences, 2 at Pressure Ulcer Care conferences and 1 at the Social Workers conference both in London.

• Prosper is working with Social work teams in Essex to expand Prosper to include enablement for interim placements

• working with the CCG’s to implement a Is my resident well booklet.

• Prosper is represented at local quality information sharing meetings across Health and Social care,

• Part of care home workstreams for the enhanced health in care homes agenda across STP footprints.

• Prosper holds six monthly community of practice for care home managers to share practice

• six monthly Prosper Champion study days for care staff

• Monthly newsletter which has a wide distribution list.

Value:

The value of Prosper can be seen in the cost of a fall which can be between £115 to £197 per fall - see attached Prosper supporting information - case studies and reduction in falls. More importantly the value is in the outcomes for residents who are actively involved in Prosper, homes read the newsletters to residents and the resident riddle is a monthly feature, Prosper has inspired homes to introduce more activities which help boost hydration and also provide meaningful occupation for people living with dementia, residents feel more secure and less afraid of falling, having more confidence in knowing that lights come on when they get up in the night or that staff members will be there to assist them.

Staff have a better understanding of certain conditions such as Parkinson’s and Dementia after attending Prosper champion study days and our GERT age simulation training gives an insight to frailty. CQC ratings have significantly increased since starting Prosper from 46% rated good prior to Prosper to 82% rated good after Prosper, which demonstrates residents are receiving good quality care which leads to better wellbeing and outcomes for residents. Attached Prosper supporting information gives more detail

Involvement:

Our main stakeholders are the care homes who are all independent organisations, we engaged them by visiting them and explaining what Prosper is about and that we are not there to tell them what to do but to work with the homes as equals, sharing ideas and trying things out to see what works and what doesn’t.

We also rely upon the support from community health providers, Suppliers of creams and products, charitable organisations such as Dementia Uk, Parkinson’s UK who provide the educational content for our Prosper champion study days. This takes a lot of work on our part to form relationships with these organisations to enlist their support which is given free of charge.

We also link in with the 5 CCG’s in Essex and will use Prosper as a way to introduce new initiatives for example in North Essex Prosper is supporting the introduction of a Is My Resident Well booklet for care homes. We also work with Contract compliance teams and through Prosper can help the care homes to meet contractual and CQC requirements, working with a positive approach to improvement rather than focusing on reaction to incidents.