1. admissions in residents in care homes.
Feasibility study of an evidence based intervention to reduce avoidable hospital
admissions in residents in care homes.
A Feast1, A Blighe2, K Froggatt3, B McCormack4, S Nurock5, C Powell2 , G Rait1,
L Robinson6, B Woodward-Carlton5, J Young7 , EL Sampson1, M Downs2
We tested the intervention by collecting data from four domains:
Individual
Process data
System level data
Economic evaluation
Data were collected via questionnaires with staff, residents, family and care home records.
Method
Develop a complex intervention to facilitate early detection of changes in health in care home residents in order to reduce avoidable hospitalisations.
Test the feasibility of this intervention in 2 care homes over 4 months to answer: Can the intervention be delivered as intended?
What refinements are required to the implementation guidance?
Is our approach to collecting data feasible?
What are the resource requirements for data collection and analysis?
Aims
Early detection and intervention for ill health in residents in care homes with nursing is problematic.  People living in care homes are sometimes admitted to hospital for conditions which, if noticed and treated earlier, could have been managed in the care home. Four common causes of unplanned hospital admissions are respiratory infections, urinary tract infections, dehydration and acute exacerbation of chronic heart failure. Reducing rates of hospitalisation is a priority for the National Quality Board and the National Commissioning Board.
Background
Intervention components
Early Warning Tool (adapted from Stop and Watch [1]).
BHiRCH Care Pathway (a clinical guidance and decision support system).
Structured method for communicating with primary care.
Knowledge and skills development for care home staff and family members of residents, family members, close friends and care partners.
Methods for involving family members, close friends or care partners.
Implementation support.
Procedure
Notice signs of deterioration
Use STOP AND WATCH [1] early warning tool
Follow Care Pathway (clinical guidance and decision support)
Use tool to facilitate communication with Primary Care
Nurses
Care assistants and nurses
Staff, family, visitors to the care home
Preliminary results*
Family= 8
Staff= 22
Residents=12
Number recruited
Month 1=11
Month 2 =12
Month 3 =2
Stop & Watch tools used
Month 1= 3
Month 2= 0
Month 3= 0
Care pathways used
Person-centred care (PCC) 2
Readiness for research 3
Nurse communication with primary care (N=6)4
Support for providing PCC remained stable over the 4-month follow-up period.
Readiness for research remained stable over the 4-month follow-up period.
Improved by 39% over the 4-month follow-up period.
Greater score indicates greater communication difficulty.
Baseline 78/140 SD=30.76
Follow up 48/140 SD=13.64
Next steps
Study procedures have been refined & there will be a greater focus on implementation support in the Pilot Trial.
The results signal that this could be a worthwhile intervention.
The cluster randomised controlled pilot trial will involve 14 care homes across West Yorkshire and London over a period of 16 months in 2017.
We will continue testing this approach with a view to improving medical care of residents in care homes.
1 University College London; 2University of Bradford; 3Lancaster University; 4Queen Margaret University, Edinburgh; 5Alzheimer’s Society;
6Newcastle University; 7Bradford Institute for Health Research
*No formal statistical tests were performed due to recruitment numbers.
Study Partners
References
INTERACT. Stop And Watch Early Warning Tool. Florida Atlantic University, 2014.
Edvardsson D, Fetherstonhaugh D, Nay R, et al. Development and initial testing of the Person-centered Care Assessment Tool (P-CAT). International Psychogeriatrics 2010;22(1):
McCormack B, Kitson A, Harvey G, et al. Getting evidence into practice: The meaning of 'context'. Journal of Advanced Nursing 2002;38(1):
Tjia J, Mazor K, Field T, et al. Nurse-physician communication in the long term care setting: Perceived barriers and impact on patient safety. Journal of Patient Safety 2009;5(3):
This poster presentation is an outcome of independent research funded by a National Institute for Health Research Programme Grant for Applied Research – “Reducing rates of avoidable hospital admissions: Optimising an evidence-based intervention to improve care for Ambulatory Care Sensitive conditions in nursing homes” (RP-PG ). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
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