1. Development and feasibility testing of a complex intervention
to reduce hospitalisations in English care homes
A Blighe1, EL Sampson2, B McCormack3, K Froggatt4, C Powell1, A Feast2,
J Young5, L Robinson6, B Woodward-Carlton7, S Nurock7, M Downs1
Background
There is now a policy directive to reduce rates of avoidable hospital admissions. People living in care homes are admitted to hospital for conditions which, if noticed and treated earlier, could have been managed in the care home [1]. Common conditions for which residents are hospitalised include urinary tract infection, congestive heart failure, dehydration and lower respiratory tract infection.
Intervention components
Six key components have been developed for the final intervention.
These are:
Early Warning Tool (adapted from Stop and Watch [2]).
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.
Feasibility testing
The feasibility study runs from Nov 2016 to Jan 2017.
We are testing the intervention in two care homes, focusing on data from four domains:
Individual
Process data
System level data
Economic evaluation
The feasibility study will address the following questions:
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
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.
Development included
Literature review.
Interviews with key informants (e.g. health and social care staff, academics with expertise in care homes research).
Consultations with professionals and experts by experience (including a Carer Reference Panel in collaboration with Alzheimer’s Society volunteers).  
Consensus workshops with key stakeholders.
The complex intervention
Two nurse champions (working with a group of staff and families) will lead the change process ensuring clear roles and processes.
Notice signs of deterioration
Use STOP AND WATCH [2] 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
References
Krüger K, Jansen K, Grimsmo A, et al. Hospital admissions from nursing homes: Rates and reasons. Nurs Res Pract, 2011:
INTERACT. Stop And Watch Early Warning Tool. Florida Atlantic University, 2014.
Next steps
The feasibility study will inform a cluster randomised controlled pilot trial. It will involve 14 care homes across West Yorkshire and London. It will run for one year from June 2017.
Study Partners
1University of Bradford; 2University College London; 3Queen Margaret University, Edinburgh; 4Lancaster University; 5Bradford Institute for Health Research; 6Newcastle University; 7Alzheimer’s Society
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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