1. Resources for Care Homes ​ Information for NPSC PINCH Project Leads Geoff Cooper Wessex AHSN – Sep 2019

2. Resources for Care Homes
Clinical
Programme
Education & Training
RESTORE2
LPZ
“React to” series
REACT
SPACE
BEACH
Significant 7
EHCH
NEWS2 (OCB)
Stop & Watch
Living Well Essex
In Development
FREED
Structured Communications
Technological
Publications
Whzan
SBARD
Emergency Admission from Care Homes (NHSE / THF)
ATMIST / SAMPLE(MIST)
CARES
Acknowledgements
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3. RESTORE2 RESTORE2 Innovation Type Clinical Author West Hampshire CCG
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
RESTORE2
Innovation Type
Clinical
Author
West Hampshire CCG
AHSN Contact
NENC AHSN
Wessex AHSN
RESTORE2 is a physical deterioration and escalation tool for care/nursing homes.
RESTORE2 is based on nationally recognised methodologies including:
early recognition (Soft Signs)
national early warning score (NEWS2)
structured communications (SBARD).
Yes
Yes (NEWS2 based)
Yes (SBARD)
Ongoing support provided by West Hampshire CCG and Regional Steering Group
No licence required, RESTORE2 must be used “as is”.
Parliamentary Award for Excellence in Primary Care - July 2019
Interest from at least 8 AHSNs

4. What is RESTORE2?
RESTORE2 is designed to support homes and health professionals to:
Recognise when a resident may be deteriorating or at risk of physical deterioration
Act appropriately according to the residents care plan to protect and manage the resident
Obtain a complete set of physical observations to inform escalation and conversations with health professionals
Speak with the most appropriate health professional in a timely way to get the right support
Provide a concise escalation history to health professionals to support their professional decision making.

5. Impact Source: West Hampshire CCG
RESTORE2 – Results & Case Studies at:
Source: West Hampshire CCG

6. RESTORE2 - More Information
RESTORE2 (West Hampshire CCG)
RESTORE2 – Training & Resources (West Hampshire CCG)
RESTORE2 – Outcomes & Case Studies (West Hampshire CCG)
RESTORE2 / Enhanced Health in Care Homes (Wessex AHSN)
‘Excellence in Primary Care’ Parliamentary Award

7. REACT REACT (REcognise and Act) to Soft Signs of Deterioration
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
REACT (REcognise and Act) to Soft Signs of Deterioration
Innovation Type
Clinical
Author
Southampton City CCG
AHSN Contact
Wessex AHSN
REACT (REcognise and Act) to Soft Signs of Deterioration cards are designed to encourage staff to look out for 'soft signs' of Deterioration in their residents and to suggest actions to take if any triggers are present.
Suggested actions include (amongst others): Raising the alert, recording observations (using NEWS2/RESTORE2) and communicating concerns by using the SBARD communication process.
Staff are also prompted to ensure that residents personal End of Life care preferences are considered as part of the response process.
Yes
n/a
(Suggests actions / pre NEWS)
Yes (SBARD)
Ongoing support provided by Wessex AHSN
No licence required, REACT cards should be used “as is” or adapted with permission.

8. What is REACT?
The Wessex PSC REACT cards are based on a project by Southampton City CCG which prompted staff to look out for 'soft signs' of Deterioration in their residents. Using a deceptively simple question 'Is my resident well today?' the card includes a series of prompts to support staff to consider possible 'soft signs' of deterioration and to suggest actions to take if any triggers are present.
Possible triggers include (amongst others): Breathing difficulties; changes in appetite, mobility, consciousness or confusional state; bowel or urinary tract problems.
Suggested actions include (amongst others): Raising the alert, recording observations (using NEWS2/RESTORE2) and communicating concerns by using the SBARD communication process.
Staff are also prompted to ensure that residents personal End of Life care preferences are considered as part of the response process.

9. REACT - More Information
REACT / Enhanced Health in Care Homes (Wessex AHSN)

10. Significant 7 Significant 7 Innovation Type Clinical Author
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
Significant 7
Innovation Type
Clinical
Author
North East London NHS FT and Barking and Dagenham, Havering and Redbridge CCGs.
AHSN Contact
tbc
The Significant 7 Signs of Deterioration Toolkit supports staff to identify deterioration earlier, resulting in residents receiving care at home rather than a hospital admission which greatly improves quality of life.
Yes
n/a
(Own Checklists / Decision Trees) No
Patient Safety in Community award (National Patient Safety Awards July 2017)

11. What is Significant 7?
The Significant 7 Training Package was developed following research with care homes, hospital doctors and local authorities for over six months which identified an opportunity to support care home staff. The training package takes into account the needs of care home workers and the identified barriers impacting on training this group of people. It includes a toolkit to support care workers to identify the health needs of residents and an interactive training session delivered by healthcare professionals in the care home setting.
The training supports staff to identify deterioration earlier, resulting in residents receiving care at home rather than a hospital admission. This greatly improves quality of life. Staff also report feeling more confident in their role post training, and therefore residents are treated in the right place and at the right time. 

12. Significant 7 - More Information
NELFT wins national patient safety award for care home training for Significant 7 project

13. Stop & Watch Stop and Watch Early Warning Tool (by Interact)
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
Stop and Watch Early Warning Tool (by Interact)
Innovation Type
Clinical
Author
INTERACT
AHSN Contact
tbc
Stop and Watch is a clinical alert, part of the American INTERACT toolkit, intended for use in nursing homes.
The tool is intended for use as a clinical alert to provide early identification of, and communication about, acute changes in the condition of a patient or resident. 
Yes
n/a
Yes (Internal own proforma) No
Clinical use of INTERACT® Licensed Materials is provided without charge, but use and access of the materials is contingent on Interact’s terms and conditions (on website)
Stop & Watch has been incorporated into the North Cumbria LeDeR project.

14. What is Stop & Watch?
Stop & Watch has been incorporated into the North Cumbria CCG LeDeR project.
Stop and Watch is intended for use as a clinical alert to provide early identification of, and communication about, acute changes in the condition of a patient or resident. 

15. Stop & Watch - More Information
The Stop and Watch Early Warning Tool can be downloaded from the Interact website. 
A presentation about using Stop and Watch across North Cumbria CCG by Director of Nursing and Quality Anna Stabler at the 'Don't let me die too young - Mortality Conference' on 1st March 2019 can be accessed on the NHS North Cumbria CCGs website as well as an Information Leaflet, Poster and Video. 

16. FREED FREED Innovation Type Clinical Author WM AHSN AHSN Contact
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
FREED
Innovation Type
Clinical
Author
WM AHSN
AHSN Contact
WMAHSN
A validated simple baseline assessment of residents' frailty on admission
A means of tracking increasing frailty- over time .
A means of demonstrating reduced frailty- evidence of good care for quality visits etc)
A route in to a conversation about end of life care planning with resident or family members
A route in to get residents reviewed by GP and on GSF register
Yes (Stop & Watch)
Yes (NEWS2)
Yes (SBARD)
Yes (DNAR & EoL)
Currently In development in WMAHSN

17. What is FREED?
The FREED document captures all elements of soft signs, frailty, and it also signposts staff to the Deterioration FLOW CHART - expected vs unexpected deterioration In terms of human factors to 'make it easy for staff to do the right thing'

18. FREED - More Information
PINCH Project AHSN Status Updates Document (West Midlands AHSN Entry)

19. Whzan Digital Health Whzan Digital Health Innovation Type
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
Whzan Digital Health
Innovation Type
Technological
Author
Solcom
AHSN Contact
NENC AHSN
Wessex AHSN
The Whzan system comprises a tablet computer with wireless instrumentation to measure vital signs, other parameters and urinalysis.
The system enables staff to conduct clinical assessments of residents identifying onset of illness and infection
n/a
NB: Records NEWS2 parameters
Equipment & Licence required
Information is automatically transmitted and stored on a secure Cloud based server
HSJ Award for Best Value in Telehealth - May 2016
AHSN Atlas entry by NENC AHSN

20. What is Whzan?

21. What is Whzan?

22. Impact (Whzan)
Source: Whzan Digital Health

23. Impact (NENC AHSN)
From April 2017 to March 2018, the small-scale evaluation compared data between eight care homes of a similar size regularly using the digital tablet intervention against data from eight care homes who were not using the tablet.
The results demonstrated:
where the tablet was in full use in eight care homes there were 192 fewer non-elective admissions over the year. This resulted in a saving of £601,920 (based on tariff)
a scatter plot of the counts of A&E attendances showed fewer attendances at every time point over the year in ‘in use’ care homes. The total difference was 336 fewer A&E attendances, resulting in a cost saving of £71,232 (A&E attendances) and £82,992 (ambulance services).
This demonstrates an overall approximate cost saving of £756,144 in one year for eight care homes.
A further analysis of data compared the performance of eight care homes in the year prior to using the digital tablet intervention against a year post implementation of full use. This also included a 13-month intermediate rollout period.
In comparing bed days for those admitted to hospital before and after the introduction of the digital tablet intervention, it was suggested there was a 49.2% reduction.  It was shown in the 35 months prior to the introduction of the tablet system that if it had not been introduced, the use of emergency bed days would have cost £837,877 in the 25 months after March However, the actual cost was £658,451 which was a saving of £179,426.
In addition, 18,000 NEWS scores have been secured.
Source: NENC AHSN – AHSN Atlas

24. Whzan - More Information
NENC AHSN Evaluation (AHSN Atlas)
Whzan Digital Health Presentation at ECO17 (Innovation Agency Event)
Whzan Digital Health Website
Whzan Architecture (Whzan Digital Health)
Whzan Digital Health Facebook Page
CareHome Professional Article - Oct 2018
IslandEcho Article re HSJ Award

25. Landelijke Prevalentiemeting Zorgkwaliteit (LPZ)
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
LPZ
Innovation Type
Audit
Author
Maastricht University The Netherlands
AHSN Contact
EMAHSN
LPZ was developed to provide a reliable mechanism for measuring the prevalence of common care problems within care homes and provide consistent recording of data to drive, or measure, the impact of quality improvement initiatives in the sector.
LPZ programme is an international benchmarking tool to measure:
• Pressure ulcers
• Continence
• Falls
• Pain management
• Hydration and nutrition
• Restraint
• and (from 2018) deterioration
LPZ is currently used to deliver an annual audit of data for care settings in the Netherlands, Austria, Switzerland, and Turkey.
n/a
Licenced by Maastricht University
Deterioration added in 2018

26. What is LPZ? What is the LPZ?
‘An appropriate instrument for measuring the quality of care’  The National Prevalence Measurement of Quality of Care (the LPZ) is an annual, independent measurement of care quality in the healthcare sector. The LPZ is used to measure the quality of care provided by an institution.
It is a reliable measuring instrument for identifying and rectifying care problems at an early stage. The LPZ presents an organisation with targeted improvements to the quality of care. Results of these measurements can be compared in a simple manner: between locations/departments within an organisation and with national care institutions.

27. Impact
Source: LPZ

28. LPZ - More Information
LPZ has provided valuable learning from local, national and international comparisons and demonstrated quantifiable improvements in standards of care problems. Details of the tool can be found at 
LPZ – improving quality and safety in care homes (AHSN Atlas)
AHSN PINCH Webex recording link

29. SPACE SPACE Innovation Type Programme Author WM AHSN AHSN Contact
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
SPACE
Innovation Type
Programme
Author
WM AHSN
AHSN Contact
WMAHSN
The SPACE programme (Safer Provision and Caring Excellence) is a large-scale care home improvement programme being undertaken in the West Midlands, which aims to strengthen safety culture and reduce the incidence of adverse safety events.
n/a
CQC recognised

30. What is SPACE? The main objectives of SPACE are:
Improved safety culture
Reduction in harms – adverse events
Reduction in hospital admission
The overall aim of the programme is to assess the extent to which safety climate in care homes can be improved and the incidence of adverse events reduced, by skilling-up care home staff in service improvement techniques and providing facilitation to enable care homes to implement changes to practice.

31. SPACE - More Information
SPACE – Safer Provision and Caring Excellence – the impact of SPACE (AHSN Atlas)
PINCH Project AHSN Status Updates Document (West Midlands AHSN Entry)

32. EHCH Enhanced health in care homes framework (NHSE)
Sutton Homes of Care Vanguard
Presentation including information on Vision, challenges, Hospital Transfer Pathway, EHCH, Red Bag, CARES & SBAR Handover and Training
6 EHCH Vanguards
Relevant FutureNHS Workspaces

33. A Care Provider Information Hub
Living Well Essex
A Care Provider Information Hub
The Living Well website has been created by Essex County Council in partnership with Healthwatch Essex to provide information on services and organisations across Essex. They have signposted two documents of particular relevance to Care Homes on their Care Provider Information Hub.
Is my resident well? (North East Essex CCG) - A Guide for Care Home Staff and Carers containing Ten Everyday Questions to help recognise when Care Home residents become unwell. 
Nursing and Residential Triage checklist (Advanced Life Support Group - ALSG) - To assist with the assessment of unwell residents.

34. Structured Communications
Safe handover BMJ 2017;359:j4328

35. SCT - SBAR/D

36. SCT – ATMIST & SAMPLE (MIST)

37. SCT - CARES

38. Education & Training

39. “REACT TO” Series React To Innovation Type Educational Author
Resource / AHSN Contact
Description
Pre-EWS (Soft Signs)
EWS
Escalation Pathway
Structured Communication Tool
Personalised End of Life
Notes inc. Support (Sustainability) & Licence requirements.
React To
Innovation Type
Educational
Author
Nottinghamshire Heathcare NHS FT
AHSN Contact
EMAHSN
“React To” is a series of training resources developed by healthcare professionals.
Aimed at care home staff the resources are also relevant to other carers and healthcare professionals.
n/a
No NEWS / Deterioration resource.

40. What is REACT TO?

41. “React To” - More Information
React to series…

42. BEACH
BEACH™ Publications   
BEACH Leaflet
Primary Health Care journal BEACH article
Contact ALERT™ Course Headquarters
2nd Floor, QuAD Centre
Queen Alexandra Hospital
Portsmouth
PO6 3LY, Hants, UK
tel:
NB: Interested organisations can establish a local training centre and deliver the BEACHTM course under licence from ALERTTM

43. https://news.ocbmedia.com/
NEWS2 (OCBmedia)
There are five NEWS2 modules including one for Care Homes…
NB: £5 charge for non-NHS Care Home staff under review by NHSI

44. Resources in development
Deterioration Film Project
A joint project between West of England and Wessex AHSNs to develop an e-learning package aimed specifically at carers loosely based on the Restore2 tool, but sufficiently generic in content that it could be used by care home and domicillary staff across the UK.
The aim is to:
Provide accessible and relevant training resources for care home staff
Accelerate the adoption of NEWS within care and residential settings
Use digital information i.e. videos to help the learner engage and understand more effectively
Timescales
Funding from HEE has been secured and the project aims to produce and evaluate a series of short videos by the end of March 2020.
RESTORE2 Video Project
A project between West Hampshire CCG and Wessex AHSNs to develop a number of short video clips to help staff understand soft signs, take observations and use the RESTORE2 tool.
Timescales
Suitable IT is being sourced and the project aims to produce and evaluate a series of short video clips by the end of March 2020.
Deteriorating Patient MOOC
A expression of interest has been registered by Wessex AHSN and HIN (Sth London) AHSN to help re-launch a Deteriorating Patient MOOC (Massive Open On-line).
The DP MOOC was originally developed by Senior Nurse Lecturers at the London South Bank University but is currently seeking a new IT platform and sustainable delivery method.
Course information can be found at:
onsouthbank/courses/deteriorating- patient
Timescales
The previous authors are seeking a new IT platform (possibly e-LfH) and if successful the material will need review and any IP issues resolved. Watch this space!

45. Improvement Analytics Unit
An innovative partnership between NHS England and the Health Foundation providing robust evaluation of complex changes in the NHS

46. Acknowledgements
This document is a “work in progress” and is intended as a resource to assist the National PSC Deterioration Care Homes leads.
Material has been gathered from a number of sources and accuracy, relevance and current status should be checked with the relevant leads before relying on the information provided. Any additions, corrections or amendments are welcomed.
Details of Lead Organisations are provided in the Contact Tab for each innovation (where identified) and are provided as a guide only, in many cases these innovations are being implemented in multiple areas around the country. Nominations for named contacts to assist with queries would be greatly appreciated.
Each Innovation has slides (where information is available / has been identified) on:
Background and Mapping against Project Elements (Soft Signs, EWS, Escalation, SCT, Eol)
Innovation Details
Further Information links
Evidence of Impact / Evaluation
Action buttons link slides to assist with navigation.
Any questions about this resource should be directed to