Meet the team: #yhRAPiD
Senior Quality Lead
Vale of York CCG
- England - Yorkshire and Humber
Joint Medical Director, Yorkshire and Humber Clinical Senate, HCV STP UECN Clinical Lead
NHS Vale of YORK Clinical Commissioning Group
- England - North East and North Cumbria
- England - Yorkshire and Humber
Patient Safety Collaborative Programme Manager
Yorkshire & Humber Academic health science network
- England - Yorkshire and Humber
- Dr Kevin Smith, Executive Director Primary Care and Population Health, NHS Vale of York CCG
The aim of this work is to reduce avoidable harm, enhance clinical outcomes and improve the experience of deteriorating individuals in the community.
To achieve this, focus will be placed on improving recognition (softer signs and NEWS where appropriate), response and communication by domiciliary carers. This approach is currently being trialled in care homes building on previous learning from patient safety collaboratives (PSC) and a validated tool successfully used with carers. Y&H PSC has already a programme of work jointly with Vale of York CCG and Care homes; this will strengthen existing work. Other PSC’s across the country (e.g. Wessex) have similar work in progress, learning can be shared nationally.
Working in care homes has provided opportunity to understand barriers and enablers to recognition, response and clear communication, focusing on the needs of residents and staff caring for them. A significant number of individuals receive care at home, domiciliary care in the UK (2014/15) was provided to 873,500 people, delivered by 629,400 employed carers, equating to 318 million hours, costing 4.6 billion (United kingdom Homecare association 2016). It is also estimated that 7 million people are informal carers, 1 in 10 people (Carers Trust, 2018). These carers are pivotal in early recognition of changes in an individual’s condition.
Following on from learning through the initial programme of work in Care Homes, it is a logical progression to engage the domiciliary setting. This is where many individuals with complex needs would benefit from better recognition and response across pathways of care improving quality, reduce harm and avoidable hospital admissions.
This project will focus on helping domiciliary care staff, carers and residents to look out for signs of deterioration (softer signs; Stop and Watch Tool) so action can be taken earlier. To improve communication and promote a safety culture in the care team through testing tools such as virtual safety huddles and clear communication tools (SBAR) helping responders assess the situation and take appropriate timely action. The project targets both improving recognition of deterioration (promoting the use of NEWS where possible/ appropriate plus softer signs where not) and developing improvements to structured communication to help ensure an appropriate response.
The model for improvement will be used to test and implement interventions in domiciliary practice. Initial testing for proof of concept is being trialled in a number of care homes (a mix of Nursing, and residential) working with key stakeholders (care home staff, YAS, GPs, Community Nursing staff, residents, carers, ED’s and CCG’s).
Case studies will be developed and the work evaluated for impact. This will be supported by developing a community of practice between care homes and domiciliary carers to share good practice and address barriers to change.
improved outcomes through earlier recognition.
Improve adherence to preferred place of treatment/death.
Improved resident satisfaction satisfaction/ QoL score
Domiciliary Carers –
improved levels of competence and confidence of staff to recognise deterioration and act accordingly.
Improved adherence of individuals wishes re end of life care.
GP’s , YAS, Health Care professional teams including domiciliary agency–
improved accuracy and depth of information being communicated leading to improved appropriateness of response.
Reduce unnecessary ED attendances and unplanned admissions.
Measurement Plan will include the following;
· Hospital: ED attendances and unplanned admissions
· YAS: Conveyance rates and outcomes
· Residents preferred place of death
Process measures include:
· YAS – calls to 111/999 (volume/ quality)
· GP’s – calls to GP’s (response/ quality)
· Care staff: Training competency/rates in recognition
Response calls using structured communication
Embedded safety huddles focussing on deterioration
· GP/Community Teams – Call out rates
A culture survey will be given to care staff at the start of the project and then repeated once interventions are embedded, to show any changes to the key safety culture domains. In addition, a simple survey will be used to evaluate confidence by residents and informal carers in their domiciliary care provider relating to recognition and appropriate response following introduction and use of the tools developed.
Responders will be surveyed to ascertain if there has been a change in the quality of communication being received and the ability to accurately respond.
The learning from this work would be transferable to other domiciliary care settings in other areas.
Learning will be shared to encourage spread once impact is seen and sustainable. Initial stakeholders’ event will link with a Community of practice so the project progress can be communicated and shared with other care agencies in readiness for adoption once tools are available. It is envisaged support for spread to other areas will be provided by the CCG’s care home networks. The Q community could be an invaluable channel for communication and sharing of learning.
How you can contribute
- It would be great to have any suggestions from colleagues who may have worked with domiciliary carers and tested ideas around deterioration.
- Any advice on measures and impact and data sources would be helpful.
This is a great project because…
This is a good opportunity to build on safety models that have been shown to work well and try to apply them to home care, engaging a group of staff who may get relatively little attention and who's status in the system could make structured communication methods helpful. While challenging to implement, if successful this could impact on quality of care and reduce unnecessary demand on other services.
By the time of the event we encourage the project team to think more about…
Further develop your plans for co-developing this with domiciliary staffing. Stay alert to the potential that approaches developed in other settings may need substantial re-work to achieve outcomes in a different setting. Consider how you will build two way links with others in the Q community to share learning.