WLCCG CARE HOME QIPP. Caroline Trevithick: Chief Nurse and Quality Officer Lead: Dr Liz Hepplewhite

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1 J WLCCG CARE HOME QIPP Caroline Trevithick: Chief Nurse and Quality Officer Lead: Dr Liz Hepplewhite 1

2 Care Home QIPP Integrated Plan commits to developing support for Care Homes. The aim of this is to improve the quality of care for patients in care homes and to reduce inappropriate admissions to secondary care. In order to achieve this a new service has been commissioned and specific developments have been undertaken as part of the care home QIPP. 2

3 Care Home QIPP :Commissioning and developments Commissioned a Specialist Nursing Support Service, for all care homes (nursing and residential) linked to Proactive Care model Developing face to face training packs for the care home staff (residential and nursing) Developed an escalation tool: Check for Change for effective communication and handover to clinicians about a residents health status Implemented Medicines Management Reviews for care homes (continuation of current transformation bid scheme) Ensured care homes have GP practices working with them (continuation of current LES scheme) Ensured developments are linked with the End of Life Care QIPP and pathway development Identifying and piloting Assistive Technologies: Telehealthcare: particularly focusing on falls prevention and elimination of pressure ulcers Ensured work streams link with Urgent Care Pathway 3

4 Specialist Nursing Support Service for Nursing Homes Service aims to develop the capability, competence and confidence of nursing home staff (nurses and support workers) to meet the health needs of older people Key objectives are : avoidance of unnecessary hospital admissions, and to improve quality of care and patient safety Integral part of the proactive care model and integrated working that is patient centred to improve outcomes Building strong collaborative and partnership working between the NHS, and independent contractor organisations to improve outcomes for older people Strong working relationships with the Local Authority

5 Nursing Home Specialist Support Service : Education and Training Service provider is LPT: whose specialist nurses who will provide education and training, facilitation and support to ensure nursing home staff are competent, confident and empowered to deliver high quality care Service will deliver training that includes a range of clinical skills, provide training packs and tools to support quality improvement Focus on: Prevention of harms that include falls and pressure ulcers, End of Life Care: ACP and Dementia care Compassion in Care: Delivery of the values and principles of the 6C s to ensure provision of high quality care 5

6 Engagement and buy-in from Nursing Home Managers and Leads Essential component of the service has been the engagement of the Nursing Home managers and leaders Earlier in the year- an engagement event was held, which was attended by some managers Head of Nursing has met individually all the managers and senior leaders to foster engagement. Received positive up-take and eagerness to work with the NHS and the new service Head of Nursing has attendance at the LLR Care Homes Provider Forum 6

7 Service Start: November 2013 Service commences in November 2013 where initially individual quality profiles will be undertaken with each care home. Total of 17 Nursing Homes in WL-and those identified with highest referrals to A and E and admissions have been targeted first Following on from the profiling-a Nursing Homes Action Plan will be developed- to meet the needs of the staff in terms of training and support LPT service will be monitored in relation to number of profiles undertaken, actions plans, training programmes, development and implementation of training packs and delivery of training 7

8 Measures of success and Evaluation Reduction of referrals to A and E Reduction in hospital admission Reduction in Harms: Falls and Pressure Ulcers Increase in more people dying in their choice of place of death Commissioning an evaluation of the new service from the perspective of collaborative working and quality improvement Already working with our patient leaders on patient experience to inform the service 8

9 Escalation Tool Check for Change Developed a tool in order to ensure effective communication between care providers to ensure quality of care and patient safety Used SBAR a recognised and proven mechanism to frame conversations requiring a clinicians immediate attention and action. Has 4 sections: Situation-what is happening at the present time Background-what are the circumstances leading up to the situation Assessment- what is the problem Recommendation-what should be done to correct the problem Prevents breakdowns in communication and situations requiring escalation, or critical exchange of information Disseminated to all care homes 9

10 GPs working within Nursing Homes: LES Requirement for weekly visit to homes to include: Structured ward round to see those patients as requested by the home. Regular review of all patients every 3 months. Review of all patients within 2 weeks of discharge from hospital. QOF Reviews. Medication Reviews.

11 Benefits of GP Care Home Scheme Outpatient appointments needed by patients in nursing homes reduced. Emergency admissions from nursing homes reduced. Fewer unplanned GP visits to homes. Good feedback from patients, relatives, nursing home staff and GPs. Improved quality of care for patients. Improved working relationships between the Nursing Home and GP Practice. GP spends more proactive time with the patient, their family and the nursing staff.

12 Medicines Optimisation Each locality pharmacist will provide a Level 3 medication review for targeted care home residents - High admissions - Recent medicine related fall - Complex, polypharmacy patients Identify training needs at the Care home to reduce errors in medication administration-link to the Specialist Nursing Support Service Review processes and policies in the home - Repeat medication ordering to reduce wastage 12

13 Medicines Optimisation Development and implementation of a Homely Remedies Policy - minor ailments Quarterly Newsletter for Care Homes - Top Tips - Preventing patient harm with high risk medicines - Drug Alerts - Case Studies sharing best practice - Prescribing therapeutic areas good practice guidance 13

14 Progress Care home reviews commenced in high admission homes. Homely remedy Policy and 1 st Newsletter circulated to all care homes Identified homes with the following criteria: - High Admissions - Poor monthly ordering process - High medication wastage - Infrequent medication reviews by the GP - Poor communication post hospital discharge 14

15 Medication Reviews cont d Action planning agreed with the homes that include: - all patients will have a level 3 medication review by the pharmacist - Ordering process will be reviewed/ meeting to be set up between surgery/community pharmacy and care home - Training to be given to staff on medication expiry dates - Homely remedy policy to be embedded with nursing support - Test case to be written up with outcomes. 15