Contacts
Contact:
Julie Bills
Community Matron (EOL lead) Care homes
Organisation:
Warrington Community Services Unit
GP liaison / end of life care department Woolston Clinic Holes Lane Warrington WA1 4LS United Kingdom
Email:
Case study:
15 November 2010
Professional support and advice for care home staff and residents
Key points
- A scheme to support and advise care home staff in Warrington has cut hospital admissions and given residents greater choice about where they die
- The care homes collectively have reduced emergency admissions by 288 and saved 8,836 bed days in the last year
- It is planned to extend the GSF programme to the remaining 22 homes in the area.
Warrington Community Service Unit has set up a ‘care home team’ to provide professional support and advice to staff, carers and residents in a number of homes in the area.
The result is that residents are being given greater choice about where they die and the number of unnecessary hospital admissions has been dramatically cut.
Between April 2009 and March 2010, the number of A&E attendances from Care homes in Warrington has dropped by 250, emergency admissions have fallen by 288 and a total of 8,836 hospital bed days have been saved.
The service, which provides a comprehensive health needs assessment for all its patients, began in 2002/03 when NHS Warrington undertook a pilot by seconding two specialist nurse practitioners( district nursing ) with the initial aim of reducing demands on GPs with inappropriate requests and call-outs and also to support and educate care home staff. Initially three nursing homes were invited to take part in the pilot.
Instead of contacting the GP surgery directly to book a visit nursing home staff were directed to ring the two district nurses who would triage the call to decide whether the individual needed to be seen by the doctor or could be helped in some other way. Every triaged call was systematically followed up by a visit.
In the first three months of the pilot there was a dramatic reduction in inappropriate GP visits. The pilot was then extended to include all care homes in Warrington and the team has expanded from two to nine staff.
The team now includes a Community Matron (EOL lead) for the care homes; a Care Home Discharge Facilitator, focusing on fast tracking patients back to care homes; a Clinical Nurse Educator, who provides GSF education and training; a designated Community Macmillan nurse as well as a team of five part-time band 6 community nurses who work across all the care home settings providing a proactive, co-ordinated service to care home staff and their residents.
All care homes in Warrington are involved in the scheme. They now have a single point of access that can triage and prioritise referrals and offer advice. The service has also been expanded from a 5-day to a 7-day service and is available from 8am until 7pm..
Data about hospital attendances and admissions is collected each week by the team and is put onto the Community Service Unit dashboard on a monthly basis. Data is also collected from the acute trust and shared with the team on a weekly/monthly basis
One of the biggest challenges was getting care home staff to adapt to a huge change in their everyday practice. Involving staff and GPs at every step of the journey helped to build trust and establish good relationships.
As a result of the project patients and families are now given a choice about where they wish their loved ones to spend the last days of their lives. In addition implementing the GSF and the involvement of the clinical nurse educator have helped to raise care home staff’s level of education and skills.
So far eight care homes are in the process of undertaking the GSF accreditation programme, with one being accredited and it is hoped to extend this to the remaining 22 homes with the aim of cutting hospital admissions and attendances and improving the choice for patients about where they want to die.
Training will be delivered to all organisations and all levels of staff on a rolling programme over the coming months and years. A work programme is currently being devised to facilitate this and work will begin shortly. The team are working closely with commissioners to develop the education programme to be rolled out next year.
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