Four projects, funded through our Innovation for Improvement programme, are using new and interesting approaches to improve care for older people. Some of these projects are at the early stages of their development but have promising ways to improve care.
1. Managing your own risk of getting a pressure ulcer
Every year in the UK approximately half a million people develop at least one pressure ulcer. Most pressure ulcers develop while patients are in their own homes, but technology tends to focus on the hospital setting. In this project, a team set out to determine whether pressure ulcer risk could be managed by patients themselves, by introducing technology, alongside patient and carer education, in community settings including patients’ own homes.
Cornwall Partnership Foundation Trust (CPFT) worked with frail older people and people with long-term conditions across Cornwall to reduce the risk of pressure ulcers. Forty-four people were recruited and used innovative continuous pressure monitoring technology to identify pressure hot spots, generated when a patient remains in one position for long periods.
The technology, developed specifically for the project, consists of a bed- and chair-sized pressure map, with hundreds of pressure sensors, connected to a monitor recording real-time data. Improvements were monitored across several areas including incidence of pressure ulcers, nursing time, and satisfaction with the new technology.
Nicci Aylward-Wotton, Tissue Viability Nurse Consultant, CPFT, said, ‘We found that this technology empowers patients, enabling them to manage their own pressure ulcer risk. The analysis also suggests that advising patients who have existing pressure to remain in bed is not necessarily the best strategy. However, we did find that some cushions and mattresses are not suitable for patients in the community, specifically when patients are unable to change their position, due to breathing difficulties. So an individual approach to care is needed. We can’t make assumptions about whether a particular pressure-relieving mattress or cushion will suit the needs of a patient, but it does give us another option to consider.’
2. See what I see: remote assessment using smart glasses
‘See what I see’ has care home workers using head-mounted technology (Xpert Eye smart glasses) to have two-way communication in real time with GPs.
Led by Eastbourne, Hailsham and Seaford Clinical Commissioning Group (CCG), the project will see GPs remaining in their practice and assessing patients, using the view of the care home worker wearing the smart glasses. Care home workers will be able to communicate in real time with the GPs providing clinical assessment. The potential benefits include shorter waiting times and reduced hospital admissions. Unplanned hospital admissions can be unsettling for care home residents, who are often frail and elderly, and their admissions can lead to deterioration in their condition. Another potential benefit is to GPs who can reduce time-consuming travel as they can conduct clinical assessments without leaving their practices.
The project will initially be tested in a single care home and a linked GP practice and out-of-hours service, with the potential to roll out to other care homes and practices if it proves successful. Kent Surrey Sussex Academic Health Science Network (AHSN) will oversee and evaluate the project.
3. Extending primary care teams
Southern Health NHS Foundation Trust in Hampshire is leading a transformational project to reduce duplication and fragmented working across primary, community and social care. By bringing together different professionals who are supporting the same person, but may have previously worked in silos, they will create an extended primary care team. Ultimately, the trust hope the extended primary care team will improve service delivery and quality of life by ensuring that patients see the right person, in the right place, at the right time.
Community care teams and adult services have already worked together in Totton and Waterside (a vanguard locality in East New Forest) to arrange joint home visits and more effective use of resources and this has resulted in improved outcomes for local people. The Better Local Care partnership (consisting of local GPs, local authorities, voluntary sector and other stakeholders) aims to continue improving the way out-of-hospital care is provided.
This project aims to build on existing relationships at a more strategic level. The project will roll out extended primary care teams across Totton and Waterside, developing the role of the ‘key worker’ from the Dutch Buurtzorg district nursing model and integrating primary and community-based care teams as quickly as possible.
The Buurtzorg ('neighbourhood care') approach to district nursing is unusual, as each team (usually up to 12 people) is responsible for the planning, delivery and co-ordination of care for their patients. The team takes decisions together, without a traditional management structure. Teams typically care for around 50 patients, and the emphasis is on getting to know patients and enabling them to manage their own care. Patients and professionals report high levels of satisfaction with the model.
4. Continence promotion in care homes
Incontinence affects 50-80% of care home residents. There is increasing demand for continence products throughout Scotland, with around £13 million a year spent on these products. NHS Lanarkshire Health Board, in partnership with NHS National Procurement, is developing and testing a ‘continence care bundle’, a range of evidence-backed interventions that, when used together, can make a positive difference to patients. The project in Lanarkshire is supporting people working in two care homes to implement the continence care bundle. It aims to improve continence among residents of the care homes and also to reduce the amount spent on containment products.
The care bundle includes the use of screening and assessment tools that focus on optimal fluids and nutrition, reduction of caffeinated products, and toilet assistance. National guidelines and research have highlighted that these interventions not only support continence rehabilitation in older people, but also reduce product usage.
The project will measure the use of high absorbency continence containment products, with the aim of reducing their use by 25% within 12 months. The project team will audit continence care and the prevalence of associated harm such as pressure damage, urinary tract infections and falls, and evaluate staff and carer experience of the improvement project.
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