PROSPER (Promoting Safer Provision of care for Elderly Residents) is a groundbreaking initiative which tested whether quality improvement methods could be implemented in care homes. It was initially funded through our ‘Closing the gap in patient safety’ programme and is now continuing for an additional year with funding from Essex County Council. In addition to working with care home staff, the team has nurtured good working relationships with the provider, commissioning and regulatory bodies in Essex. The Care Quality Commission (CQC) is also supportive of the project, encouraging homes to take part.
PROSPER is working at scale in 90 residential and nursing homes, using quality improvement methods to reduce preventable harm from falls, urinary tract infections and pressure ulcers. It is innovative as it broadens the training on offer to people working in care homes. It not only works with care home managers, but successfully involves the wider workforce in developing and delivering improvement ideas. As a result, it has delivered professional development and improved care, successfully changing behaviours and culture within care homes.
We spoke to Lesley Cruikshank, Innovation Manager at Essex County Council, about some of the safety innovations developed by care home staff so far.
Pimp my zimmer
‘People working in care homes have come up with some good ideas that have had quite an impact on reducing the numbers of falls. The Pimp my zimmer idea got a lot of attention! In one of the homes, the residents have dementia and some didn’t want to use their walking frames. There were falls as a result and one lady in particular was falling every day. The manager came up with the idea of decorating a walking frame with her. Together they personalised it, and then the resident recognised it as being hers, she started using it and her falls reduced dramatically. The staff did the same with other residents and other homes in PROSPER have picked up the idea as well.’
The initiative has helped to reduce falls in some care homes by up to 60%.
Light my night
‘One home had a lot of falls happening at night. After looking at the problem, people working at the home realised it was because their residents were getting up to go to the toilet. The residents were quite able to go to the toilet, but in the dark they were falling. So they trialled an idea they called, Light my night.
‘They painted around the door frame of the toilet and the light switch with luminous paint. They put glow-in-the-dark footprints going from the bed to the toilet door, and when you got into the toilet, there was a light inside the bowl of the toilet... The idea really worked, and the manager reported that the number of falls reduced dramatically.’
Making safety issues more visible
Two-thirds of the 90 care homes involved have reported changing care processes, including proactively tracking data and making safety issues more visible. A formal evaluation found that PROSPER has helped to increase knowledge and awareness of resident safety and has encouraged new approaches. As the people working in the homes gained confidence in their skills, they felt able to make changes.
Demonstrating improvement in the data has been a challenging part of the project. Staff have been encouraged to report incidents more accurately as part of the programme, and this is thought to explain the increase in reported urinary tract infections and A&E attendances. However, the numbers also show a clear reduction in the rates of falls and pressure ulcers since the project has been running. It is hoped that the additional year of funding provided by Essex County Council will enable longer-term evaluation of results.
A creative approach to building improvement skills
The project team has always taken a creative approach to building quality improvement skills for the people working in care homes. Senior carers and care home managers are brought together in a community of practice, and carers and other care home staff come together for champion days. At the champion days, attendees rotate through hour-long training sessions, designed to be engaging and fun.
Lesley says, ‘At one session we had people on the training session making frozen banana penguins, which is an idea that came from a home. In the summer, one of the homes was thinking about how to increase hydration and nutrition, and they had the idea of getting the residents to make little penguins from frozen bananas. When bananas freeze, they stay quite soft, but they’re obviously nice and cool, so the care home team found that their residents liked eating them. We did that as an activity and we combined it with educational content around hydration and nutrition. Quite a few of the homes then went back and did it as an activity with their residents.’
A trial run of using a Mr Potato Head to teach quality improvement methodology with managers and senior staff also went down well. This involves working as a team to assemble the Mr Potato Head doll to demonstrate the value of PDSA (plan, do, study, act) cycles for testing change.
This creative approach is paying off as people working in care homes are engaging with the project and their ideas are being tested and spread. PROSPER is changing behaviours and culture and has shown that, with appropriate support, quality improvement methods can be successfully used at scale in care homes to improve care for residents.