Sutton Homes of Care Health forum newsletter: January 2016 Welcome to the latest edition of our care home forum newsletter, following our forum on 22 January 2016. Thank you to everyone who attended it is always great to see so many of you at the meetings. We had a busy agenda, as usual, and whether you were able to attend the meeting or not this time we hope you find the summaries of our agenda items below helpful. Our next Care Home Forum will be on Friday 18 March, please attend if you can as we will be celebrating our first birthday as part of the Vanguard programme and launching the reference cards and posters on the conditions discussed. Christine Harger Quality Assurance Manager (Care Homes and Older People) In this edition Older person s assessment form Hospital transfer pathway (Red Bag initiative) update Sepsis End of life care E-learning Safeguarding Medicines optimisation NHS Net (secure email) General updates Dates for your diary Older person s assessment form Caroline Pollington, our Clinical Nurse Lead and Darzi Fellow, discussed the older person s assessment form. All our care homes are encouraged to use this form to assess their residents. The form details baseline information and will provide a comprehensive assessment which will prove invaluable for other health and social care professionals involved in providing care to your residents. The form is also an important part of the Hospital Transfer Pathway (the Red Bag initiative ) as it one of the main forms within the standardised paperwork that the ambulance and the hospital teams will require. If you have any questions or queries please contact the Vanguard team on sutccg.carehomevanguard@nhs.net Page 1
Support to help you complete the assessment forms for your residents is available from our continuing healthcare team or from Ian Cahill, Link Nurse, Sutton and Merton Community Services. Hospital transfer pathway (Red Bag initiative): Update Christine Harger, Jason Morris (LAS) and Kim Barnes (ESH) updated the Forum on the Hospital Transfer Pathway. London Ambulance Service (LAS) Jason Morris from LAS responded to feedback some ambulance crews in the area do not seem to be aware of the Hospital Transfer Pathway. Jason advised that this is mainly because some crews may be coming into Sutton from out of our area (for example from Kingston). However, he assured the forum that LAS will continue to promote the service and are planning further communications at the end of February to promote the pathway to all the ambulance crews who may cover Sutton. Epsom and St Helier University Hospital NHS Trust (ESH) Kim Barnes from the Older Persons Team at St Helier Hospital provided an update on an initial evaluation of the pathway within the hospital that they are carrying out with their staff to help raise awareness. They have promoted the Red Bag in a number of ways; on the older person s page on their intranet, through face to face conversations and internal meetings. Feedback obtained so far has been extremely positive, many staff surveyed had been aware of the Red Bag although some staff reported that there had been occasional instances of incomplete paperwork in the bag. Overall staff felt that the pathway was really positive. The formal hospital transfer process means that that when a care home resident is admitted to hospital it is a better experience for patients as the process is now much smoother. There were some concerns that the Red Bag could be mislaid but it was confirmed each bag has an individual serial number so if it goes missing, it can be traced. Kim also reported that ESH are also doing further promotions to hospital staff to raise awareness of the Red Bag, through posters and screen-savers, and they are looking into developing a Red Bag magnet to be placed above the care home resident s hospital bed. sutccg.carehomevanguard@nhs.net Page 2
Sepsis Jason Morris from LAS highlighted the importance of sepsis awareness. Sepsis is a common and potentially life-threatening condition triggered by an infection. In sepsis, the body s immune system goes into overdrive, setting off a series of reactions including widespread inflammation, swelling and blood clotting. This can lead to a significant decrease in blood pressure, which can mean the blood supply to vital organs such as the brain, heart and kidneys is reduced. If not treated quickly, sepsis can eventually lead to multiple organ failure and death. Each year in the UK, it is estimated that more than 100,000 people are admitted to hospital with sepsis and around 37,000 people will die as a result of the condition. Early symptoms of sepsis usually develop quickly and can include: a high temperature (fever) chills and shivering a fast heartbeat fast breathing In some cases, symptoms of more severe sepsis or septic shock (when blood pressure drops to a dangerously low level) develop soon after. These can include: feeling dizzy or faint confusion or disorientation nausea and vomiting diarrhoea cold, clammy and pale or mottled skin Jason has produced a leaflet for care home staff with advice on what to do if you suspect one of your residents has sepsis. The leaflet is available on our website: www.suttonccg.nhs.uk/vanguard/publications National Early Warning Score (NEWS) for sepsis Sepsis usually requires urgent medical attention and can be a medical emergency. A national early warning score (NEWS) has been developed help you to score symptoms if you suspect sepsis. You should always seek medical advice if you are at all concerned from the patient s GP, the CPAT team or by calling 111. sutccg.carehomevanguard@nhs.net Page 3
If you suspect severe sepsis or if the NEWS score is four or above then it is important that you get urgent medical help for your resident by calling 999. NEWS can be used by care homes and nursing homes. Although training is required before it can be used effectively. LAS are developing training to help raise awareness of sepsis amongst care home staff. Phase one of this is will be in April and will look at training staff to use scorecards to increase your observations on any resident on antibiotics. More information on the sepsis scorecard will be discussed in the joint February forum for care homes and nursing homes. For more information contact Jason Morris, Clinical Team Leader, LAS, Jason.morris@nhs.net End of life care Launch of Priorities for the Care of the Dying Person in Sutton poster Zoe Robinson from Sutton and Merton Community Services presented the poster for the Priorities for the Care of the Dying Person in Sutton. The poster is available to all care homes in Sutton, developed through the vanguard partnership and designed with services to support the care home with end of life care. It details the support services available for your residents (including telephone numbers). Pocket reference cards Zoe also highlighted that the vanguard programme is also working on a range of other support tools and resources for care home staff. The resources will include information on a set of reference cards and posters. Topics covered will include: Concerned about a Resident Preventing and managing UTIs Bristol stool chart Sepsis - Postural drops The plan is to produce a mixed resource pack consisting of A4, A3 and A5 posters and cards for care homes to choose from, these can be placed next to medicines trolley and nurses stations for easy access for staff, put up in staff offices, or as pocket reference cards on key rings. sutccg.carehomevanguard@nhs.net Page 4
Initially the vanguard programme will provide nursing and residential care homes with a sample of 200 packs in Sutton and pilot in a selection of domiciliary care agencies. E-learning Deborah Gordon from Sutton Council updated the forum on the E-Learning programmes available from Sutton Council on several health topics provided for care home staff. In partnership with the Vanguard programme three additional modules have been launched: Continence care Dementia Person-centred thinking Staff completing the modules will receive a certificate and care homes are encouraged to promote the free learning resources and ensure staff have access to the programmes. Courses can be accessed via www.kwango.com. Through the vanguard programme ongoing monitoring will take place to see how many homes are accessing the E-learning programmes. This is to help to understand the numbers of staff who have undertaken the training modules form part of quality assurance for both Sutton Clinical Commissioning Group and Sutton Council. New course: Mental capacity and safeguarding Training days for care home and other staff, are now available and run by St Thomas Training. This free training takes place at Sutton Civic Centre, St Nicholas Way. Both courses will run twice a month throughout 2016 (except in August). Places need to be secured via London Borough of Sutton (LBS). Please note: 1) LBS has asked that anyone attending the MCA training first completes the level one MCA training on-line Kwango, or confirms that they have received the basic awareness training by another means. 2) LBS requires anyone attending the safeguarding adults training to have first attended the MCA training. 3) Please book the courses together and if you have to cancel please give as much notice as possible if you need to cancel. If you have any questions or accessing problems, please contact Deborah Gordon at LBS (deborah.gordon@sutton.gov.uk). sutccg.carehomevanguard@nhs.net Page 5
Safeguarding Claire Symons, our Safeguarding Adult and MCA lead, is happy to visit any care homes and review their current policies for safeguarding compliance, advise on assurance and/or meet with staff teams to answer any queries. CQC is very supportive of MCA and DoLS compliance and since the Care Act there is a stronger focus on adult safeguarding than ever before. If you would like to organise for Claire to visit, please contact her: c.symons@nhs.net / 020 8254 8171 (direct line please do leave a message). New Pan London Procedures The Pan London Procedures were launched on 9 February 2016 and all services are expected to be compliant by 1 April 2016. The replace the 2011 Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse, and can be found here http://londonadass.org.uk/safeguarding/review-of-the-pan-london-policy-and-procedures/ Medicines optimisation Hai To, Care Home Pharmacist from the Vanguard Programme, talked to the forum about unused prescription medicines. It is estimated that across the UK medicine worth over 300 million every year is wasted and, of this, medicine worth 50 million is wasted in care homes. Hai discussed the new NICE guidance on medicine optimisation and outlined care homes responsibilities when ordering medicines for residents. The NICE guidance outlines how putting people at the centre of decisions about their care can enable them to use the medicines they are prescribed safely and effectively and get the best possible outcomes from them. Staff should also talk to a pharmacist or GP if a resident is no longer able to swallow or has hearing difficulties which restricts their ability to consent. Key areas covered by the new guidance: Care homes should retain the responsibility for reordering of medication on behalf of their residents Care home staff should check medications are accurate based on the prescription by GP/hospital. Keep records of medicines ordered and the reference. Hai asked the care homes to check their medication processes to make sure they are compliant with NICE guidance and raise awareness with staff about the NICE guidance. Posters are available for display in care homes. Please contact Hai. sutccg.carehomevanguard@nhs.net Page 6
Acute Kidney Injury (AKI) Hai also discussed Acute Kidney Injury (AKI) with the forum. Any residents taking medication such as NDSAIDs, ACE, ARBs, diuretics and metformin are more at risk as these medications can cause AKI. Hai highlighted the importance of alerting the resident s GP to review their medication if a resident becomes unwell. Please also be aware that when a resident returns from hospital, any drugs that have been stopped as noted on the hospital discharge letter should only be reinstated by a GP. Please read and ask the GP to review the medication as appropriate. Medication to be taken when required (PRN) policy Hai reminded the forum of the NICE SCI recommendation 1.14.2 which states care home providers should ensure that a process for administering 'when required' medicines is included in their care home medicines policy. Please refer to NICE recommendation 1.1.2. The NHS Constitution states residents have the right to accept or refuse treatment that is offered to them. If the resident has the mental capacity to refuse treatment offered to them and does so, please inform a nurse, GP and a member of family. A best interest meeting can then be called to discuss and agree whether administering medicines without the resident knowing (covertly) is in the resident's best interests. For more information or if you any queries contact Hai To, Care Home Pharmacist, email hai.to@nhs.net NHS.net secure email Marco Epifano from the Continuing Healthcare Team advised that NHS.net email addresses have now been set up for all care homes. Having an NHS email account means that care homes can receive confidential patient information directly from acute and primary care provider organisations via a secure email service which complies with strict NHS information governance guidelines. This is an important development which means that care homes will have access to information more quickly on their residents for example discharge summaries usually sent to GPs can be sent to care homes directly. For more information on NHS.net including policies, procedures and guidance for use - visit: http://systems.hscic.gov.uk/nhsmail/. For confidentiality purposes, please do not set up NHS.net on your personal mobile phones. If you have any questions or queries please contact the Vanguard team on sutccg.carehomevanguard@nhs.net Page 7
For further information and assistance contact Marco Epifano, Business, Information & Commissioning Manager, Continuing Care, NHS Sutton CCG (marco.epifano@nhs.net) DeAR GP: Dementia case finding tool Ian Cahill Link Nurse Sutton & Merton Community Services advised that we are planning to introduce a simple dementia case finding tool into our care homes to help identify patients who are showing signs of dementia but do not have a formal diagnosis. Introducing DeAR-GP in Care Homes is expected to increase the identification of potential dementia cases. DeAR-GP will initially be piloted in six nursing homes who are currently in phase one of the Vanguard Programme, designing and testing the new model of care, along with three residential homes who have volunteered to participate, these are: Crossways Nursing Home Southdown Nursing Home Beverley Lodge Nursing Home St Judes Nursing Home Chegworth Nursing Home Shirley View Nursing Home Eversfield Residential Home Eothen Residential Home Grange Cottage Residential Home This pilot will highlight any initial implementation issues. All being well we envisage the DeAR-GP scheme will be rolled out to all our older peoples care homes within the first quarter of this year. If you have any further questions on the tool or any concerns/feedback, please contact the Vanguard Sutton Homes of Care team on SUTCCG.carehomevanguard@nhs.net General updates Music mirror programme Christine reminded care homes to email SUTCCG.carehomevanguard@nhs.net in response to the flyer for Music Mirrors to deliver train the trainer sessions in Sutton. Training requirements survey A survey monkey questionnaire is going out to care homes from Sutton Council to find out training requirements. Christine asked all care homes to complete this as it will inform future training programmes and help us ensure that you are getting the training you need. If you have any questions or queries please contact the Vanguard team on sutccg.carehomevanguard@nhs.net Page 8
Dates for your diary Care Home Forums 18 March 2016 Priory Crescent, MR1 13.00-16.30 22 April 2016 Priory Crescent, MR1 13.00-16.30 15 June 2016 Sutton Council 13.00-16.30 15 July 2016 Priory Crescent, MR1 13.00-16.30 19 August 2016 Priory Crescent, MR1 13.00-16.30 If you have any questions or queries please contact the Vanguard team on sutccg.carehomevanguard@nhs.net Page 9