Sutton Homes of Care Health forum newsletter Welcome Welcome to the second edition of the Care Home Forum newsletter, following the Forum on 20 November that saw the launch of one of our exciting new Vanguard initiatives the Red Bag. Thank you to all of those who attended, it was great to see so many of you there. The meeting kicked off with a showing of a short film about the Red Bag and Betty, a care home resident. The film is aimed at staff involved in Betty s care and explains what the Red Bag is and how it should be used. You can find the film on YouTube (https://www.youtube.com/watch?v=xoyzpxmulhe) please do add it to your websites and any other online areas that staff use so that we can make sure everyone knows about the initiative and what part they need to play. Following on from the film, a number of colleagues from different partner organisations, kindly agreed to take us through different aspects of the Red Bag, including the standardised forms that you will all need to use. The presentations have been summarised below, for those not able to attend and for future reference. We have also collated all of the questions into a Q and A at the end.
You have all now received your Red Bags and we hope that you have started to use them. Please do let us have feedback on how it is working and any issues or concerns. The vanguard team will be evaluating the use of the Red Bags and how well the initiative is working, please ensure you complete the Checklists provided to you and forward them to the team when the resident is back home with you. The Red Bag has been really well received so far, and I am thrilled that it has been embraced with such enthusiasm. I want to thank everyone involved for all their hard work to get us to this point and I look forward to working with you to make the initiative a real success for our care home residents. Christine Harger Quality Assurance Manager (Care Homes & Older People) Red Bag Initiative launch: 20 November 2015 Personal experience of the journey Sarah Stacey and Kate Frances talked to the Forum about their personal experience of the journey to develop the Red Bag. They talked through some of the issues that the Red Bag aims to resolve when care home residents go into hospital such as: No standard paperwork A&E lose documentation Lost belongings No system in place to track residents through the hospital Care homes find it difficult to get information from hospitals Once admitted residents can remain in hospital for long periods of time Poor communication between hospitals and care homes on discharge And how the red bag offers a solution: One bag for all personal belongings, medication and paperwork Standard paperwork to assist ambulance staff and A&E staff, and ensure they have all relevant information available about the patient s medical background Enables a baseline set of information for each resident Enables better communication between care homes and hospitals Ensures that senior staff from care homes visit their residents in hospital within 48 hours of admission Sarah and Kate s presentation is attached to this e-newsletter.
What s in the Red Bag? Kate Anderson, Project Manager for the Vanguard programme, went through the bag and what should be included in it. The main compartment of the bag is for day of discharge clothes, toiletries any other items of a personal nature. The resident s medication should also be included here. There is a smaller compartment inside for personal aids such as dentures, glasses and hearing aids. There is a pocket on the outside of the bag which will be used to hold the completed standardised paperwork. This should be placed in a non-transparent file and then into the pocket which can be fastened using the velcro strip in place (no patient identifiable information should be viewable). Older Persons Assessment Form Karen Haviland and Ian Cahill talked through the Older Persons Assessment Form. Karen highlighted some of the key issues that the form picks up such as information on: - next of kin - whether the resident is under a DoLS - whether the family has power of attorney - any issues around mental capacity Once complete this form will provide a standard set of information for each resident and should be used by staff as a baseline. In an emergency situation you can then quickly establish whether the resident is outside of their normal symptoms/behaviour. Karen and Ian are both able to provide support to staff if you have any questions around this form and how to use it. CARES Escalation Record Zoe Robinson explained how the form was developed and that its purpose is to capture current issues and anything that has changed for the patient, as opposed to the assessment form, which provides a baseline for each resident. C = Concerns A = Actions R = Response E = Examination S = Shared Information Any tests or observations that staff have undertaken for a resident, e.g. blood pressure, dipstick urine test etc. can be recorded on this form. Please remember that this is a standardised form, so not all tests will be relevant for all residents please treat this as a record rather than a checklist!
The CARES record also forms the basis of the handover process with the ambulance service. Ian Cahill and Zoe offered to help provide training on the form and how to use it effectively. Zoe and Ian s presentation is attached to this e-newsletter Handover Process: Care home to ambulance/ambulance to hospital Jason Morris from London Ambulance Service then took the group through how to manage an effective handover using the CARES Handover Process as below. CONCERNS - WHY ARE YOU CALLING? ACTIONS - WHAT ACTIONS HAVE YOU TAKEN SO FAR? RESPONSE - HAS THE RESIDENT HAD ANY RESPONSE? EXAMINATION - WHAT ARE THE OBSERVATIONS? SHARED INFO - HAVE YOU COMPLETED THE NECESSARY DOCUMENTS? OLDER PERSONS ASSESSMENT FORM, CARES ESCALATION RECORD, THIS IS ME FORM, MARS SHEET Handovers currently vary greatly in quality of information and level of detail. This handover process enables the paramedics to quickly and succinctly receive the important information about the resident and they are then able to relay accurate information to the hospital when they arrive there with the resident. In turn, this handover will provide the hospital with everything they need to know about the resident, enabling each stage of the patient s journey to run much more efficiently, including facilitating handovers between hospital teams. There are of course benefits for the resident: - improved information sharing - improved multi-disciplinary team working Handover process: A&E to AMU Kim Barnes, OPALS Nurse from Epsom and St Helier, then talked about the process once the patient is on a ward in the hospital. Part of the Red Bag initiative is that a member of staff from the resident s home will visit them within 48 hours of admission. Kim confirmed that visiting care home staff can review the notes of their resident if this is helpful and encouraged them to write in the hospital notes about their visit. We have asked each of you to nominate three people who are most likely to make these visits from
your care home. Their names will be passed to security at Epsom and St Helier for them to hold. When a visit is needed, please go straight to security before your visit to get a visitor pass, which you will need to return to security at the end of the visit. Kim noted that the initiative has been really well received by staff at Epsom and St Helier, and they hope that it will help to minimise phone calls to care homes for information on residents. She also asked for feedback on how the scheme is working so that they can resolve any issues that arise. Please remember not to include any patient identifiable data in the feedback. Handover process: SWOOP team Trish Sitch from the SWOOP team at Epsom and St Helier explained that they are a nurse therapy team, who try to move patients quickly through the hospital where possible and facilitate a speedy discharge. She highlighted some important areas where information is really useful for them: Mobility: knowing what the patient was like the week before will enable a quicker and more accurate assessment Pressure areas: any information about the equipment that a patient normally uses is really helpful and will ensure that appropriate arrangements can quickly be made. Epsom and St Helier discussed the possibility of introducing red magnets that will be placed over hospital beds to visibly identify care home residents. However, these are not yet ready and for now, the patient s notes will contain a picture of the red bag. Infection control: cleaning the Red Bag Carolyn Moore, Infection Control Nurse at Sutton CCG, then went through the necessary stages of cleaning the bag. She highlighted the following: The Red Bag is completely washable Each Red Bag will contain a laminated sheet of cleaning instructions You will need to use a bleach-based product - diluted to 10,000 parts per million to clean the bag Clean the bag after every use Make sure that you dry it properly Don't leave the Red Bag in a resident s room store them centrally Make sure that you check for tears and rips Please let the CCG team know if you need a new bag and a replacement will be sent. Carolyn also took the opportunity to remind everyone about arranging a flu vaccine for staff. Every year 25% of staff get flu so it is really important that you arrange vaccines for your staff and encourage them to take up the opportunity. Local pharmacists are willing to visit care homes to provide the vaccines, as long as you have at least 10 confirmed recipients. Please do encourage your staff to have the vaccine and protect themselves and your residents.
Red Bag: Q and A Is the Red Bag just for emergencies or for planned procedures as well? At the moment, the Red Bag is just for emergencies and only at St Helier hospital. However, in the future it could be used for planned admissions and would certainly facilitate earlier discharges. It could also be used with other hospitals but they won t necessarily know the Red Bag process, and so would just be a convenient bag for the resident to use. What happens if the Red Bag is not big enough for everything? Medicines should always take precedence if there is not enough room. Each home has been given three bags. If you do find you need more, just let the project team at the CCG know. Is the Red Bag just for registered care homes? Could it be used in independent living/ sheltered accommodation residence? For now it is just for nursing and residential homes but this will be expanded as we develop the project. However, other types of residence/homes could use the standardised paperwork, which would really help paramedics and hospital staff. Should the DoLs paperwork be included with the paperwork in the Red Bag? This is not needed since a person is only subject to DoLS within the setting that they are in, so as soon as they leave the care home to go to hospital, it is no longer valid and becomes the hospital s responsibility. We are considering including a tick box under the consent box on the Older Persons Assessment Form to alert the hospital to the fact that the resident has a DoLS. Can the paperwork be shared with homes outside the borough? Yes it is fine to share the standardised paperwork with other homes outside of the borough. Is testing within care homes becoming more the norm e.g. doing urine dipstick tests? Yes, this does seem to be the case and is certainly becoming good practice. It is important to note that taking and recording some key tests and then talking to a clinician, who can help review the results, is really helpful and could help with the early identification of a medical condition for a resident. The Care Homes are encouraged to contact Ian Cahill who is offering to train staff on administering urine dipstick tests. When we go to visit Betty, is there someone specific I can talk to about her progress? Your visitor pass will identify you as a member of the care home staff and will enable you to speak to the ward nurse or a senior nurse regarding your resident s progress and any issues or concerns you may have. What happens if a bag gets lost whilst the patient is in hospital? All of the bags carry a unique serial number and can be tracked, so once it is found it can be returned to the right care home. Will the family have access to the bag? The bag will be accessible to the family whilst the resident is in hospital and it is possible that they might take items out of the bag. Therefore it is important that families also understand the role of the Red Bag and ask hospital staff to note on the checklist any personal items that they remove to
avoid confusion. What if Betty died in hospital? In this scenario, the family would be able to pick up any personal items that were in the bag from the hospital. If there are no relatives, the bag would be passed to the OPALS team at St Helier who will clean it and send back to the CCG, who will then ensure it is returned to the right care home. What happens if a resident is taken to St George's rather than St Helier? It is fine to still send them with the Red Bag. Even though they won t know about the initiative (although this will change over the coming months), it is still a useful way of making sure that the resident s belongings and paperwork can all be kept together. Sutton Integrated Digital Care Record (IDCR) Lesley Godden from the London Borough of Sutton attended the Forum to talk about the introduction of the new Sutton IDCR, which is a joint project between the London Borough of Sutton and NHS Sutton Clinical Commissioning Group, supported by a number of other NHS partners and voluntary agencies, to improve health and social care services in Sutton. The Sutton IDCR contains the following information: Information from the GP clinical system: clinical data such as recent tests and treatments, allergies, diagnosis and any current medication. Comments and discussions recorded when a patient visits their GP will not be shared. Information from the social care system: social care data such as details of a support plan and the care received, Social Worker information where relevant, and details of when the plan was last reviewed. The Sutton IDCR will provide some clear benefits for local people: No need to repeat health and social care information No more unnecessary appointments and tests They can be more involved in decisions about their care and for health and social care professionals: Enable them to find accurate information quickly when they need it No need to wait for a GP to send paper records Informed and improved decision-making Everyone will have a choice about whether to share their information, as well as who can see it. Health and social care professionals who need to look at a record on the Sutton IDCR must ask the person for their permission to look at it, unless, in an emergency someone is so ill that they are not able to be asked. People who have opted out of the national Summary Care Record will automatically be opted-out of the Sutton IDCR but can choose to just opt-in to the Sutton IDCR if they so wish.
Sylvia will be bringing letters round to homes with residents who receive adult social care, to make sure that they are aware of this new integrated record and that they have the opportunity to make an informed decision about whether they want to opt out or not. If you receive the letter for a resident who has no mental capacity, please return the letter with a note explaining the situation and the adult social care team will then ensure that the resident is properly assessed. Sylvia explained that at the start only certain health and social care professionals would have access; alongside GPs will be the clinicians in A&E at Epsom and St Helier and the local Out of Hours GP provider, SELDOC. However, it is expected that this will grow in time and expand to other health and social care providers. For more information, please go to www.suttonccg.nhs.uk Other news Representatives from NHS Sutton CCG (Sutton CCG) attended a special reception hosted by the Prime Minister at 10 Downing Street on Monday 23 November 2015 to celebrate the work of the 50 vanguards helping to deliver the Five Year Forward View, the vision for the future of the NHS. Sutton CCG s Director of Quality, Mary Hopper, and Maggie Gairdner, Divisional Director for Sutton Community Services (part of The Royal Marsden NHS Foundation Trust) joined more than 100 other NHS and care staff at the event. They were also joined by patients and patient representatives. See more at www.suttonccg.nhs.uk under Latest News. Feedback We welcome all your feedback, whether it is to comment on the last forum or to make suggestions for the next forum. We would also welcome your feedback on this newsletter is it useful, do you like the format, what else would you like to see included? Please send your comments to jo.flint@nhs.net. Sutton Homes of Care Priory Crescent, Sutton SM3 8LR www.suttonccg.nhs.uk/vanguard @SuttonHoC