Nurses within South Norfolk CCG supported residential and nursing homes to reduce avoidable hospital admissions. They developed a checklist and trained care staff in its use, to help them when making urgent calls to other services. There are fewer urgent calls as a result, as the care staff feel better equipped in making decisions on which services a resident needed – meaning calls were only made when appropriate to do so.
Where to look
There was unwarranted variation in how local care homes accessed urgent help for their residents. GPs, ambulance staff and 111 call handlers had reported that the right call wasn’t always made or enough information given for timely decision-making. The CCG nurses recognised that care staff needed help in sign-posting their residents appropriately to ensure the most-appropriate care for the residents.
What to change
The CCG care home practitioners identified that in crisis situations, there was a need for care staff to communicate a resident’s change in condition with their colleagues as well as other professionals when discussing a resident’s symptomatology, which is not always easy to convey or to swiftly make a judgement on.
There was reported anxiety about making such calls and a lack of confidence about who to contact or what information to provide. There was unwarranted variation in the care pathway due to a disparity in the recommended steps care staff should follow in these situations. If improved this could result in better resident experience, better patient-centred outcomes, as well as a better experience for staff with improved confidence in managing the situation.
How to change
The CCG nurses recognised that standard communication tools such as SBAR (Situation, Background, Assessment, Recommendation) and frameworks for clinical assessment such as ABCDE (Airway, Breathing, Circulation, Disability, Exposure/Examination) were well embedded in acute settings, but care homes were not using them. The CCG nurses proposed delivering a simplified form of training in these tools, accompanied by an easy-to-use document.
Following consultation in the nursing team at the CCG, the nurses developed the Urgent Call Communication Checklist – a straightforward A4 document for care home personnel to complete before making an urgent call. Advocated by three Norfolk CCGs and the ambulance and providers of 111 services for the area, the checklist aims to:
- Help care home staff decide whether to call 999, 111 or the GP practice;
- Enable them to describe the situation and be a part of the decision making process regarding the care the resident needs;
- Provide an assessment that allows the call handler or clinician to make decisions and recommendations based on clear, precise information;
- Enable care staff to escalate the call if a resident continues to deteriorate;
- Record and hand over decisions and the plan for managing the resident’s care.
The checklist can also be used to audit performance and provide evidence of how urgent events were managed to support future response.
The training package and accompanying checklist has now been delivered to 510 staff from 65 care homes across central Norfolk. Sessions were observed by ambulance staff and community and CCG clinicians to monitor quality.
Training is ongoing and has been extended to domiciliary care providers.
- Better outcomes – initial ambulance data indicates that following the training package, call volumes in two of the CCG areas reduced by 30% and 50% respectively. An A&E audit over one weekend confirmed that 100% of care home calls were made appropriately. It also showed that 15% of the actual admissions were considered avoidable and was linked to those care homes who were yet to receive the training package.
- Better experience – care home staff are being surveyed to assess any changes in their experience and confidence. Training has also been given to informal carers at a local GP practice with very positive feedback supporting the model of care closer to home.
- Better use of resources – unplanned emergency admissions have fallen by 22% in South Norfolk, with smaller reductions in the other two local CCGs. This is encouraging, but should be viewed within the broader context of other admission avoidance work.
Challenges and lessons learnt for implementation
- The time needed to do the training and engage the care homes was under-estimated but the outcomes support the added value for residents and staff when the training is completed in care homes.
- It is important to ensure that outcomes are fully understood and can be consistently measured.
- Feedback from the homes has been achieved more successfully via face to face contact, as there is a variation in the strength of connectivity across the area.
Find out more
For more information contact:
Irene Karrouze firstname.lastname@example.org
Kate Wyatt email@example.com
Care home practitioners (nurses)