Leading change

The Head of Care Strategy at the Good Care Group led on a programme to improve at home treatment and care for urinary tract infections (UTI’s) with its clients. Through enhanced training and support, combined with collaborative working, this programme has led to improved outcomes, experiences and use of resources locally.

Where to look

Urinary tract infections are caused by the presence and multiplication of microorganisms in the urinary tract, with an infection defined by a combination of clinical features and the presence of bacteria in the urine (NICE 2015). The National Institute for Health Research (NIHR, 2016) report that UTIs are among the most common types of infections with in excess of 92 million people affected worldwide. UTIs are a significant cause of mortality, especially amongst the elderly population, with UTI related symptoms accounting for between 1-3% of all primary care consultations and being the main reason for 13.7% of community antibiotic prescriptions.

The Head of Care Strategy identified unwarranted variation when assessing hospital admissions data from incidents such as slips, trips or falls and from staff feedback. There was a higher than expected number of clients being admitted to hospital with a UTI or a UTI associated condition.

Feedback from staff identified that clients were frequently seen as being ‘not right’ or ‘out of sorts’ before they were found to have a UTI, but were unable to express more specific detail about what was wrong. The staff were therefore unable to accurately articulate the needs of the client when speaking with the clients’ GP or other healthcare professionals. GPs were often unable to attend the clients’ home on the same day and would often schedule a house call in for a couple of days’ time, advising a call to 111 if they were worried in the meantime. The Head of Care Strategy saw an opportunity to equip and empower staff in the clients’ own home to identify the symptoms of a UTI, test for it and to refer the client to further care as required. This empowered the staff to better support clients and enhance outcomes with fewer clients needing to be admitted to hospital.

What to change

The Good Care Group, a provider of live-in care services, supports people to live well in their own homes for longer by providing high quality live-in care services. The Head of Care Strategy presented his findings to the Senior Leadership team and Medical Advisory panel for the Good Care Group, where it was agreed there could be a positive solution to reduce the number of clients needing to leave their homes to access treatment and care for UTI’s.

The NIHR state that Point-of-Care (PoC) testing kits for UTIs can potentially:

• decrease the time involved in getting an accurate diagnosis;
• provide doctors with specific guidance on which antibiotics to prescribe for maximum therapeutic benefit;
• reduce use of laboratory resources for urine specimens and associated costs;
• mitigate the increasing prevalence of antibiotic resistance with inappropriate broad-spectrum antibiotic prescribing;
• minimise the number of GP visits and hospital admissions associated with urinary tract infections;

Through education and PoC testing equipment, staff could identify signs of a developing UTI, test for this and make timely referrals for treatment all from the clients’ own homes.

How to change

The Good Care Group invested in urinalysis testing kits for all clients, and commissioned and rolled out education and training for care staff, focused on:

• taking a pulse;
• taking a respiration reading;
• general signs and symptoms that may indicate a UTI;
• skill to undertake a dip test analysis.

The package included an online webinar, online test and learning materials, as well as support to managers in enhancing staff confidence in implementing these changes and use of equipment. The Head of Care Strategy supported staff to understand the need for change and to use these new skills to both escalate concerns as well as to lead on treatment referrals. The new way of working was piloted within two teams in London.

Adding value

Better outcomes – The new ways of working under this programme has seen a 60% reduction in the need for clients to go to hospital to access treatment for a UTI. Anecdotal feedback from both staff and  GPs indicate that there has been a significant increase in the number of UTIs being diagnosed early by live-in carers and treated in the clients’ own home.

Better experience – Live-in carers and local GPs are positive about the new way of working and clients are happier with receiving care and treatment at home. Examples of this feedback include:

“The new urinalysis testing service has reduced the stress involved in caring for elderly relatives”

“The new approach to identifying infections has exceeded my expectations in every way. Knowing my father is in safe hands is an enormous weight off my shoulders”

“The urinalysis training was easy and informative. I feel stronger as a carer, being able to help the GP to identify issues like infections quickly”

“I love the new UTI tests we have. I used it when my client was poorly, it turned out she had a UTI. The GP was able to do a prescription directly to the pharmacy and we were able to treat it within two hours”

Better use of resources – Training was provided within existing business cost models and the cost of the urinalysis equipment was minimal. Anecdotal information indicates that the staff are utilising their time more effectively to support clients. The ability to collect data on the impact on other services is very difficult, however the knock-on effect of the changes made is anticipated to reduce calls to clients’ GPs and to reduce calls to ambulance services.

Challenges and lessons learnt for implementation

The nature of staff working remotely is an ongoing challenge. It was important to create education and support that worked for staff; the use of webinars, training documents and online support has greatly supported the rollout being effective.

Professional live-in carers are well placed to play a key role in both the prevention of infection, but also in early identification, escalation and treatment at home. By equipping staff with the skills knowledge and resources to articulate their concerns and share high quality, useful information with GPs, the number of unnecessary hospital admissions for UTIs in elderly people can be significantly reduced.

Key stakeholders, such as GPs, have been imperative to the success of this programme. They have been very engaged in the programme and very supportive with care staff. The ability for staff to communicate more effectively with GPs and other healthcare professionals regarding their client’s ill health has improved working relationships and outcomes for clients.

Good baseline data is imperative as well as routine and robust collection of data, to monitor the effectiveness of a programme and the need to change or adjust the programme.

It is important to work with staff to establish clear boundaries and support in their own expectations as well as those of the organisation and other healthcare professionals. Leaders may also need to alleviate fears that there is not an expectation to diagnose medical conditions, but to support clients more effectively as part of their routine care.

The Good Care Group continue to build on the success of this initial programme and are now focussed on clients who have catheters, who are particularly at risk, and whom urinalysis is not generally recommended.

Find out more

For more information contact:

• Zoe Elkins, Head of Care Strategy, The Good Care Group, Zoe.Elkins@thegoodcaregroup.com