The Community Matron at Dorset Healthcare University NHS Foundation Trust led on the local implementation of the national Red Bag Scheme in Care Homes across North Dorset. The success of the programme has led to improved outcomes, experiences and use of resources locally.
Where to look
NICE (2016) describes the ‘Red Bag’ Scheme a whole-system approach to improving the transition between inpatient hospital settings and the care home setting. The integrated ‘Red Bag’ pathway is designed to support care homes, ambulance services and the local hospital meet the requirements of the NICE guidance regarding transition between these settings. This guidance emphasises the need to ensure that the person, their carers and all health and social care practitioners are involved in someone’s move between hospital and home, with open communication lines – working in partnership – to truly co-ordinate and personalise arrangements.
The red bag is used to transfer standardised paperwork, medication and personal belongings and stays with the resident throughout their hospital episode returning home with the resident. The standardised paperwork aims to ensure that everyone involved in the care for the resident will have necessary information about the resident’s general health, e.g. baseline information, social information and any medications. On discharge, the care home will receive a discharge summary with the medications in the red bag. The pathway has also been shown to significantly reduce the amount of time taken for ambulance transfer times, A&E assessment times and to reduce avoidable hospital admissions.
The community matron was aware of the adoption of the red bag scheme in other areas of Dorset and identified that across the region’s 27 residential/nursing homes, there was unwarranted variation in the process and pathways for transferring residents to local A&E departments and hospitals which was associated with length of stay in hospital. The community matron identified the opportunity to implement the Red Bag Scheme to address this and support local providers to streamline care for residents.
What to change
Before the implementation of the Dorset Red Bag Scheme, residents from care and nursing homes would be taken to hospital with varying levels of personalised documentation. Sometimes this was a verbal handover and others a detailed care plan.
Following admission, the ward staff would often need to phone the nursing home to get additional information regarding the patient and previous medical history. The matron observed that communication could improve between the care home staff and the acute care setting which would enhance the availability of accurate, relevant and appropriate information to be transferred. The red bag scheme seemed an appropriate choice.
North Dorset providers committed to use the scheme as part of a programme of work to:
- Improve people’s experiences;
- Support collaborative working and communication resulting in less reliance on ad hoc telephone calls;
- Aid early discharge where people are medically fit to return home and ensure care homes are involved early in discharge planning to avoid delayed transfers of care (DToC’s);
- Improve the approach to keeping resident’s documents and belongings together during their stay; and,
- Advocate support from community services for residents at discharge.
How to change
The Community Matron and the team approached all the nursing homes within North Dorset providing information on the Red Bag Scheme. Appointments were made with home management teams to provide information and resources including the demonstrable benefits of the scheme shown in other areas.
All 20 homes engaged with the scheme. They were provided with the red bags, education and training, as well as support to adopt the scheme within the homes – supporting implementation.
The education programme included a 3-week timetable consisting of a 2-hour session for each member of staff. The course includes:
- Introduction to the Red bag scheme;
- Communication tools including the Situation, Background, Assessment, Recommendation (SBAR);
- Basic observations and sepsis screening; and,
Meetings were also held at the local hospitals, general practices and other care services to support them to understand the principles of the scheme and adopt it in practice. Discharge coordinators, emergency department staff and care of the elderly teams at Salisbury District General Hospital, Dorset County Hospital and Yeovil hospital were supported to engage with the scheme and the care home providers. Clinical pathways and protocols have also been adapted to reflect the red bag scheme, to support staff caring for residents in the local care homes.
Better outcomes – The scheme has been successfully adopted by each of the 20 homes with education and training sessions being well attended by a variety of staff including care home managers, healthcare support assistants and registered nurses. Staff have reported that the red bag scheme supports residents to access the care they need earlier in their attendance at hospital, as well as supporting timely discharge back to their homes when medically well. Initial reports demonstrate improved communication between acute settings and care homes using the red bag. The training programme has encouraged the staff to ask the residents about their health wishes and future care management. The scheme has also strengthened the links between across nursing, care home staff and allied health professionals in the area, which has enhanced signposting to other services and resources locally.
Better experience – Verbal feedback has been positive. This has included better communication between services, as well as a reported reduction in the number of calls from the acute setting to the care home during a hospital stay. Care home staff report feeling more confident to escalate concerns, write handover sheets and provide relevant information now that they understand the process. Crucially staff feel involved in decision making regarding discharge processes.
Better use of resources – Whilst it is difficult to demonstrate the impact of the red bag scheme on reducing length of stay locally, staff have described how the red bags have truly impacted positively on the pathway of care – positive clearly for the individual, but also increasing efficacy across the system too. It is anticipated the scheme will reduce delays in discharge as well as streamlining admission processes. This could release staff time and other resources in the longer term.
Challenges and lessons learnt for implementation
The scheme has supported staff from acute settings and care home settings to work collaboratively, which has been invaluable.
Empowering care staff has been particularly important especially in places where variable communication existed.
For more information contact
Dorset Healthcare University NHS Foundation Trust