References
Managing deterioration in older adults in care homes: a quality improvement project to introduce an early warning tool
Abstract
Many older adults living in care homes have complex health needs requiring comprehensive care. Early warning tools can help identify deterioration, but currently they are less often used in care homes. The aim of this quality improvement project was to introduce an early warning tool, the Significant 7, to facilitate identification and management of deterioration in care home residents. The plan, do, study, act (PDSA) method was used, and process mapping informed a tailored intervention. Introducing the tool had positive outcomes for residents and care staff. There was a reduction in the incidence of pressure ulcers and falls, and care staff were more confident in recognising resident deterioration. Next steps include scaling up the project to further examine how this early warning tool can improve resident, staff and organisational outcomes, in order to explore the potential use of the tool by community nurses with older people living at home.
Care staff in the care home sector make an invaluable contribution to older residents' care. However, many staff feel undervalued, and support for their training and development varies (Spilsbury et al, 2015). The NHS should support care homes, as emphasised by a Care Quality Commission (CQC) report which highlighted that over 40% of care homes in England either require improvement or are inadequate (CQC, 2016).
Locally, within the Thurrock area of Essex where the project lead (SL) works, care home residents have multiple hospital attendances and admissions. Smith et al (2015) reported that older people living in a care home postcode had 40–50% more emergency department attendances and emergency admissions than the general population of the same age. Nationally, a proactive strategy is needed to prevent deterioration of care home residents (Cavendish, 2013).
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