Download January 2016

Sutton Homes of Care
Health forum newsletter: January 2016
Welcome to the latest edition of our care home forum newsletter, following our forum on 22
January 2016.
Thank you to everyone who attended – it is always great to see so many of you at the
meetings. We had a busy agenda, as usual, and whether you were able to attend the
meeting or not this time we hope you find the summaries of our agenda
items below helpful.
Our next Care Home Forum will be on Friday 18 March, please attend if
you can as we will be celebrating our first birthday as part of the Vanguard
programme and launching the reference cards and posters on the
conditions discussed.
Christine Harger
Quality Assurance Manager (Care Homes and Older People)
In this edition
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Older person’s assessment form
Hospital transfer pathway (Red Bag
initiative) update
Sepsis
End of life care
E-learning
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Safeguarding
Medicines optimisation
NHS Net (secure email)
General updates
Dates for your diary
Older person’s assessment form
Caroline Pollington, our Clinical Nurse Lead and Darzi Fellow, discussed the “older person’s
assessment form”.
All our care homes are encouraged to use this form to assess their residents. The form
details baseline information and will provide a comprehensive assessment which will prove
invaluable for other health and social care professionals involved in providing care to your
residents.
The form is also an important part of the Hospital Transfer Pathway (the “Red Bag initiative”)
as it one of the main forms within the standardised paperwork that the ambulance and the
hospital teams will require.
If you have any questions or queries please contact the Vanguard team on
[email protected]
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Support to help you complete the assessment forms for your residents is available from our
continuing healthcare team or from Ian Cahill, Link Nurse, Sutton and Merton Community
Services.
Hospital transfer pathway (Red Bag initiative): Update
Christine Harger, Jason Morris (LAS) and Kim Barnes (ESH)
updated the Forum on the Hospital Transfer Pathway.
London Ambulance Service (LAS)
Jason Morris from LAS responded to feedback some
ambulance crews in the area do not seem to be aware of
the Hospital Transfer Pathway. Jason advised that this is
mainly because some crews may be coming into Sutton from out of our area (for example
from Kingston). However, he assured the forum that LAS will continue to promote the service
and are planning further communications at the end of February to promote the pathway to
all the ambulance crews who may cover Sutton.
Epsom and St Helier University Hospital NHS Trust (ESH)
Kim Barnes from the Older Persons Team at St Helier Hospital provided an update on an
initial evaluation of the pathway within the hospital that they are carrying out with their staff
to help raise awareness. They have promoted the Red Bag in a number of ways; on the older
person’s page on their intranet, through face to face conversations and internal meetings.
Feedback obtained so far has been extremely positive, many staff surveyed had been aware
of the Red Bag – although some staff reported that there had been occasional instances of
incomplete paperwork in the bag.
Overall staff felt that the pathway was really positive. The formal hospital transfer process
means that that when a care home resident is admitted to hospital it is a better experience
for patients as the process is now much smoother. There were some concerns that the Red
Bag could be mislaid but it was confirmed each bag has an individual serial number so if it
goes missing, it can be traced.
Kim also reported that ESH are also doing further promotions to hospital staff to raise
awareness of the Red Bag, through posters and screen-savers, and they are looking into
developing a Red Bag magnet to be placed above the care home resident’s hospital bed.
If you have any questions or queries please contact the Vanguard team:
[email protected]
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Sepsis
Jason Morris from LAS highlighted the importance of sepsis awareness.
Sepsis is a common and potentially life-threatening
condition triggered by an infection.
In sepsis, the body’s immune system goes into overdrive,
setting off a series of reactions including widespread
inflammation, swelling and blood clotting. This can lead to a
significant decrease in blood pressure, which can mean the
blood supply to vital organs such as the brain, heart and
kidneys is reduced.
If not treated quickly, sepsis can eventually lead to multiple organ failure and death. Each
year in the UK, it is estimated that more than 100,000 people are admitted to hospital with
sepsis and around 37,000 people will die as a result of the condition.
Early symptoms of sepsis usually develop quickly and can include:
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a high temperature (fever)
chills and shivering
a fast heartbeat
fast breathing
In some cases, symptoms of more severe sepsis or septic shock (when blood pressure drops
to a dangerously low level) develop soon after. These can include:
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feeling dizzy or faint
confusion or disorientation
nausea and vomiting
diarrhoea
cold, clammy and pale or mottled skin
Jason has produced a leaflet for care home staff with advice on what to do if you suspect one
of your residents has sepsis. The leaflet is available on our website:
www.suttonccg.nhs.uk/vanguard/publications
National Early Warning Score (NEWS) for sepsis
Sepsis usually requires urgent medical attention and can be a medical emergency.
A national early warning score (NEWS) has been developed help you to score symptoms if
you suspect sepsis. You should always seek medical advice if you are at all concerned – from
the patient’s GP, the CPAT team or by calling 111.
If you have any questions or queries please contact the Vanguard team:
[email protected]
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If you suspect severe sepsis or if the NEWS score is four or above then it is important that
you get urgent medical help for your resident by calling 999.
NEWS can be used by care homes and nursing homes. Although training is required before it
can be used effectively. LAS are developing training to help raise awareness of sepsis
amongst care home staff. Phase one of this is will be in April and will look at training staff to
use scorecards to increase your observations on any resident on antibiotics.
More information on the sepsis scorecard will be discussed in the joint February forum for
care homes and nursing homes.
For more information contact Jason Morris, Clinical Team Leader, LAS, [email protected]
End of life care
Launch of ‘Priorities for the Care of the Dying Person in Sutton ’poster
Zoe Robinson from Sutton and Merton Community Services
presented the poster for the ‘Priorities for the Care of the Dying
Person in Sutton’.
The poster is available to all care homes in Sutton, developed
through the vanguard partnership and designed with services to
support the care home with end of life care. It details the support
services available for your residents (including telephone numbers).
Pocket reference cards
Zoe also highlighted that the vanguard programme is also working on a range of other
support tools and resources for care home staff. The resources will include information on a
set of reference cards and posters. Topics covered will include:
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Concerned about a Resident
Preventing and managing UTIs
Bristol stool chart
Sepsis - Postural drops
The plan is to produce a mixed resource pack consisting of A4, A3 and A5 posters and cards
for care homes to choose from, these can be placed next to medicines trolley and nurses
stations for easy access for staff, put up in staff offices, or as pocket reference cards on key
rings.
If you have any questions or queries please contact the Vanguard team:
[email protected]
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Initially the vanguard programme will provide nursing and residential care homes with a
sample of 200 packs in Sutton and pilot in a selection of domiciliary care agencies.
E-learning
Deborah Gordon from Sutton Council updated the forum on the E-Learning programmes
available from Sutton Council on several health topics provided for care home staff.
In partnership with the Vanguard programme three additional modules have been launched:
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Continence care
Dementia
Person-centred thinking
Staff completing the modules will receive a certificate and care homes are encouraged to
promote the free learning resources and ensure staff have access to the programmes.
Courses can be accessed via www.kwango.com.
Through the vanguard programme ongoing monitoring will take place to see how many
homes are accessing the E-learning programmes. This is to help to understand the numbers
of staff who have undertaken the training modules form part of quality assurance for both
Sutton Clinical Commissioning Group and Sutton Council.
New course: Mental capacity and safeguarding
Training days for care home and other staff, are now available and run by St Thomas Training.
This free training takes place at Sutton Civic Centre, St Nicholas Way.
Both courses will run twice a month throughout 2016 (except in August). Places need to be
secured via London Borough of Sutton (LBS).
Please note:
1) LBS has asked that anyone attending the MCA training first completes the level one MCA
training on-line “Kwango”, or confirms that they have received the basic awareness
training by another means.
2) LBS requires anyone attending the safeguarding adults training to have first attended the
MCA training.
3) Please book the courses together and if you have to cancel – please give as much notice
as possible if you need to cancel.
If you have any questions or accessing problems, please contact Deborah Gordon at LBS
([email protected]).
If you have any questions or queries please contact the Vanguard team:
[email protected]
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Safeguarding
Claire Symons, our Safeguarding Adult and MCA lead, is happy to visit any care homes and
review their current policies for safeguarding compliance, advise on assurance and/or meet
with staff teams to answer any queries. CQC is very supportive of MCA and DoLS compliance
and since the Care Act there is a stronger focus on adult safeguarding than ever before.
If you would like to organise for Claire to visit, please contact her: [email protected] / 020
8254 8171 (direct line – please do leave a message).
New Pan London Procedures
The Pan London Procedures were launched on 9 February 2016 and all services are expected
to be compliant by 1 April 2016. The replace the 2011 “Protecting adults at risk: London
multi-agency policy and procedures to safeguard adults from abuse”, and can be found here
http://londonadass.org.uk/safeguarding/review-of-the-pan-london-policy-and-procedures/
Medicines optimisation
Hai To, Care Home Pharmacist from the Vanguard Programme, talked to the forum about
unused prescription medicines. It is estimated that across the UK medicine worth over £300
million every year is wasted and, of this, medicine worth £50 million is wasted in care homes.
Hai discussed the new NICE guidance on medicine optimisation and outlined care homes’
responsibilities when ordering medicines for residents.
The NICE guidance outlines how putting people at the centre of decisions about their care
can enable them to use the medicines they are prescribed safely and effectively and get the
best possible outcomes from them. Staff should also talk to a pharmacist or GP if a resident is
no longer able to swallow or has hearing difficulties which restricts their ability to consent.
Key areas covered by the new guidance:
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Care homes should retain the responsibility for reordering of medication on behalf of
their residents
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Care home staff should check medications are accurate based on the prescription by
GP/hospital. Keep records of medicines ordered and the reference.
Hai asked the care homes to check their medication processes to make sure they are
compliant with NICE guidance and raise awareness with staff about the NICE guidance.
Posters are available for display in care homes. Please contact Hai.
If you have any questions or queries please contact the Vanguard team:
[email protected]
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Acute Kidney Injury (AKI)
Hai also discussed Acute Kidney Injury (AKI) with the forum. Any residents taking medication
such as NDSAIDs, ACE, ARBs, diuretics and metformin are more at risk as these medications
can cause AKI. Hai highlighted the importance of alerting the resident’s GP to review their
medication if a resident becomes unwell.
Please also be aware that when a resident returns from hospital, any drugs that have been
stopped as noted on the hospital discharge letter should only be reinstated by a GP. Please
read and ask the GP to review the medication as appropriate.
Medication to be taken ‘when required’ (PRN) policy
Hai reminded the forum of the NICE SCI recommendation 1.14.2 which states care home
providers should ensure that a process for administering 'when required' medicines is
included in their care home medicines policy. Please refer to NICE recommendation 1.1.2.
The NHS Constitution states residents have the right to accept or refuse treatment that is
offered to them. If the resident has the mental capacity to refuse treatment offered to them
and does so, please inform a nurse, GP and a member of family. A best interest meeting can
then be called to discuss and agree whether administering medicines without the resident
knowing (covertly) is in the resident's best interests.
For more information or if you any queries contact Hai To, Care Home Pharmacist, email
[email protected]
NHS.net – secure email
Marco Epifano from the Continuing Healthcare Team advised that NHS.net email addresses
have now been set up for all care homes.
Having an NHS email account means that care
homes can receive confidential patient information
directly from acute and primary care provider
organisations via a secure email service which
complies with strict NHS information governance
guidelines.
This is an important development which means that
care homes will have access to information more
quickly on their residents – for example discharge summaries usually sent to GPs can be sent
to care homes directly.
For more information on NHS.net – including policies, procedures and guidance for use visit: http://systems.hscic.gov.uk/nhsmail/.
For confidentiality purposes, please do not set up NHS.net on your personal mobile phones.
If you have any questions or queries please contact the Vanguard team on
[email protected]
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For further information and assistance contact Marco Epifano, Business, Information &
Commissioning Manager, Continuing Care, NHS Sutton CCG ([email protected])
DeAR GP: Dementia case finding tool
Ian Cahill – Link Nurse Sutton & Merton Community Services advised that we are planning to
introduce a simple dementia case finding tool into
our care homes to help identify patients who are
showing signs of dementia but do not have a formal
diagnosis.
Introducing DeAR-GP in Care Homes is expected to
increase the identification of potential dementia
cases.
DeAR-GP will initially be piloted in six nursing homes who are currently in phase one of the
Vanguard Programme, designing and testing the new model of care, along with three
residential homes who have volunteered to participate, these are:
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Crossways Nursing Home
Southdown Nursing Home
Beverley Lodge Nursing Home
St Judes Nursing Home
Chegworth Nursing Home
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Shirley View Nursing Home
Eversfield Residential Home
Eothen Residential Home
Grange Cottage Residential Home
This pilot will highlight any initial implementation issues. All being well we envisage the
DeAR-GP scheme will be rolled out to all our older peoples care homes within the first
quarter of this year.
If you have any further questions on the tool or any concerns/feedback, please contact the
Vanguard Sutton Homes of Care team on [email protected]
General updates
Music mirror programme
Christine reminded care homes to email [email protected] in response to
the flyer for Music Mirrors to deliver train the trainer sessions in Sutton.
Training requirements survey
A survey monkey questionnaire is going out to care homes from Sutton Council to find out
training requirements. Christine asked all care homes to complete this as it will inform future
training programmes and help us ensure that you are getting the training you need.
If you have any questions or queries please contact the Vanguard team on
[email protected]
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Dates for your diary
Care Home Forums
18 March 2016
Priory Crescent, MR1
13.00-16.30
22 April 2016
Priory Crescent, MR1
13.00-16.30
15 June 2016
Sutton Council
13.00-16.30
15 July 2016
Priory Crescent, MR1
13.00-16.30
19 August 2016
Priory Crescent, MR1
13.00-16.30
If you have any questions or queries please contact the Vanguard team on
[email protected]
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