A joint project to reduce avoidable harm in Walsall’s nursing homes and cut down on unnecessary hospital admissions is showing positive results thanks to staff commitment and enthusiasm.
The SPACE – Safer Provision and Caring Excellence – initiative is being pioneered by the Walsall Quality Improvement Project, a partnership between Walsall Healthcare NHS Trust and NHS Walsall Clinical Commissioning Group (CCG). It is sponsored by West Midlands Patient Safety Collaborative.
Its focus is on supporting nursing home staff to reduce avoidable harm such as pressure ulcers, falls and community acquired infections. There is also an emphasis on improving communication and handover processes and providing a range of free training opportunities for staff.
Progress is encouraging and since the SPACE project started last December, nine of the 12 homes have implemented daily safety crosses to monitor avoidable harm and another four have introduced staff champions to concentrate on ensuring residents are well hydrated.
Caroline Maries-Tillott, Walsall Quality Improvement Project Lead Nurse, said: “All of the 12 nursing homes we have across the borough are supporting SPACE and staff should be applauded for getting on board and signalling their clear intention to work in partnership with the trust and CCG to improve the health and wellbeing of their residents.
Harrison Unit at Parklands has focused on reducing avoidable harm from pressure injury.
“Since this project started the staff have improved the quality of information communicated at handover about ‘residents at risk’ of developing pressure injury,” said Caroline.
“They have also implemented a number of changes to repositioning and continence practices. It’s early days yet, but before the project commenced approximately one resident per month developed a pressure injury in the unit. However, since the QI project started on 1 January 2017, none of the residents has developed avoidable pressure injury. This is a fantastic improvement, given the severe frailty of the residents in their care.
“Our nursing homes are now caring for an increasing number of people with dementia which increases the risk of falls, so this is a key area for us. Last year Clarendon Unit at Parklands Court Care Home made significant progress in reducing falls. The unit has monitored the locations and times of residents’ falls and has now adjusted staff rotas to match times of highest falls incidents. Staff are now focusing on improving hydration to help reduce avoidable falls even further.
“Hydration is another aspect of the work we are doing as evidence shows that if people are well hydrated this reduces avoidable harm from pressure ulcers, falls and Urinary Tract Infections (UTIs). Many elderly patients, and particularly those who are living with dementia, can be reluctant to eat and drink regularly, but it is so important to try and help prevent health concerns by ensuring their fluid intake is adequate.
“We have worked with the dementia support workers to deliver free, high quality dementia training and end of life training to staff at all of our homes so they can better meet the needs of their residents with this condition.”
Caroline, who is based at Hollybank House in Willenhall, said a high number of hospital admissions were as a result of people developing UTIs which caused them to be confused and become generally unwell.
“None of us enjoy being in hospital, and for our patients living with dementia in particular, to have to leave a home environment that they’re comfortable in and used to and go into a strange environment can be extremely distressing and confusing, having a poor impact on their recovery. We want to reduce avoidable hospital admissions as much as possible in the best interests of people staying where they feel happiest and healthiest.”
She added that Ash Grange Nursing Home in Bloxwich had also done a lot of work to improve communication and handover, developing a safety board with clear symbols to ensure all staff clearly understood each patient’s needs.
“The SPACE project is all about equipping staff with some simple Quality Improvement (QI) tools and techniques to help them develop a culture of continuous improvement which creates safer environments. Staff in our nursing homes have a huge responsibility on their shoulders and we want to support them and encourage them wherever we can. Their commitment and enthusiasm so far have been fantastic and I’m sure that together we can make a real difference to some of the most vulnerable people in Walsall.”
One of the homes that Caroline has been working closely with is Parklands Court in Bloxwich, where staff have really embraced the initiative. This home offers nursing and residential dementia care, in addition to Parkinson's, palliative, respite and convalescence care.
Caroline explained: “One of the focuses for the Harrison Unit has been on reducing avoidable harm from pressure injury and this has proved to be a really effective way to engage staff and make them appreciate even more the important role they have.
“Last year, there were 12 residents who developed a pressure injury, and one of the features we’ve introduced is a “safety cross” which shows every day of the month and has a red, amber or green colour code. Red indicates a pressure injury that developed in Parklands, amber denotes a patient arriving at Parklands with a pressure injury acquired elsewhere and green signals no pressure injuries. I am so proud of the team here because so far this year, as not a single resident has developed an avoidable pressure injury.
“Care home staff are often, understandably, very aware of what is going on in the particular area they cover, but don’t always have the time or opportunity to look at the bigger picture. At Parklands, many were shocked to discover there were 12 avoidable pressure injuries throughout last year. They really wanted to be part of the drive to reduce this and it is down to their hard work and willingness to come up with ideas that this improvement has come about,”
Speaking earlier this year, Parklands Court Duty Manager Fabienne Harris said the Quality Improvement Project was also a positive move towards improving staff motivation and morale.
“Carers have a huge responsibility and the majority are compassionate and dedicated, yet care homes do attract negative publicity and this affects morale,” she said. “Involving them in championing quality care like this is tremendously empowering for them. They have proved that they are willing to try new systems and innovate and if something doesn’t work they’re keen to develop other ideas.
“Our handovers have really been transformed as we have developed easily identifiable symbols that place an even greater emphasis on residents at risk of developing a pressure injury and this focuses us all on prevention and good practice.
“We have benefited greatly from Caroline’s input as she is a real support to us. But we are also determined to continue our good work and make even greater progress without her – in the nicest possible sense! She has helped us create a good base to work on.”
Resident Irene Proffitt, aged 102, pictured with Caroline, Fabienne and Parklands staff, said: “They are all lovely to me and look after me very well indeed. They should have a medal.”