Care of Older People
As life expectancy has increased so has the number of older people with complex health and care needs. These patients are cared for in nearly all health and social care settings, and the vast majority of nurses will care for frail older people at some time. However, while a growing older population is driving greater demand for health and care services overall, there are also opportunities to improve health in later life and to develop more appropriate services that may reduce demand for more expensive care. This award seeks to highlight the excellent care being provided by nursing staff for older patients and shine a light on innovation in an area that is far too often ignored.
Dementia UK
Frailty service
Emerging and increasing frailty often goes unidentified, and families living with dementia and frailty are missing vital opportunities to receive the right support, at the right time. People living with frailty are less able to adapt to stress factors such as acute illness, injury, or changes in their environment, personal or social circumstances; and such changes are more likely to result in adverse health outcomes and an earlier loss of independence. We receive lots of contacts to our Dementia UK Helpline in relation to aspects of frailty, some of these refer to unrecognised frailty, and others to seeking an understanding of the signs and symptoms of frailty syndromes. We have developed a unique and innovative frailty Consultant Admiral Nurse role and service to address this concern. This service has been developed alongside a recognition of an overall need for better national awareness, knowledge, resources, and support around the management of frailty and dementia. The aim of the nationally delivered service is to provide professional leadership, consultancy, education, alongside offering expert clinical practice to families. The service has been operational for 12 months, and with excellent quantitative and qualitative outcomes to date, we now hope to grow the service further. To date, 536 people have received specialist frailty and dementia training. Within the first year of operational service, clinical interventions equated to 2862 activities (directly delivered to support families). From carers surveyed, 100% of survey respondents stated that the service helped them in their ability to respond to and manage symptoms of frailty occurring alongside dementia, 100% of respondents stated that the service helped them in their understanding of frailty occurring alongside dementia and furthermore; 100% of respondents stated that the service helped them in their ability to cope with the challenges posed by frailty occurring alongside dementia.
Lancashire and South Cumbria Integrated Care Board
Care home vaccinations project
Since the pandemic began, people living and working in care homes have been disproportionately affected by COVID-19. The Joint Committee on Vaccination and Immunisation (JCVI) have advised the first priority group for receipt of COVID vaccination are residents in care homes for older adults and their carers. This is to protect both residents and staff. In a nationwide first, during the Autumn/Winter 2023 COVID-19/Flu vaccination campaign, we led a new model of delivery that aimed to improve vaccine uptake, and the overall experience of vaccination among residents and staff of care homes at Risedale Care Homes in Barrow-in-Furness. This approach to the winter vaccination campaign successfully utilised the unique bond between residents by training and supporting the brilliantly competent nurses in the care home to administer vaccinations. We developed and delivered a practical, in-person training programme which enhanced the NHS standard online vaccination training and incorporated peer support for registered nursing staff to undertake vaccinations. The new model resulted in increased vaccination uptake among residents and, significantly, among staff. Residents COVID-19 vaccination uptake increased from 259 in the previous winter campaign to 294. Staff vaccinations for COVID-19 increased from 25 in the previous winter campaign to 156, which represents 6.24 times more staff vaccinated against COVID-19 in 2023 than in 2022. In addition to these statistics, the care home residents, their families, staff and the PCN members described that the new model improved the experience for all involved, both in the deployment of the new model and in the vaccination experience. There is support to scale up this model across the region and we are working with NHSE colleagues to address the contracting mechanisms that would facilitate wider implementation of the model.
Lancashire and South Cumbria NHS Foundation Trust
Reducing patients’ anticholinergic burden score on admission
Skylark ward team aimed to reduce patients’ anticholinergic burden score (ACB) on admission to the ward. The aim was for the anti-cholinergic burden score to be completed for 100% of patients admitted to Skylark Older Adult Mental Health ward within a week of admission, and any patient scoring 3+ to have a full anti-cholinergic burden medication review within one month of admission. Service users/carers were involved in their medication reviews and in any discussions on the reduction or discontinuation of any medications. the team deliberately took a gentle approach to discussing the risks of a high ACB score with patients because they did not want to cause extra anxiety or distress, especially when sometimes reducing the ACB burden is clinically risky itself. Initially the team introduced a standardised ACB screening tool – this was administered by team pharmacists and/or consultant within 1 week of admission. The team standardise reporting of ACB scores for discussion in ward MDT. The initial review of patients informed care planning and prescribing practice with a view to reduce ACB if greater than 3. The team delivered a package of ACB awareness training to clinical team in support of this improvement - this was delivered to all registered nurses, medical staff and Allied Health Professionals on the ward.
Leeds Teaching Hospitals NHS Trust
SIGHT C. difficile campaign 16 years on – a reduction of cases in specialty and integrated medicine
The Specialty and Integrated Medicine (SIM) unit in Leeds Teaching Hospitals Trust (LTHT) experienced a 44.7% rise in cases of Clostridioides difficile infection (CDI) in 2022/23. In the first half of 2023/24 CDI cases increased at a similar rate. In this clinical unit, 13 of 17 wards are for older adults and clinical concerns were raised as mortality rises following CDI in adults over 65, and steeply in those over 85 (UKSHA 2023). Control of infection in this group is difficult due to complex care needs, and confused patients walking with purpose. In 2023/24, LTHT agreed a trust-wide annual commitment to reduce healthcare associated infections (HCAIs), the SIM unit embarked on a 10-week multidisciplinary campaign to drive the reduction of nationally reportable CDI. Following an initial staff focus group exploring areas of new opportunity, a wide range of interventions were structured around the mnemonic SIGHT (DOH 2008) with a campaign strapline ‘Keep your eyes on best practice, Spread the message, not the spores!’. Since the introduction of the campaign, the unit experienced stabilisation of CDI in Quarter 3, and a reduction in Quarter 4 2023/24. In April 2024 SIM had only three cases of CDI compared with eight in April 2023. The CDI per 1000 bed-day data demonstrates that infections were below the mean for the last six months of the year. It is hoped the evaluation of, and sharing learning from, the campaign will have a positive impact on future HCAI reduction campaigns across our large Teaching Hospitals Trust, which will impact positively on both patient safety and experience. Resources from the campaign have been shared with the UK Health Security Agency (UKHSA), and the SIM team are planning to present at the UK’s Infection Prevention Society conference and hope to publish in national IPC journals.
Mersey and West Lancashire Teaching Hospitals NHS Trust
Urgent community response frailty
As our population is aging and people are living longer and with the huge pressure on the NHS in particular accident and emergency, it is paramount that we avoid hospital admission for our frailty population. Urgent community response teams provide urgent care to people in their own homes, which helps to avoid hospital admissions and enable people to live independently for longer. As a service we have experienced a growing number of referrals and our workforce has been increased to meet demand.
Middlesex University in partnership with North Central London Integrated Care Board and North Central London Training Hub
Using simulation learning for adult social care nurses
Adult social care (ASC) nurses advised of the desire to access high quality clinical training with competency sign off. This aligned with the analyses of NHS data, which indicated the need for further training provision to ASC nurses, particularly to enhance the level of knowledge and skill with infection control precautions with an aim to reduce catheter associated infections. North Central London (NCL) ASC Education Lead collaborated with Middlesex University (MU) Head of Clinical Skills and Simulation Centre, ASC nurses and residents to develop a bespoke one-day training and assessment programme on catheter care. The focus of this training was aimed at catheter care competency and associated infection control precautions. This training programme enabled ASC nurses to attend MU’s simulation centre to undertake contextualised simulated learning experiences through immersion, reflection, feedback and practice in a controlled environment, where it is safe to make mistakes and learn from these. The training was facilitated by experienced nurse lecturers. ASC nurses were able to have hands on experience during this training with the insertion, removal and overall management of catheters using mid fidelity simulators which provide as close to reality learning experience as possible. The collaborative partnership allowed for identified challenges to be addressed promptly, an example of this was the need to provide more time for learning around aseptic non-touch technique. For any nurses who were unsuccessful in the competency sign-off were provided with further support to ensure that the nurse felt secure in their knowledge and skill and that competency was achieved. We also offered additional time with the nurse within the clinical setting or return to the simulation centre for further support. The training programme has resulted in the reduction of relevant infections and has allowed for the development of further bespoke training programmes for the ASC nurses.
Midlands Partnership University NHS Foundation Trust
The Green Wellbeing Project
The Covid-19 pandemic brought unprecedented challenges and vulnerabilities to healthcare systems, particularly in care homes and support facilities. In response, the Green Wellbeing Project — aimed to redesign care service delivery in these settings and prioritise mental health and wellbeing . The project integrated the National Health Service (NHS) ‘delivering a net zero’ plan (NHS England, 2020) into care delivery. Affording residents the opportunity to follow their hobbies and interests, with the added benefit of improving mood and reduced rates of hospital admissions and GP visits through early identification of deterioration. The project leads completed a successful application to the Queen’s Nursing Institute (QNI), Elsie Wagg annual scholarship programme, which supports nurses to deliver gardening projects in conjunction with the National Garden Scheme (NGS). A £5000 funding grant was used to help initiate the project and it was agreed with the project leads and care home managers that the project would be delivered through a six-week pilot. Through these sessions, healthcare professionals delivering the project holistically assessed the residents, observing any barriers to optimising their health and wellbeing. Continuity in care delivery was provided to enable early identification of deterioration in residents and a non-pharmacological approach to therapy-based care interventions was used. This included residents taking part in several activities, exploring the outdoor space and accessing gardens. Time restraints and availability of clinicians posed a challenge but the involvement of students and VCSE organisations supported this. The project outcomes showed enhancements in quality of care for residents and reduced healthcare costs by taking a more preventative approach to care and providing timely interventions and early assessment of needs. This contributes to a more sustainable future. The project identified that continuity of care delivered by the same health professional is a major factor for effective and efficient healthcare.
Rotherham NHS Foundation Trust
Person-centred approach to reconditioning
The initiative aimed to recognise the importance of Person Centred Care to enhance the quality of care for older people, particularly post-Covid, and promoting their health, independence, and wellbeing. To tackle these challenges, the Trust implemented a series of strategies and interventions. This included initiatives such as the “You Look Your Best When You’re Up and Dressed” campaign, which encouraged patients to get out of bed and dressed by 11:30 each day. Additionally, the Trust designed new bedside boards to facilitate communication, assessed patients for their walking aids and dietary needs, and introduced various amenities such as bus stops on medical wards to promote mobility and social dining through initiatives like “Tea for Two.” Throughout the implementation process, the Trust faced several challenges, including resource allocation, staff training, and ensuring multidisciplinary collaboration. However, they overcame these obstacles through dedicated efforts, such as organising rapid improvement events and launching monthly Trust-wide Person-Centred Care Study Days. The outcomes achieved by the initiative were significant. They successfully decreased the length of stay for older patients, improved patient experience indicators based on data from complaints per 1000 bed days, and enhanced various aspects of care, including reconditioning, dementia care, nutrition, and end-of-life care. Looking ahead, the Trust plans to build upon the success of the current initiatives by continuing to foster a person-centred approach to care, expanding initiatives and exploring new opportunities for innovation and improvement. Additionally, they aim to further integrate nursing leadership into multidisciplinary teams to ensure sustained progress and excellence in care provision for older patients across all settings. Stow Healthcare and University Hospitals of Leicester NHS Trust The Decaf Project Could introducing decaffeinated drinks reduce falls associated with toileting? This was the question first explored by University Hospitals Leicester in 2021 and taken up in social care by trade association Care England and elderly care provider Stow Healthcare in 2023. Caffeine has a diuretic effect, impacting the bladder and bowel and increasing the urgency of using the toilet. This may be a contributing factor to falls, particularly among elderly or infirm people who often have limited mobility and a higher prevalence of incontinence than the general population. In this innovative cross-sector learning opportunity, the three organisations operationalised a unique trial focused on a low/no cost innovation to improve lives and potentially reduce the significant cost to the NHS associated with fractures caused by falls (£4.4bn per annum). UHL and Stow Healthcare engaged staff and participants with both blind taste testing and health information around the potential health benefits of reducing caffeine intake. This resulted in a high take up of decaffeinated products – 89% of Stow Healthcare’s 350 elderly residents chose to take part in the trial. In both settings, caffeinated products always remained available upon request, with decaf becoming the default option. UHL’s trial saw an initial reduction of 30% in falls occurring on the way to the toilet, eventually dropping by 61% compared to pre-trial by Autumn 2023. In Stow Healthcare’s care homes, toileting-falls reduced by 35% compared to pre-trial data. Both organisations are now recommending decaf as the default option. Challenges have included accurately identifying falls associated with toileting, which can be more complex in those unable to vocalise reasons for their fall, and sharing information effectively to engage participants and staff. Enthused by the excellent results, Care England, UHL and Stow Healthcare are promoting their work nationally to engage ICBs, acute settings and social care providers.
Royal Wolverhampton NHS Trust
Femoral fracture service
Prior the establishment of the Femoral Fracture Service, it was evident that inconsistencies were prevalent in the care received by patients sustaining femoral fractures. The best practice tariff (BPT) figures reflected these gaps in care provision. The discrepancies in care were particularly visible on weekends, holidays, and in the care of patients admitted overnight. The primary aim of forming the Femoral Fracture Service was to ensure that there was a consistent and improved service was provided for patients sustaining this form of fracture. The service aimed to ensure that all elements of the BPT were addressed and the fundamental aim was to strive to provide a consistent and improved standard of care for femoral fracture patients. The provision of this service aims to improve the patient journey. This is done by ensuring that there is continuity and improved communication with the patient and members of the MDT which subsequently improves the patient outcome. The team is committed, dedicated, and all share a common goal to improve the patient experience. The Femoral Fracture Service consists of a Complex Trauma Lead and two Femoral Fracture Nurse Practitioners. The expansion of the service has enabled us to provide a seven-day service. As the Complex Trauma Lead and a trainee ACP I have completed the Health Assessment module and the V300 prescribing module. This enables the team to provide holistic care for femoral fracture patients at the Royal Wolverhampton NHS Trust. The Femoral Fracture Team takes a leading role in service and staff development.
Stow Healthcare, University Hospitals of Leicester NHS Trust and Care England
The Decaf Project
Could introducing decaffeinated drinks reduce falls associated with toileting? This was the question first explored by University Hospitals Leicester in 2021 and taken up in social care by trade association Care England and elderly care provider Stow Healthcare in 2023. Caffeine has a diuretic effect, impacting the bladder and bowel and increasing the urgency of using the toilet. This may be a contributing factor to falls, particularly among elderly or infirm people who often have limited mobility and a higher prevalence of incontinence than the general population. In this innovative cross-sector learning opportunity, the three organisations operationalised a unique trial focused on a low/no cost innovation to improve lives and potentially reduce the significant cost to the NHS associated with fractures caused by falls (£4.4bn per annum). UHL and Stow Healthcare engaged staff and participants with both blind taste testing and health information around the potential health benefits of reducing caffeine intake. This resulted in a high take up of decaffeinated products – 89% of Stow Healthcare’s 350 elderly residents chose to take part in the trial. In both settings, caffeinated products always remained available upon request, with decaf becoming the default option. UHL’s trial saw an initial reduction of 30% in falls occurring on the way to the toilet, eventually dropping by 61% compared to pre-trial by Autumn 2023. In Stow Healthcare’s care homes, toileting-falls reduced by 35% compared to pre-trial data. Both organisations are now recommending decaf as the default option. Challenges have included accurately identifying falls associated with toileting, which can be more complex in those unable to vocalise reasons for their fall, and sharing information effectively to engage participants and staff. Enthused by the excellent results, Care England, UHL and Stow Healthcare are promoting their work nationally to engage ICBs, acute settings and social care providers.
Tameside and Glossop Integrated Care NHS Foundation Trust
ME in deMEntia
Our aim was enable staff to recognise the challenges patients with dementia face when admitted to hospital to facilitate empathy. Building empathy amongst staff is an important aspect of caring for people with dementia. It was our intention to make participants feel disoriented, insecure and anxious, before placing them in familiar situations used in clinical practice within this organisation. We ran four pilot sessions deliberately inviting a diverse group of staff ranging from volunteers to the Medical Director, and focused on all feedback in to ensure the end result was the best possible version of a Dementia Simulation training we possibly could. We did face some challenges sourcing some of the equipment required, but managed to overcome this. The training requires two rooms within the same building which was at times logistically difficult, and was initially resource heavy. We now use the same two rooms one day a month, and run a morning and afternoon session on that day. Despite consideration of equality and diversity impact, we did encounter some obstacles throughout our journey, which we had failed to recognise initially. After four pilot sessions we managed to curate a more considered simulation, with suitable methods of adaptation for equality and diversity requirements. Due to the popularity of this training we have been able to use this to increase the attendance at our Dementia Awareness sessions, by making it it prerequisite to attend this first. -We have been approached by a number of organisations within Greater Manchester, who are keen to adopt this training for their staff. -It is our intention to further develop a catalogue of scenarios for simulation based on clinical incident themes and complaints to ensure this offer remains contemporaneous and meaningful.
University Hospitals of North Midlands NHS Trust
Older adult's diversional therapist pilot
During the winter of 2022 falls across our Older Adults wards had increased with severe harm. My vision was to expand on a role we had previously attempted to initiate with an activity co-ordinator and develop a team of Diversional Therapists that would work alongside our nursing teams on the inpatient wards to assist with planning and promoting patient activities to engage patients and encourage patients to maintain mobility. The overall impact of this new service was to improve patient experience, and motivate patients to want to sit up, get dressed and to keep moving with the ultimate goal to reduce our inpatient falls with severe harm. The vision was to have a diversional therapist on each of the 6 inpatient older adult wards. The initial challenge we faced was the funding of the pilot. At the time, we had a number of nursing assistant vacancies that had not filled across Older Adults. Following discussions with both divisional and directorate mangers, we decided that we would use one nursing assistant vacancy off each ward to fund the pilot as the diversional therapists would be a band 2. Working with our clinical educator for Older Adults we developed a competency booklet for the diversional therapists as we were aware that there was no other role within the trust like this. We also developed a Diversional Therapist communication form. The trusts Charity funded trolleys and equipment. Since the initial pilot commenced, we have seen a reduction in falls with severe harm along with a reduction in hospital related harms such as pressure damage. We have also seen a reduction in complaints along with a reduction in reported incidents related to patient violence and aggression towards staff and other patients. We have had phenomenal feedback from staff, patients and their relatives.