This case study looks at a project to develop an effective system to work with vulnerable people in care homes in the North East. The aims were to improve patient safety, reduce emergency hospital admissions and A&E attendance and also reduce medicine wastage.
Summary
A multi-disciplinary team was formed to work closely with all care homes and six general practices across Greater Eston to improve the quality of care that residents receive. As well as being able to better support residents, this project has resulted in significant savings and is attracting interest from people who are keen to register with the care homes involved and neighbouring pathfinders.
The situation before
Residents of care homes are a vulnerable group of patients who are often unable to access, or have great difficulty accessing services within a general practice. Care home staff had many different general practices to communicate with – each with different systems and processes. Also, the figures showed that residents had a high rate of emergency admission and readmission into hospital.
What has been done
A multi-disciplinary team was formed including a nurse practitioner, a chronic disease nurse specialist, a pharmacist and a pharmacy technician. The team covers all of the care homes in the Greater Eston area and works closely with all six general practices for GP support.
The nurse practitioner has both clinical and prescribing skills and can respond quickly to acute problems, visiting the care homes instead of a GP. An individual management plan has been developed for each resident, which includes medication reviews with priority given to new residents and those recently discharged from hospital.
Improvements
Better relationships and communications channels have been formed between the care home staff, GPs and the team to improve the quality of care for residents in the Greater Eston area.
During the project, there has been a consistent fall in emergency admissions and A&E attendance. This has shown annual savings of £122,000 against A&E attendances and outpatient appointments, including a £108,000 reduction for emergency admissions.
In addition, there have been savings on prescribing medication with each resident having a regular medication review by the pharmacist on the team. The evaluation report shows prescribing annualised savings of over £77,000 in the first year.
The number of patients registered with general practices in the care home project has increased by 15 per cent in recent months with the success of the scheme.
Other joint working arrangements with the Macmillan nurse, community psychiatric nurse, a physiotherapist and Speech and Language Therapy (SALT) service have also been very positive.
The care home residents now have a dedicated team in place that can ensure the right care, at the right time, closer to home reducing unnecessary emergency admissions. The team has also worked closely with the Gold Standards Framework and robust end of life pathways, to help residents to stay at home to die if it is their wish.
Dr Janet Walker, Chair of Greater Eston GPCC says, “The project is a really good success because not only has it shown significant cost saving in terms of reduction of medicines wastage and reducing emergency admissions, but it has improved the chronic disease management of this vulnerable group of patients.”
Comments from a survey of carers include:
“Excellent, the nurses are able to spend more time with patients and chat to them. We are able to call on their help with any problem we have.”
“Some health problems have been picked up and treated promptly which we would not have known about. Regular input has meant less need to contact GPs, saving invaluable time for us and them.”
“Pharmacy advice and advice about wound care, chronic conditions etc. have been very beneficial for patients and unqualified staff.”
“Residents feel their health needs are more “looked after” and we find liaison with the nurses quicker and easier than a short visit from the GP. As our nurse visits weekly, some problems can be left till then rather than bothering the surgery”.
Next steps
It is clear that the residents living in the care homes involved in this project value the service they are receiving. As a result, there has been more interest from people keen to register with these care homes.
The next phase of the project will be to ensure that the project is rolled out further and to increase capacity of the team to satisfy this demand. The project will aim to include social services in the future and the team is keen to share the learning with other pathfinders and use it to develop the virtual ward concept – providing support in the community to people with the most complex medical and social needs.