Case Study: HIWM supporting care homes to use deterioration management tools

Elderly Carer Sitting With Two Of Her Patients having tea

What is the Health Innovation West Midlands (HIWM) deterioration improvement programme?

Delivered by the West Midlands Patient Safety Collaborative (WMPSC), which is hosted by the HIWM, the safety and improvement team designed and delivered an improvement programme to upskill and empower the care home workforce to recognise and respond more effectively to residents showing signs of deterioration.

Previously, a HIWM-led audit showed inconsistent escalation pathways for deterioration between healthcare professionals across the region. This resulted in delayed escalation of care for some residents and avoidable hospital admissions for others, so the new improvement programme was developed to improve this.

What were the aims of the deterioration improvement programme?

To support and upskill the care home workforce in recognising and responding to deteriorating residents.

To improve consistency between healthcare professionals across the region in escalation pathways for deterioration.

To reduce avoidable hospital transmissions in patients and improve the rate of escalation of care for those who need it.

What did we do?

HIWM safety & improvement team developed a webinar series to upskill care home staff in recognising deterioration in residents and to escalate it as early as possible. The series included three learning sessions across a three-month period, as well as a dedicated webinar for services who support care homes such as GP practices and Community Healthcare NHS Trusts.

The team also built six Integrated Care Systems (ICS) Deterioration Safety Networks across the West Midlands to ensure strategic transformation. The networks meet on a quarterly basis and include a multitude of system partners including Primary Care, Community Health Trusts, and Acute Trusts.

What were the outcomes?

In 2020/21, the HIWM improved the managing deterioration support programme, growing uptake from 45 to over 750 care homes, and over 22,500 residents – 45% of the region’s total. The care homes engaged are now implementing or have adopted deterioration management tools.

223 GP practices across four ICS’ have also been trained and 100% of Community Trusts and Mental Health Trusts in the West Midlands are now using the deterioration management tools.

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Jo Stinton, manager of Marian House Nursing Home in Birmingham, said: “We introduced the Stop and Watch soft signs tool following the workshop and the impact has been tremendous. We are able to identify residents more quickly when deterioration happens, and audits show improved health outcomes. The involvement of other professionals has also changed as they can see we have put reasonable actions in place and we make less referrals, which are timelier and more focused.”

Caroline Morris, manager of Bradwell Hall Nursing Home in Staffordshire, added: “By the staff introducing the deterioration management tool, we have reduced risks for our residents. We have prevented harm by early detection, resulting in a reduction in safeguarding referrals. The falls rate for the service is low, there are no home-acquired pressure injuries, and the early detection has also resulted in hospital avoidance.”

Dr Steve Fawcett, Medical Director for North Staffordshire CCG and Stoke-on-Trent CCG, commented: “The programme has allowed health services, local authorities, and providers to come together with a common purpose. It has delivered real quality improvement for care home residents alongside supporting staff, while at the same time helping system partners – it can genuinely be described as transformative.”