85HOW CARE HOMES IDENTIFY ACUTE DETERIORATION IN RESIDENTS AND COMMUNICATE THIS TO NHS PROFESSIONALS

Abstract

Background: Supporting care homes to identify and respond to residents who deteriorate , and to communicate concerns to healthcare professionals, is important. We set out to survey current care home practices with regard to deterioration in the East Midlands of the United Kingdom. Methods: We surveyed 15 care homes taking part in the annual East Midlands Prevalence of Care Problems benchmarking audit. Paper questionnaires were completed alongside the electronic questionnaires which comprise the routine benchmarking audit during a single week in November 2018. Participants were asked 4 categorical response and 6 open answer questions covering recognition of deterioration, use of external agencies and communication protocols. Results: Amongst the 15 participating homes, 14/15 and 6/15 had contacted their usual GP or practice nurse respectively for resident deterioration in the last 30 days. 9/15 and 2/15 had contacted an out-of-hours GP and out-of-hours nurse for deterioration respectively. The average (range) number of contacts with an external healthcare professional for deterioration per home was 7 (1-40). 4/15 homes used the National Early Warning Score (NEWS). One home was piloting the second version of NEWS (NEWS-2) in addition to using NEWS. 2/15 homes used an in-house sepsis screening tool and one home used the Modified Early Warning Score (MEWS) to identify deterioration. 8/15 had no specific tool in place for identifying deterioration. 2/15 and 4/15 homes used the Situation-Background-Assessment-Recommendation (SBAR) and Concern-Action-Response-Examination-Shared Information (CARES) tools respectively when communicating with external agencies. The remainder of homes did not structure their communication using a tool. In free text comments, 5/15 care homes requested further training in identifying and communicating acute deterioration. Conclusions: There is considerable variation in practice regarding the identification of acute deterioration and communicating with health professionals outside of care homes. Over half of participating homes had no solution in place to identify deterioration or communicate their concerns to healthcare professionals. We plan now to audit deterioration practice using these questions on an annual basis and to co-design solutions with care homes in the intervening periods.