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IN DEPTH: FRAILTY CARE


FRAILTY CARE S


COLLABORATING ON Going beyong our hospitals to improve care.


ince April 2019, Rawlda Downes, Trust care home liaison nurse, has been working with Chiswick Nursing Centre and St Vincent’s Nursing Home as part of a pilot to prevent unnecessary hospital admissions.


Based in the care homes four days per week, Rawlda works with the care home managers, GPs, carers and nursing teams to carry out assessments and design care plans for residents. These plans reflect the resident’s frailty score, assessments of their cognition and mental health, as well as wishes and desires for care as they approach the end of life. Care plans are made available to all health professionals involved in the patient’s care to ensure the best treatment plan is in place at every stage. “It’s important to me that we provide care to the residents in the most suitable environment for them, rather than defaulting to admitting them to an acute hospital,” says Rawlda. “Hospital isn’t


always the best place for care home residents. By working with the patient and their family we can include all their needs in an advanced care plan.”


“We started with acutely unwell patients but our ambition is to have a plan in place for every resident across both care homes. As I also support the residents’ families, having these plans in place means everyone is aware of their wishes.”


As part of the role, Rawlda provides adhoc, on-the- spot education and training to the care home staff and GPs. Sessions have included pressure ulcer


Rawlda Downes


management, device care, fluid targeting and fluid balance. She also helps staff manage the challenging behaviours often seen in people with


It’s not unusual for residents to require adjustments to their catheters or to have a mild chest discomfort that often leads to hospital admission. The care home liaison has been able to intervene to help community professionals manage these issues without sending the residents to hospital unnecessarily.


problems affecting communication and the brain, such as a learning disabilities or dementia. For more detailed training needs, the Trust frailty clinical programme manager, Kate Sendall, goes out to the care homes to deliver full-day, bite-size training. “The feedback has been really positive,” says Rawlda. “The care home staff and GPs really believe in this model of care too, so it’s been a great partnership from the beginning.”


BED DAYS SAVED EQUATES TO: CHISWICK NURSING CENTRE


ST VINCENT’S NURSING HOME


953 days 150


in 8 months


in 2.5 months Both equate to a


58% drop in bed days 12 /Trust


LENGTH OF STAY – AVERAGE FOR CARE HOME PATIENTS COMPARED TO LAST YEAR


CHISWICK


average stay of 9.7 days down to 6.8 days


23%


ST VINCENT’S average stay of


7.6 days down to 5.4 days 29%


REDUCTION IN THE NUMBER OF RESIDENTS ADMITTED COMPARED TO LAST YEAR:


45% CHISWICK ST VINCENT’S 59% www.imperial.nhs.uk


TOTAL AVERAGE COST SAVED SINCE APRIL 2019:


£460,976*


*Costs based on £400 national average for a bed day and £206 Trust estimate for an emergency attendance


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