scholarly journals Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050665
Author(s):  
Jason Scott ◽  
Katie Brittain ◽  
Kate Byrnes ◽  
Pam Dawson ◽  
Stephanie Mulrine ◽  
...  
Keyword(s):  
Data Extraction ◽  
Care Home ◽  
Incident Reporting ◽  
Care Homes ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Safety Issues ◽  
Care Home Staff ◽  
Service Specification ◽  
The Impact

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

scholarly journals Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fiona Marshall ◽  
Adam Gordon ◽  
John R. F. Gladman ◽  
Simon Bishop
Keyword(s):  
Central Government ◽  
Resource Constraints ◽  
Care Delivery ◽  
Care Home ◽  
Third Sector ◽  
Care Homes ◽  
Framework Analysis ◽  
Local Networks ◽  
Care Home Staff ◽  
East Midlands

Abstract Background From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed. Methods Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals. Results Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care. Conclusions This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

scholarly journals The Contribution of Pharmacists and Pharmacy Technicians to Person-Centred Care within a Medicine’s Optimisation in Care Homes Service: A Qualitative Evaluation

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 34
Author(s):  
Sally Fowler Davis ◽  
Rachel Cholerton ◽  
Louise Freeman-Parry ◽  
Jo Tsoneva
Keyword(s):  
Care Home ◽  
Pharmacy Practice ◽  
Qualitative Evaluation ◽  
Care Homes ◽  
Framework Analysis ◽  
Medicines Management ◽  
Team Members ◽  
Care Home Staff ◽  
Management Interventions ◽  
Pharmacy Technicians

Pharmacists and pharmacy technicians seek to improve person-centred care. Improvements to systems for care homes seeks to reduce medicines waste and inefficiency, particularly through supporting care home staff, to enhance safer administration of medicines. A complex evaluation used qualitative design and utilised narrative enquiry, and team members and key stakeholders were interviewed. Framework analysis was used, aligning findings to a person-centred care framework for older people. The Medicines Optimisation in Care Homes (MOCH) team brokered improvement practices across care homes to enhance person-centred care. The framework analysis confirms that the team used ‘authentic attention’ in relation to the residents’ experiences and flexibility in relation to negotiating medication. The importance of transparency of processes and systems in medicines management is highlighted, alongside requirements for person-centred care to make explicit the reason for taking a medication, and the continuous discussion with a range of stakeholders about the continuing need for particular medications. The outcome of the evaluation includes insights into a new area of pharmacy practice in community, based on the skills, knowledge, and experience of pharmacists and pharmacy technicians working in the care home sector. Further study is needed into the efficacy and outcomes of medicines management interventions.

scholarly journals Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

2020 ◽  
Author(s):  
Fiona Marshall ◽  
Adam L Gordon ◽  
John RF Gladman ◽  
Simon Bishop
Keyword(s):  
Central Government ◽  
Resource Constraints ◽  
Care Delivery ◽  
Care Home ◽  
Third Sector ◽  
Care Homes ◽  
Framework Analysis ◽  
Local Networks ◽  
Care Home Staff ◽  
East Midlands

AbstractBackgroundFrom late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed.MethodsTen managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals.ResultsThree key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care.ConclusionsThis study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

scholarly journals Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19

2021 ◽  
Author(s):  
Clarissa Marie Giebel ◽  
Kerry Hanna ◽  
Jacqueline Cannon ◽  
Paul Marlow ◽  
Hilary Tetlow ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Care Home ◽  
Home Visitation ◽  
Control Measures ◽  
Care Homes ◽  
Family Carers ◽  
Care Home Staff ◽  
The Uk ◽  
The Impact

Background: Vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods: Family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results: Across 62 baseline and follow-up interviews with family carers (n=26; 11) and care home staff (n=16; 9), five core themes were developed: Delayed and inconsistent offers of face-to-face visits; Procedures and facilitation of visits; Frustration and anger among family carers; Variable uptake of the COVID-19 vaccine; Misinformation, education, and free choice. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions: We make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff.

scholarly journals The “Cameos of Care Homes” project – care home staff’s Vanguard involvement and reflections

2019 ◽  
Vol 23 (2) ◽  
pp. 107-115
Author(s):  
Jess Harris ◽  
Jill Manthorpe
Keyword(s):  
Design Methodology ◽  
Research Output ◽  
Care Home ◽  
Care Homes ◽  
Content Type ◽  
Care Home Staff ◽  
Learning Cultures ◽  
Care Workers ◽  
The Impact ◽  
Practical Implications

Purpose The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes’ learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure.

scholarly journals Remembering the past, enhancing the present and sharing the future: a qualitative study of the impact of film screenings in care home communities

2020 ◽  
pp. 1-26
Author(s):  
Jenna P. Breckenridge ◽  
Thilo Kroll ◽  
Gavin Wylie ◽  
Ana Salzberg
Keyword(s):  
Qualitative Study ◽  
Care Home ◽  
Social Activity ◽  
Care Homes ◽  
Social Connection ◽  
Emotional Wellbeing ◽  
Care Home Staff ◽  
People With Dementia ◽  
The Rich ◽  
The Impact

Abstract Many care home residents lack opportunities for meaningful activity and social connection, resulting in poor physical and emotional wellbeing. Providing residents with varied activities and social opportunities can improve their quality of life. In this paper, we examine the potential for film to provide a meaningful, social activity. The limited existing research on film in care homes has predominantly examined the use of film clips and materials in stimulating reminiscence for people with dementia. In this paper, we adopt a broader, trans-disciplinary perspective of film, drawing on evidence from Film Studies that shared spectatorship has social and emotional benefits for the viewer. We offer the first qualitative study of care home residents’ social, emotional and embodied engagement with feature-length film and identify the key benefits of film in this setting. We ran social film screenings in two Scottish care homes over six weeks. Underpinned by psycho-cinematic theory, we collected and analysed observational data alongside interviews with care home staff and discussion groups with residents. Our findings identified three ways in which film screenings benefit residents and supports social connection: prompting reminiscence; enhancing residents’ experiences in the present; and creating a shared future and intergenerational connections. The paper offers useful insights into the rich potential for film to enhance the care home community, facilitate social connectivity and promote resident wellbeing.

scholarly journals EMPOWERING CARE HOME STAFF TO DELIVER QUALITY END OF LIFE CARE: THE IMPACT OF THE SIX STEPS TO SUCCESS PROGRAMME ON END OF LIFE CARE IN CARE HOMES IN NORTH WEST ENGLAND

2014 ◽  
Vol 4 (Suppl 1) ◽  
pp. A32.2-A32
Author(s):  
Mary O'Brien ◽  
Jennifer Kirton ◽  
Katherine Knighting ◽  
Rob Gandy ◽  
Barbara Jack ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Home ◽  
Care Homes ◽  
Life Care ◽  
North West ◽  
Care Home Staff ◽  
The Impact

scholarly journals 210 - Are visits allowed? The impact of the COVID-19 pandemic on care home visitation and care delivery in the UK

2021 ◽  
Vol 33 (S1) ◽  
pp. 12-13
Author(s):  
Clarissa Giebel ◽  
Kerry Hanna ◽  
Jacqueline Cannon ◽  
Hilary Tetlow ◽  
Paul Marlow ◽  
...  
Keyword(s):  
Research Team ◽  
Care Delivery ◽  
Care Home ◽  
Family Members ◽  
Care Homes ◽  
Family Carers ◽  
Care Home Staff ◽  
The Uk ◽  
The Impact

Background:COVID-19 has caused the sudden closure of care homes to the outside world, to stem the virus from infecting some of the most vulnerable groups of people – older adults residing in care homes. With very little knowledge to date, we aimed to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members’ perspectives.Methods:Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or Zoom. Participants took part in a semi-structured remote interview. Baseline data were collected between October and November 2020, and follow-up interviews were collected throughout March 2021. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input.Results:42 participants (26 family carers and 16 care home staff) took part in the baseline interviews, and 20 purposefully sampled participants (11 family carers and 9 care home staff) were followed up. Prior to vaccination roll out in the UK, at baseline, family carers expressed concern about a lack of clear guidance throughout the pandemic, with care homes delivering care differently and disparities noted in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Data on follow-up interviews are still being analysed.Conclusions:This is the first empirical evidence to show how the pandemic has caused severe difficulties in providing adequate care for care home residents, with not only residents, but also care home staff and family carers being negatively affected. Follow-up data will shed light onto the impact of vaccination and eased visitation rights put in place since March 2021 on care delivery and connections between family carers and residents.

scholarly journals Study Protocol: Understanding SARS-Cov-2 infection, immunity and its duration in care home residents and staff in England (VIVALDI)

2021 ◽  
Vol 5 ◽  
pp. 232
Author(s):  
Maria Krutikov ◽  
Tom Palmer ◽  
Alasdair Donaldson ◽  
Fabiana Lorencatto ◽  
Gill Forbes ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Qualitative Interviews ◽  
Care Home ◽  
Care Homes ◽  
Test Results ◽  
Care Home Staff ◽  
Co Morbidity ◽  
National Public Health ◽  
Protocol Registration ◽  
The Impact

Global infection and mortality rates from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are disproportionately high in certain populations, including amongst older people. Care home residents are frequently exposed to infection due to contact with staff and other residents, and are highly susceptible to infection due to their age and co-morbidity. In England, official statistics suggest that at least 25% of all deaths in care home residents since the start of pandemic are linked to coronavirus disease 2019 (COVID-19), but limited testing for SARS-CoV-2 early in the pandemic means estimates of the true burden of disease are lacking. Additionally, little is known about patterns of transmission between care homes, the community and hospitals, or the relationship between infection and immunity in care home staff and residents. The VIVALDI study plans to address these questions. VIVALDI is a prospective cohort study aiming to recruit  6,500 staff and 5000 residents from 105 care homes across England. Successive rounds of testing for infection will be performed over a period of 12 months.  Nasopharyngeal swabs will detect evidence of viral RNA and therefore active infection (accompanied by collection of data on symptoms), whereas blood tests will detect antibodies and evidence of cellular immunity to SARS-CoV-2. Whole genome sequencing of viral isolates to investigate pathways of transmission of infection is planned in collaboration with the COVID-19 Genomics UK Consortium. Qualitative interviews with care home staff will investigate the impact of the pandemic on ways of working and how test results influence infection control practices and behaviours. Data from residents and staff will be linked to national datasets on hospital admissions, antibody and PCR test results, mortality and care home characteristics.  Data generated will support national public health efforts to prevent transmission of COVID-19 and protect care home staff and residents from infection. Protocol registration: ISRCTN14447421 05/06/2020

scholarly journals 25 A Pilot Implementation of Providing Enhanced Support to Care Homes within A Primary Care Network

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
R Didehvar ◽  
G Ehtheshamirad ◽  
G Batty ◽  
S Sage ◽  
S Mullins ◽  
...  
Keyword(s):  
Primary Care ◽  
Planning Process ◽  
Care Home ◽  
Care Homes ◽  
Care Planning ◽  
Care Network ◽  
Care Home Staff ◽  
Care Plans ◽  
Pilot Implementation ◽  
The Impact

Abstract Introduction People living with severe frailty in care homes are vulnerable to frequent non-elective hospital attendances. However provision of enhanced healthcare support to care home residents can reduce this risk and increase quality of life for residents.1 The framework for enhanced health in care homes (EHCH) summarises best practice in this area and provides guidance for implementing services.2 Methods This study was a pilot implementation of the EHCH framework based on a Primary Care and Specialist Frailty Multidisciplinary Team (MDT) and delivered on a Primary Care Network (PCN) footprint. The MDT targeted five care homes in a PCN area with historically high levels of non-elective attendances. The model of care was based on the principle of anticipatory care planning, training and support for care home staff to understand and implement plans. Results Over the pilot period of 9 months, non-elective attendances from the 5 homes reduced by 27% compared to the previous year, which was a significant reduction (p<0.042). There was variation between the homes in the reduction in non-elective attendances with the greatest impact seen in the homes that had the highest level of attendance at training and engagement in the care planning process. Feedback received from the care home staff indicated that they felt more confident to refer to the care plans and had alternative options to calling 999. A quality audit of the care plans completed as part of the pilot revealed a number of additional training needs for clinicians completing the plans to ensure consistency of recoding. This training was delivered following the pilot period. Conclusions The pilot demonstrated that the EHCH framework could be successfully implemented on a PCN footprint. Analysis shows this implementation coincided with a reduction in non-elective attendances from the targeted homes. Further analysis is required to compare the impact in different homes and to understand contributing factors. The pilot implementation provides helpful information to inform PCN development. References 1. Lloyd T, Wolters A and Steveton A (2014) The impact of providing enhanced support for care home residents in Rushcliffe: Health Foundation consideration of findings from the Improvement Analytics Unit. The Health Foundation. 2. NHS England (2016) The framework for enhanced health in care homes.

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