Abstract
Introduction
This report aims to demonstrate how a podiatry service quality improvement project into a residential care home was implemented and why it was needed. Risk of foot ulceration increases in those with age, neuropathy, peripheral vascular disease and immobility. In 2013 the Sunderland Care Commissioning Group piloted, through the readmission scheme, a podiatry service providing specialist care into 11 care homes in the Coalfield’s locality of Sunderland, which are a mixture of both nursing and residential homes. The service provides, foot care for all residents and prevention strategies for those classed at risk of developing foot ulceration and to provide specialist wound care interventions for residents presenting with foot ulcers into each care home in the Coalfield’s locality. There are financial constraints to rolling out the Coalfield’s model to the further 36 care homes in Sunderland. Therefore, a new model was explored. This is a high-risk model only, piloted in one care home.
Methods
Driver diagram was used to define key problems, activities required to deliver improvement. Fish bone diagram was used to establish the route cause analysis. The plan do study act (PDSA) cycles were used to pilot the interventions at the study site to ensure effective small change The Comb-B Behaviour Change Wheel was also included to ensure that interventions undertaken were sustainable by identifying the behavioural change required.
Results
There were no pressure injuries identified at post-intervention, this was a significant improvement from baseline. Staff had referred three grade 1 pressure injuries and one foreign body, one foot pain and two trauma ulcers during the intervention, showing a 300% increase in reported grade 1 pressure injuries.
Conclusions
This quality improvement project has demonstrated a person centred, evidence based, older person service delivery for sustainable future that embeds a multi-disciplinary team to the high-risk podiatry model of service. It has shown that behavioural change has occurred with small change interventions. It has used the robust methodology of PDSA to effect this change and allow for a clear report to be able to articulate the benefit.
130“TO DIP OR NOT TO DIP”: A QUALITY IMPROVEMENT PROJECT TO IMPROVE THE DIAGNOSIS AND MANAGEMENT OF URINARY TRACT INFECTION IN CARE HOMES
