Helping care home residents get the right treatment quickly

Image shows woman in wheelchair having her blood pressure checked

Fessey House is a residential care home in Swindon for people with dementia, learning disabilities and other enhanced needs. Local GP, Chris Turner and Senior Community Nurse, Soghra Bi have been supporting Fessey House to introduce RESTORE2, in collaboration with the local Clinical Commissioning Group (CCG), to help staff more quickly identify when residents’ health is deteriorating.

Here Chris and Soghra share how staff at Fessey House have been supported by the West of England AHSN’s online RESTORE2 training, and how the residents are benefiting.

Soghra Bi, Swindon Intermediate Care Centre Liaison Nurse Assessor, Fessey House:

The carers in Fessey House were enthusiastic from the outset and worked hard to complete the RESTORE2 training. The majority had never taken physiological observations before but quickly became competent in the use of RESTORE2. They found the educational material very helpful.

Feedback from the carers who underwent the training was unanimously extremely favourable. They reported feeling empowered and confident in recognising deteriorating patients and felt better equipped to communicate their concerns to healthcare professionals to ensure that their residents got timely medical care.

The key takeaway message was to keep calm.

Fessey House reports that the RESTORE2 tool has already identified a resident with soft signs of deterioration and staff believe that the use of the tool allowed for earlier identification of deterioration and the need for medical intervention, and that treatment commenced sooner than would have occurred previously.

This resulted in the patient recovering sooner, with less of an impact on their functional ability and avoiding hospital re-admission.

Dr Chris Turner, GP, Swindon Community Health Services, Great Western Hospitals Foundation Trust:

On 7 September I was informed that the RESTORE2 toolkit which Soghra Bi, Senior Community Nurse, and I implemented in Fessey House had saved two GP visits that day.

The first patient was an elderly gentleman who looked unwell and carers identified that he was showing soft signs of deterioration. The carers used the RESTORE2 toolkit and calculated that his NEWS2 score was 7 and so called an ambulance as per the NEWS2 escalation. When the paramedics arrived they were very complementary and impressed with the use of the RESTORE2 tool and after conducting a further assessment of the gentleman, conveyed him to hospital.

The second patient was seen by a community nurse who was visiting to dress a wound on the gentleman’s leg. She took a set of observations and identified that his NEWS2 score was 3. She discussed this with the carers who explained about the RESTORE2 toolkit and that the escalation for such patients was to repeat the observations in 30 minutes. The carers repeated the observations half an hour later whilst the community nurse went on to see other patients. It had returned to zero and so the patient continued to be observed but required no further escalation.

The carers informed me that prior to RESTORE2 being in place they would have contacted the GP to come and see these patients. So this would have resulted in two GP visits from separate practices. Because of RESTORE2, two GP visits were avoided and, more importantly, ensured that one patient was promptly conveyed to hospital, avoiding the delay of waiting to see a GP first.

As a GP I can clearly see how RESTORE2 would benefit patients through the earlier identification of deterioration and treatment commencing earlier. When I am triaging home visits, having a NEWS2 score and soft signs of deterioration available allows me to ensure that a visit is prioritised within an appropriate timescale, and would avoid unnecessary visits where the most appropriate response is an emergency ambulance.

As more care and nursing homes start using the tool, I anticipate that there will be a reduction in unnecessary 999 calls, a reduction in hospital conveyance and a reduction in hospital length of stay for my patients, and a reduction in GP workload.

Do you support services in the West of England that could benefit from our free training?

If so, you can sign up for free RESTORE2 training here.

Would you like to know more about the West of England Learning Disabilities Collaborative?

Please visit our dedicated web pages.

Posted on October 26, 2020 by Chris Turner (GP) and Soghra Bi (Senior Community Nurse)

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