In August 2020, four nurses completed the West of England AHSN’s free RESTORE2 Train-the-Trainer learning to implement and embed RESTORE2 into Mortimer House Nursing Home. In this case study, nursing Clinical Lead, Lorna Hewlett, describes her experience of using RESTORE2 and the impact the tool has had on the home’s ability to effectively manage deteriorating residents. Mortimer House has 13 beds, with a team of four nurses and 19 support staff looking after residents.
Lorna, how did you come to embed RESTORE2 within your care home?
We heard about the AHSN’s RESTORE2 learning sessions through the Milestones Trust who were encouraging all homes to take up the offer of free training. All nurses completed the Train-the-Trainer session, and we now deliver training for all new starters, aiming to keep the training at 100%, despite a high turnover of staff. We have adapted the session to suit our local needs, deliver annual refresher training and even deliver sessions during the evening shift to also ensure that night workers are captured.
As a nursing team, we have found short, on the spot, training sessions to be particularly helpful, focussing on smaller and specific elements of RESTORE2. We have found that support workers are confident taking observations, but less confident in documenting the observations on the New Early Warning Score 2 (NEWS2) chart, so we have spent more time focusing on this.
What is the process for escalation in your care home?
After taking observations, if staff have any concerns about residents showing signs of deterioration, the support workers will contact the nurse who is on shift, who will retake observations. The nurse will either continue to monitor more frequently or escalate through the GP or 999 as appropriate. If the nurse is not available, the home manager, also trained in taking observations, will support the care worker to escalate the care. The nurse will be available to provide support where necessary, but the support worker takes the lead. All residents have a nursing plan folder which includes their ReSPECT form, RESTORE2, GP contact details and protocols which we can refer to.
If the support worker is unable to get hold of the nurse, they are now more confident in taking the initiative and starting the escalation process to ensure residents get the right help at the right time.
Additionally, support workers take residents observations at the beginning of every month to ensure that their baseline is up to date. These are recorded on the NEWS2 chart and are used if the resident becomes unwell during the course of that month.
Can you describe a time where RESTORE2 has been particularly helpful?
There have been many occasions, but there was one resident recently who the support worker recognised as being unwell as they were not eating or drinking, were very sleepy and looked pale. The support worker took the observations, and despite these being lower than expected, they followed NEWS2 guidance to contact the out of hours GP. The GP asked what we thought was appropriate, as we know the residents well, and it was agreed to send the patient to hospital where he was admitted immediately.
This admission was in line with the resident’s ReSPECT form; however this has now changed following a review after this latest admission.
Has Restore2 implementation made any impact at Mortimer House?
Prior to the RESTORE2 training, the support workers would frequently rely on the nurses which created a heavier workload for us. The support workers now contact us with more appropriate concerns, as they feel empowered to start the process of getting the right help for the resident. The SBAR (Situation, Background, Assessment, Recommendation) tool has been particularly helpful in giving support workers the confidence to speak to the GP. Their conversations are calmer, and they share all the relevant information with the GP.
It’s also helped the support workers to understand the physiology of the signs of deterioration. They feel that their role is more meaningful and feel empowered to get the additional support when needed for residents. They know the residents best and are best placed to identify when they are deteriorating. The refresher training is important as it helps them to stay competent and confident in their abilities. The more that they practice with the SBAR tool, the more they realise that they’ve got everything across in an efficient way.
RESTORE2 has added a quick ‘go-to’ to our toolkit as it provides an initial response to someone being unwell, which has allowed the team to escalate care if needed. That’s proved really useful for staff and residents.
Posted on April 11, 2023 by Lorna Hewlett, Nursing Clinical Lead, Mortimer House Nursing Home