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Reading: A collaborative response to person centred care of East Dunbartonshire Care home residents.

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A collaborative response to person centred care of East Dunbartonshire Care home residents.

Authors:

Michelle Dalgarno ,

GB
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Kerry Donoghue

GB
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Abstract

Introduction: In May 2020, due to COVID outbreaks in our local care homes, East Dunbartonshire HSCP set up a local enhanced service delivered by Advanced Nurse Practitioners (ANP’s). The service was set up in response to the difficulties our care home staff were experiencing, accessing professional support from NHS 24 at the weekend. Due to the unprecedented volume of calls that NHS 24 were receiving, there were subsequent lengthy delays in escalating clinical review of care home residents; resulting in treatment delay, poor symptom control and distress for patients families and staff. Our team consisted of two ANP’s, who responded to calls on a designated mobile phone from care homes experiencing outbreaks in East Dunbartonshire. The ANP would conduct an initial telephone consultation and then decide on an appropriate action. The various outcomes after the initial consult were: face to face assessment, authorisation of Level 2 and 3 medications, remote prescribing, palliative care support and sourcing of controlled drugs if required. The ANP’s would receive a handover from the care home liaison nurses and GP practices on a Friday afternoon for any patients of clinical concern. They would then feedback on a Monday morning to the care home liaison service at the local care home over sight group meeting. The patients GP was also updated on a Monday morning. 

Objectives: Our vision for the service was to provide direct access to a clinician who could review patients in a timely manner with the aim of:

•Reducing patient wait times for clinical review and subsequent management of acute presentations and symptoms at end of life.

•Increase access to face to face review of acutely unwell and rapidly deteriorating residents; with the aim of initiating the most appropriate care.

•Encouraging and supporting anticipatory care planning; liaising with patients and their families to discuss and support their preferred place of care.

•Reducing anxiety experienced by care home staff who were caring for rapidly deteriorating patients.

•Reduced inappropriate hospital admissions.

•Support timely and appropriate conveyance to secondary care. 

Results: Between the 5th of May 2020 and 6th of June 2020 the service received 158 telephone calls. 64 of these resulted in a prescription being generated, 54 for authorisation of medication and 38 resulted in face to face assessment. There were no patients admitted to hospital by the service as care home staff were supported to manage patients within the care home setting with oxygen concentrators being provided by the community respiratory team when requested by the care home directly or ANP.

Conclusion: The service was extremely well received by care home nursing staff, managers and relatives alike. It provided invaluable support during an incredibly stressful time for care home staff. Staff were challenged with looking after rapidly deteriorating patients, some of whom were at end of life, but with the expertise of the ANP service to refer to. Reassurance was given to residents relatives that their loved ones had being seen by a clinician and were updated promptly of the treatment and management plan; ensuring they were involved in decision making and informed at all times.

Implications: The service was an excellent example of collaborative working between the care sector and the health and social care partnership. The oversight group brought together health and social care with commissioning to take a holistic multidisciplinary approach to supporting our care homes during the pandemic. By appropriately realigning this small ANP resource; we ensured maximum impact was achieved in an area of critical concern, without any detriment to the delivery of unscheduled care during the in hours period. We provided a real time solution which was both responsive and effective. Most importantly patient care was positively impacted through a realistic medicine approach. Care home staff were empowered and resilience strengthened during a very challenging period.  

How to Cite: Dalgarno M, Donoghue K. A collaborative response to person centred care of East Dunbartonshire Care home residents.. International Journal of Integrated Care. 2022;22(S3):479. DOI: http://doi.org/10.5334/ijic.ICIC22251
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Published on 04 Nov 2022.

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