“Keeping it simple means it's not only easy to implement, but also easy to sustain.”
Sundus Jawad, Prescribing and Care Homes Support Pharmacist, East Berkshire Clinical Commissioning Group
Overview

Fewer residents are suffering urinary tract infections (UTIs) following the introduction of a hydration programme in care homes. UTIs are closely associated with dehydration. The Good Hydration! project was designed to encourage residents to drink more fluids with the aim that this would lead to fewer UTIs requiring medication or hospital admission. This approach involved introducing structured drinks rounds seven times a day, designed and delivered by care home staff.

This initiative was developed by the Oxford Patient Safety Collaborative and East Berkshire Clinical Commissioning Group. Across these care homes there was a 36% reduction. The number of UTIs requiring antibiotics also fell by 58% with the frequency of UTIs dropping from one every nine days to one every 80 days. One residential home was UTI-free for 243 consecutive days. Skin integrity also improved and GP calls fell. These improvements have been sustained.

The Good Hydration! approach quickly spread to six more care homes in east Berkshire and three in Oxfordshire – making 13 in total. Plans to implement Good Hydration! programmes are also being developed in Luton, Milton Keynes, Berkshire West, Swindon, Coventry and Rugby with more regions expressing interest.  Project resources, including a series of animated videos, have been developed and shared to spread the learning among care home staff. The Good Hydration! project has won a number of national prizes and awards.

Aims, objectives and scope

Oxford House ice lollies for residents - hydrationDehydration is one of the most common causes of admission to hospital for care home residents. One in four nursing home patients admitted to hospital is dehydrated. Dehydration increases the risk of urinary tract infections (UTIs) which can lead to multiple complications including confusion, falls, acute kidney injury and hospital admission.

The Oxford Patient Safety Collaborative identified addressing care home hydration as a key priority within its acute kidney injury programme.

To address this it began building relationships initially with Windsor, Ascot and Maidenhead Clinical Commissioning Group (now East Berkshire CCG) and residential/nursing homes in their area.

A pilot project was established in 2016 with four care homes in east Berkshire with a total of 150 residents. These homes had above average hospital admission rates for UTIs over the previous three years.

Method and approach

Hydration training was delivered to more than 220 care home staff who then designed and delivered structured drinks rounds seven times every day. The trolleys were bright, inviting and offered multiple options of drinks, cups and glasses. Staff used their imagination to create attractive themed trolleys, e.g. Halloween/St Patrick’s Day/sporting events.

Measurement plan

A PDSA cycle was applied:Oxford PSC PDSA cycle hydration

Find out more here.

Results and evaluation

Oxford PSC Hydration - Halloween

The initial target was to reduce UTI-related hospital admissions year-on-year by 5%. In reality the results were far more impressive. Across the four care homes in the pilot there was a 36% reduction. with just four UTI-related hospital admissions in the first nine months of 2017/18. UTIs requiring antibiotics also fell by 58% with the frequency of UTIs dropping from one every nine days to one every 80 days. One residential home was UTI-free for 243 consecutive days.  Skin integrity also improved and GP calls fell. These improvements have been sustained.

The four pilot care homes also demonstrated sustained compliance with the commitment to provide seven structured drinks rounds each day. Qualitative data from a focus group of managers and staff indicated that residents were more alert and willing to participate in activities. One resident who had had recurrent UTIs every six weeks was UTI-free for eight months after getting actively involved in the project and recording their food and fluid intake in a diary. His mobility and social interaction improved as a result too.

The Good Hydration! project has won a number of national prizes and awards:

  • NICE Shared Learning Award 2018 – overall winner
  • HSJ Patient Safety Award 2018 – quality improvement initiative of the year
  • PrescQIPP Awards 2017 – three prizes.
Feedback

“I like all the choice and I’ll carry on having the cold drinks in the winter too..”

Care Home resident

“The training has given us understanding of why it’s important to ensure that residents have enough fluids – it’s looking at the whole system, not just a drink.”

Care home staff member

“It’s going great here. We’ve gone from a UTI every three days to some months when we have none at all.”

Julie Bignal, Care home manager

“We’ve demonstrated that introducing structured drinks rounds and educating care staff around the importance of good hydration improves patient outcomes and significantly reduces risk of urinary tract infections. That’s really good news for residents who are less likely to spend time in hospital or take additional medication as a result.”

Sundus Jawad, Lead medicines optimisation care homes pharmacist

Learning points
  • Always have a dedicated local authority or clinical commissioning group link who knows the care home, works with them and who can support them, especially until this approach becomes routine practice.
  • Extra support is necessary in the first three months of the project.
  • It would be wise to include HealthWatch at the beginning of the project and also look at cross-boundary working including infection control, pharmacists etc.
  • Review guidance on UTI management locally in care home and GP services and implement good practice guidance.
Start and end dates

July 2016 to present

Contact us for help and advice

Katie Lean, Patient Safety Manager, Oxford AHSN/Oxford Patient Safety Collaborative
E: [email protected]

More AHSN hydration projects

Kent, Surrey and Sussex AHSN has a hydration in care homes programme. For more details read the case study.