As we mark the Institute of Healthcare’s (IHI) Patient Safety Awareness Week, Natasha Swinscoe, patient safety national lead for the AHSN Network, looks at the importance of safer care in community settings, such as care homes.
Patient safety awareness week is an opportunity to celebrate the NHS as a world-leader in recognising and promoting better patient safety. The national Patient Safety Improvement Programmes (SIPs) collectively form the largest safety initiative in the history of the NHS. They are delivered by 15 Patient Safety Collaboratives (PSCs), each hosted by an Academic Health Science Network (AHSN).
However, while we have done some work in out-of-hospital settings in the five years since PSCs launched, there is massive potential to explore improving patient safety outside of acute hospital trusts and expanding into more community settings.
The IHI sees patient safety as a public health concern. Everyone interacts with the healthcare system at some point in their life, and so we all have a role to play in advancing safe health care. One place we see this manifest on a daily basis is in care homes, which look after residents with complex healthcare needs reflecting multiple long-term conditions, significant disability and advanced frailty. All of these factors make caring for residents an incredibly difficult job for care homes and their staff.
Approximately 410,000 people live in care homes in the UK, according to a study in 2017 by the Government. This represents 4% of the population aged 65 years and over, rising to 16% of those aged 85 or more, and it’s only going to grow. Around 5,500 different providers operate 11,300 care homes for older people and people with learning disabilities, meaning there is considerable scope for variation in their training and improvement practices.
AHSNs have risen to this challenge with some fantastic examples of care, safety and quality improvement in care homes. These have included projects on improving hydration and reducing urinary tract infections, to falls prevention tools, a care homes collaborative and a checklist to help reduce unplanned hospital admissions.
We have gathered over 30 of these great projects together in the ‘Improving safety in care homes’ report, which also covers our work on managing deterioration and sepsis, dementia medicines optimisation and workforce development.
The power of these initiatives is that they have double the impact. Not only do we keep people safer in residential care homes, but we also go a long way to stopping the revolving door of emergency admissions to hospital. As the country continues to respond to the fast-changing impacts of coronavirus, anything we can do to take the pressure off emergency departments and ambulance services is vital.
Together with Health Education England (HEE), West of England and Wessex AHSNs will soon be launching a series of short e-learning videos that care homes will be able to freely access from HEE’s e-Learning for Healthcare (e-LfH) hub to help train their staff. These cover a range of topics where a consistent approach is important, including taking measurements, spotting the soft signs of deterioration, and treatment escalation procedures.
AHSNs have also successfully delivered medicines safety programmes, including TCAM (Transfers of Care Around Medicine) and PINCER. When some patients leave hospital they may need extra support taking their prescribed medicines. Around 30-70% of patients experience unintentional changes to their treatment or an error is made because of a miscommunication. The TCAM project identifies patients who need extra support, who are then discharged to their local community pharmacist for advice and review of their entire medications needs.
Since AHSNs started on the TCAM project in April 2018, figures show it has spread from 20 to 51 trusts, with over 55,000 patient referrals completed, meaning over 10 times as many people were benefitting.
Similarly, the PINCER project aims to reduce prescribing errors in general practice, which is thought to contribute to 1 in 25 hospital admissions with more than 21,000 instances of potentially hazardous prescribing identified across 2.9 million patients.
The PINCER intervention is led by primary care pharmacists and technicians, searching GPs’ clinical systems using specific indicators to identify patients at risk from their medications.
All of these patient safety initiatives fit perfectly with the new Primary Care Networks’ ambition to foster closer working with community, pharmacy and social care services in their area. AHSNs are well-placed to help with this, leveraging our unique role as system connectors that bring together local health and care systems with innovators and research partners to evaluate the impact of the changes we make within our systems.
You can find your local AHSN here to discuss support for patient safety where you work.