Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham and a Consultant Geriatrician at Derby Teaching Hospitals NHS Foundation Trust. He is a specialist advisor to the East Midlands Academic Health Sciences Network Patient Safety Collaborative on Care Homes and will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @adamgordon1978
Contrary to what might be gleaned from the lay media, the quality of care received by residents in care homes – whether from care home or National Health Service staff – is frequently exceptional. Care home residents are amongst the most complex recipients of care within the health and social care system and so they can stretch even the most capable and dedicated of staff. It is therefore, perhaps, unsurprising that things do not always go to plan – even in the best of homes. There are also, undoubtedly, examples of care homes where things go wrong more frequently – where shortcomings in care are not so much sporadic, as systematic. This is unacceptable.
There is growing recognition, across all care sectors, of the need for all providers to engage in processes of continual quality improvement and assurance. Benchmarking – where multiple care providers compare their performance and practices using standardised measures reported in standardised ways – can provide a useful starting point and also a regular touch point in such discussions. Benchmarking is not, in and of itself, a sufficient form of measurement to support and drive change as part of quality improvement, but it is one possible starting point.
When the East Midlands Academic Health Sciences Network Patient Safety Collaborative was established, it identified quality improvement and assurance work with long-term care homes as a priority. Early stakeholder interviews suggested the need to focus on pressure ulcers, continence, polypharmacy, falls, hydration, nutrition, delirium and social isolation. It quickly became clear that there were no systematic benchmarks of quality in long-term care which enabled us even describe the size of the problem, let alone to be able to work out what to do next.
After some work to scope out UK-specific alternatives, we connected with colleagues at Maastricht University who have been key in developing the Landelijke Prevalentiemeting Zorgkwaliteit (LPZ). This is a quality of care measure that audits the prevalence of common care problems – falls, pressure ulcers, incontinence, malnutrition and physical restraint – alongside measures to mitigate against them in long-term care. It enables care homes to benchmark their own performance against other care homes in their area, other care homes internationally and their own performance year-to-year.
We found it feasible to implement in the East Midlands, that homes were highly engaged, and that they improved their practices around staff education, documentation and communication in the run up the audit. We found, though, that care home staff were reluctant to access their data reports, even when they were presented to them on user friendly dashboards. We also found that care home staff struggled to make sense of their data and to start to use it as a way to start to think about quality. We reported these findings online as part of the East Midlands Research into Ageing Network (EMRAN) discussion paper series.
We are now exploring, as part of years 2 and 3 of the UK implementation of the LPZ, how to support care homes to make better use of their data, how to start and support quality improvement dialogues with them, and the cost and economic implications of embedding the LPZ as a core part of care, if we were to choose to do so. Ongoing process will be presented at the forthcoming British Geriatrics Society’s Autumn Meeting at the Excel in London, as part of the first day’s programme focusing on Community Geriatrics and Care Home Practice.