Scenario

The Long-Term Plan by the NHS includes to promote the use of technology to help reduce the pressures on GP Practices and improve care which would in turn help support those who live and work in and around Care Homes. Urgent care services in Norfolk and Waveney, in common with many other places, are stretched. There is evidence to suggest that many older people deteriorate after a stay in hospital, and homes often lack the extra staff that would be needed to escort their elderly residents, resulting in a lonely and confusing experience.

The Enhanced Health in Care Homes Framework 2.0 supports the better use of technology in Care Homes

“The appropriate use of sensors and monitoring technology can help reduce the incidence of falls and the prevalence of poor nutrition. It can also help alert Care Home staff and staff working in the wider health system about the deteriorating health of an individual before a crisis occurs”.

Solution

This project aimed to provide Care Home staff with a digital solution for remote observations to enable timely, responsive care and treatment for residents. A NEWS2 score / Is My Resident Unwell assessment aids early identification of deteriorating health and so improves health outcomes for Care Home residents. Bluetooth technology enables Care Home staff to easily take observations to detect deterioration in residents earlier, along with an escalation protocol to ensure that the resident receives the right treatment at the right time in the right environment. When consulting with Care Home staff about a resident, clinicians can benefit from accurate and timely observations.

The Whzan Blue Box enables staff to take observations using Bluetooth connected devices and produce a NEWS2 score / Is My Resident Unwell assessment.  The NEWS2 score / Is My Resident Unwell assessment aids early identification of deteriorating health and so improves health outcomes for Care Home residents.

Clearly defined pathways for escalating concerns provided guidance for non-clinical Care Home staff to enable timelier and more responsive care and treatment for their residents.

Care Home managers and staff were provided with a virtual training programme covering NEWS2, soft signs of deterioration, how to use the Whzan portal (set up staff users and resident caseloads) and how to use the Bluetooth equipment and the tablet in the Whzan Blue Box.

Care Home staff use the remote monitoring solution to record baseline observations for their residents at regular times.  This information can then be accessed by clinicians to inform them of comparable readings if a resident is unwell.  Clinicians can also be alerted to any abnormal/out of range observations which can support management of long-term conditions. Recordings of vital signs has also been evidenced in detecting new medical conditions.

Benefits

Care Home staff feel more empowered and upskilled by using technology for observations they complete with residents. Care staff have also said during weekly ward rounds they feel more comfortable discussing residents that are unwell, as they have a NEWS2 score to support their concerns.

• Care Home staff can identify the early signs of deterioration
• Improved ability for healthcare staff to prioritise clinical assessment, diagnosis and care / treatment
• Improved collaboration between Care Home staff and clinicians
• Regular recording of observations to inform ward rounds, MDTS and monthly wellness checks
• Reduced GP and Primary care visits

Implementation Success:

• 951 residents with verified NHS numbers were registered on portal
• 240 staff were set up over the pilot with usernames and passwords
• 464 NEWS2 assessments completed from July 22 to June 23
• 9287 Observations were completed from July 22 to June 23
• 236 S1 transfers completed from July 22 to June 23 (patients observations uploaded to clinical record by practice)
• 79 training sessions were delivered by the Whzan team, an external training and the Digital Health and Social Care Team

Feedback

Care Providers recently told Norfolk County Council’s Integrated Quality Service that using DSCR means:

“Working with residents living with a dementia diagnosis often means it is hard for them to articulate health needs. A serious BP issue was identified which resulted in a prescription being completed by the GP.” – Team Leader, Nursing Home
“We had one lady who looked very pale. We completed a set of observations and she was ok. We called the GP instead of an ambulance for her.” – Deputy Manager, Residential Care Home

Feebris Remote Observations Pilot

The significant positive outcomes from the homes that successfully embedded the use of remote observations in everyday working practice demonstrated the benefits for residents and gave us the confidence to continue to use remote observations across Norfolk and Waveney. We used the findings from the Whzan pilot to inform the approach to the Feebris project.   

We recognise that the patient journey needs to be joined up across the ICS so that clinical information can be seen by various healthcare professionals to support treatment and management of residents.  With this in mind, and alongside the ICS approach for step up- and step-down virtual ward remote monitoring, we made the decision to trial the same digital solution, Feebris.

Feebris is a remote observation kit using a mobile app and web based Feebris portal that enables Care Home staff to take monthly observations and to conduct additional check-ups when a resident is unwell, capturing observations from Bluetooth connected medical grade sensors. The Feebris app allows users to use the escalation protocol through the established NEWS2 guidance and take appropriate action providing enhanced care and support for their residents.

GP’s and Clinical professionals also have access to view observations on the Feebris portal. Here, they can review observations and adjust patient’s NEWS2 baselines to establish Personal Early Warning Scores. Care Home staff are then able to ensure that escalation occurs when appropriate.

Project Aims

• Equip Care Home staff with a digital solution to provide the information to aid a clinical assessment, treatment and management
• Improve resident and Care Home staff access to Primary Care and Community Services
• Reduce unplanned admissions
• Management of long-term conditions
• Aid early detection of deterioration and escalation using standardised decision support tools – e.g. NEWS2/Soft signs assessment (other assessment tools available)
• Improve communication between Care Homes and Health Professionals

A training programme has been developed for Care Home staff to include NEWS2, soft signs assessment screening tools and the use of an escalation pathway.  Staff can access support from the Digital Health and Social Care Team to ensure they are confident using the Bluetooth connected equipment and portal.

The team are continuing to monitor adoption of the remote observation equipment through KPIs and provide targeted support.

We have paid particular attention to ensuring that GP practices are fully engaged and have multiple staff who can access the portal.  This has already delivered some positive outcomes:

“The home had completed some observations on a resident including a picture of a rash. Usually in the summer months a rash would be due to the heat, but the rash looked like it needed attention.  Within 20 minutes of the observations being uploaded I was at the home and was able to give antibiotics for a skin infection.  The ward round for this home was not due for 3 more days and the resident was “well” in themselves at the time so we would not have attended for a rash in a well patient without having the photo to work with.” – Advanced Nurse Practitioner, Coastal Villages GP Practice