By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland

Argyll and Bute Health and Social Care partnership has been holding a series of quality improvement workshops for care home staff, in collaboration with Scottish Care. I went along to one of their workshops with care home staff in Dunoon on 10^th May to find out more about the work that the partnership is doing with care homes.

Background

All 20 care homes in Argyll and Bute are signed up to a quality improvement project to reduce falls. Funded by the Integrated Care Fund, and supported by health professionals in each locality, the project aims to support care home staff to address falls risks in their care home. A particular emphasis is on improving physical activity for health and wellbeing.

The quality improvement workshops

Dr Christine McArthur, NHS Highland Coordinator Prevention and Management of Falls, Jane Howe, Quality Improvement Manager, and Kirsty Brown, Assistant Practitioner (Physiotherapy), facilitated the workshops. The team worked collaboratively with Scottish Care to develop events which met the needs of care home staff. The care homes requested a series of smaller local workshops, rather than one big event, as some staff do not drive and it was easier them to attend local events.

The team held workshops in Bute, Oban, Campbeltown, Dunoon and Helensburgh. Having dedicated events for care home staff and small group sizes ensured that all participants were able to contribute to discussions and ask the team for advice.

On the day

Staff from Struan Lodge, Invereck, Ashgrove and Beechwood care homes all attended the workshop in Dunoon. The team asked them to record their thoughts before the session on post-its. Participants were keen to see how they could prevent falls and keep residents safe, and whether the work will help to improve practice. They were also hoping to gain an increased understanding of the falls prevention tool, learn about risk assessment and see how they could develop a more standardised approach to falls prevention.

Christine McArthur gave an overview of Up and About in Care Homes, a national improvement programme based on the Managing Falls and Fractures in Care Homes for Older People good practice resource. She highlighted the success of the collaborative in reducing falls. The presentation included a digital story from Margaret Kelly, which described her involvement in the collaborative and the improvements that it led to in Lancraigs Care Home in West Dunbartonshire.

There was a clear emphasis on knowledge sharing and learning from good practice. The collaborative’s principles were:

• Everybody teaches
• Everybody learns
• Share generously
• Steal shamelessly
• Acknowledge gracefully.

The team urged workshop participants to learn from good practice in other care homes and see what ideas they could ‘steal’ to improve care.

Jane Howe introduced the Highland Quality Approach and the Institute for Health Improvement Model for Improvement. She gave an overview of Plan Do Study Act (PDSA) cycles, a tool for documenting and recording tests of change.

Jane emphasised the importance of testing change to determine whether a proposed change will work in your context and minimise resistance on implementation. She also stressed the need to set out a clear aim which is safe, effective, person-centred, timely, efficient and equitable.

There was then the opportunity to put quality improvement learning into practice, with the help of Mr Potato Head…

Care home teams were asked to present theories of what would happen when they attempted to assemble Mr Potato Head, and to record the time that was taken to put him together, and the quality rating that they received for each attempt.

This was then used to create basic run charts to illustrate trends. In most instances there was an upward trend in quality and a downward trend in assembly time as the teams’ Mr Potato Head assembly skills improved with practice!

While run charts can be useful for understanding the direction of improvement, Jane warned the care home teams not to be disheartened by early failure: it may take some time to see the impact of any changes that have been made, and there could be an increase in falls as people get better at recording them. What is important is that care home staff understand their data, and the measures that have been put in place to address any issues which have been identified.

Care home staff then had the opportunity to identify areas for tests of change based on gaps that they had identified in their self assessments. They completed PDSA templates for these areas, under guidance from the falls project team. Areas that care home staff identified for PDSA cycles included:

• Developing a directory of local services
• Introducing a postural hypotension check before medication reviews
• Ensuring that all staff follow the pathway for assessing injury to minimise variation.

Staff from one care home noted that they had been making a number of changes, such as fitting new carpets, but that they hadn’t always been measuring these changes to assess whether they had led to improvements in care.

The care home teams agreed that the PDSA cycle is a tool that they can use in the future, and that it is a useful tool for testing change. Post-session feedback also highlighted that staff felt more confident about using the falls management tool, and that they thought that they could learn a lot by sharing resources and ideas from other homes.

Next steps

The care home teams will now be working to progress the PDSA cycles that they identified, and Kirsty will be spending time with staff from the different care homes to support them in using the Care Inspectorate data collection tool.

It was great to see the high levels of commitment that staff had to reducing falls and improving care for residents, and it will be interesting to see how the work progresses.

For more information on the project, contact Dr Christine McArthur: christinemcarthur@nhs.net.

To find out more about the Care Inspectorate data recording sheet, contact Edith Macintosh: edith.macintosh@careinspectorate.com. 

Information on the Up and About programme and falls prevention resources can be found on the Falls and Bone Health community site.