Older people living with frailty in hospital

Comprehensive care: research on older patients living with frailty in hospital | The National Institute for Health Research

Comprehensive Care looks at the concept of ‘frailty’ in older people living in hospital. It brings together NIHR research on what can be done to identify and manage the needs of this group of people and avoid potential problems. With the right support, patients can continue to live well at the end of their hospital stay.

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Image source: http://www.dc.nihr.ac.uk

This themed review highlights completed and ongoing studies outlining best practice in secondary care for older people living with frailty.  It covers assessment; identifying and managing symptoms associated with frailty in hospital; discharge planning; and caring environments.

Full report: Comprehensive care: research on older patients living with frailty in hospital

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Children and young people’s survey 2016

Latest CQC survey looks at the experiences of children, young people and their parents and carers attending hospital for treatment as an inpatient or day case.

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The Care Quality Commission (CQC) has published the findings of it’s national survey looking into children and young people’s experiences of inpatient and day case care. Just under 35,000 respondents, including over 11,000 children and young people, were able to speak up about their healthcare experience.

Overall children and young people’s experiences of inpatient and day case care were mostly positive. The majority of children and young people said they were well looked after while in hospital, staff were friendly and that they received answers to their questions. Most parents and carers reported positive experiences for how their child’s pain was managed and for receiving enough information about new medication.

The survey results suggest there is scope for improvement in a number of areas, including:

  • Children and young people having enough things to do whilst in hospital
  • Involving children and young people in decision making
  • Being treated on age appropriate wards

Full detail at Care Quality Commission

 

National Audit of Inpatient Falls

The National Audit of Inpatient Falls (NAIF) is designed to capture data from acute, community and mental health hospitals relating to falls | Royal College of Physicians

This report provides:

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Image source: http://www.rcplondon.ac.uk
  • aggregated national results for the organisational aspects of leadership responsibilities, policies and procedures, highlighting deficiencies and changes since 2015
  • aggregated national averages for the clinical audit items, focusing on change since 2015, particularly where little progress has been made overall, or where there is a large variation in what has been achieved
  • detailed results from all individual hospitals, enabling comparison with their own performance in 2015, their performance against the guidance standards and a comparison with other hospitals.

Full report:  NAIF audit report 2017

Improving the care of people living with dementia admitted to hospitals

This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ 

Abstract

Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review | BMJ Open 2017; 7:e015257

See also: Dementia care in hospital: training, leadership and culture change needed | The Mental Elf

NHS staff shortages are compromising patient care

New report from the Royal College of Nursing calls for urgent review of Nurse staffing levels to ensure patient safety this winter. 

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The Royal College of Nursing (RCN) has today published a report, Safe and Effective Staffing: Nursing Against the Odds which shows the results of a recent staff survey. The survey, carried out in May 2017  reveals more than half (55%) say shifts did not have the level of nurses planned, and that shortages were compromising patient care (53% ).

Nursing staff in all four UK countries were asked about staffing levels on their most recent shift and the quality of care provided. More than a third (36%) report having to leave elements of patient care undone due to a lack of time, while two thirds (65%) work an unpaid extra hour on average.

Seven in 10 nurses (71%) in England said their last daytime shift exceeded NICE guidelines, which states that more than eight patients to one nurse should act as a ‘red flag’. A quarter (26%) reported shifts with 14 or more patients per nurse.

The respondents also reported that:

  • patients are no longer afforded enough dignity, even dying alone;
  • colleagues have burned out and have become sick themselves, unable to come to work;
  • staff leave work “sobbing” at the impact of shortages on patient care;
  • many question their future in nursing and contemplate leaving the profession;
  • they struggle to give their children and families enough support after shifts that can exceed 12 hours.

Full report: Safe and Effective Staffing: Nursing Against the Odds

Royal College of Nursing: Urgent action needed to tackle staffing crisis

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Number of NHS beds more than halved over the past 30 years

The number of NHS beds has fallen by half in 30 years, and plans for further cutbacks are “unrealistic” | The Kings Fund

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A study from The Kings Fund has found that bed numbers – including general and acute, mental illness, learning disability, maternity and day-only beds –  have dropped from 299,000 to 142,000 since 1987.  Hospitals in England now have the least number of beds for their population compared with any other country in the European Union, with just 2.3 per 1,000 people.

The report explains that this decline is in part due to factors such as an increase in care being delivered outside hospitals. It also highlights the impact of medical innovation including an increase in day-case surgery, which has also had an impact by reducing the time that many patients spend in hospital.

The report however warns that there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. The authors state that in this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

Full report: NHS hospital bed numbers: past, present, future

Adult and older adult mental health services 2012-2016

Adult and older adult mental health services 2012-2016: An analysis of Mental Health NHS Benchmarking Network data for England and Wales | Centre for Mental Health

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Image source: http://www.centreformentalhealth.org.uk

The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health.

The briefing, Adult and older adult mental health services 2012-2016, analyses data collected by the NHS Benchmarking Network since 2012/13 up to the publication of the Five Year Forward View for Mental Health.

The briefing finds that while psychiatric acute inpatient beds for adults fell by 15% between 2012 and 2016, and staffing levels fell by 20%, the number of people admitted and the time they stayed in hospital did not change. This means that bed occupancy levels have risen to an average of 94%.

During the same time, community mental health service provision fell slightly: the number of people on community team caseloads reduced by 6%, staffing levels fell by 4% and contacts reduced by 7%. By contrast access to psychological therapies rose rapidly, reaching some 900,000 people a year by 2015/16.

Full report:  Adult and older adult mental health services 2012-2016