A Handbook was designed to highlight and raise awareness of the importance of fundamental care for care workers and carers, the book is simple and easy to read. It was anticipated that by giving the carers (unpaid carers and paid care workers) the handbook, we would be promoting best practice by:
- Explaining why different aspects of observation and care are important therefore increasing knowledge, awareness and confidence
- Explaining what to look for and how to recognise changes in an individual’s condition or any deterioration in a person’s wellbeing
- Knowing what action to take and when to refer on
We decided the actions in the book should be colour coded like a traffic light system providing a STOP LOOK CARE approach
Green- ACTION - None
ORANGE – ACTION - Monitor and Document
RED – ACTION – REFER - seek further support and advice
By identifying any concerns early, along with early signposting it was anticipated it would prevent unplanned hospital admissions, and prevent harm.
- Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (CG32)
- Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset (NG16)
- Care and support of people growing older with learning disabilities (NG96)
- Learning disabilities and behaviour that challenges: service design and delivery (NG93)
Aims and objectives
The aim of the project is to help reduce unplanned hospital admissions by introducing an ‘increased awareness model’ for carers. The handbook maps to the dedicated page for carers on the NICE web pages, and the information within the handbook links to a number of NICE Guidance and Quality Standards.
Carers need a basic awareness of health related conditions and an understanding of why simple aspects of care and daily living are important in keeping a person at their optimum health. They need to have the underpinning knowledge to:
- Understand the range of normal, for health topics in the handbook
- Have increased awareness of the importance of certain aspects of care
- Recognise when someone is unwell or not coping
- Know how to make ‘Every Contact Count’ by understanding their role in health promotion (NHS 2012)
- Identify when to refer to a professional or other service, for more support and advice; thus reducing potential complications.
It was considered there would also be an improvement in the quality of care delivered and therefore reduce the number of Safeguarding issues raised through improved clinical effectiveness through early intervention and enhance patient/service user experience.
Reasons for implementing your project
In 2013/14 there were a number of delayed discharges from our local hospitals due to the number of people needing to be discharged with complex health needs. This was putting increasing pressure on health and social care services. The delay was due to home care support workers not having the knowledge and skills to care for people with complex needs i.e. Percutaneous Endoscopic Gastrostomy (PEGS)..
The above situation highlighted that carers who are on the frontline of delivering day to day care, need to have an increased knowledge base and core competencies to support their work, and not only help delayed discharges but may help to prevent hospital admissions. Nationally this has also been recognised in the Francis Report (2013) and the Cavendish Review (2013). Every support worker is now encouraged to undertake the minimum training of the Care Certificate that was introduced in March 2015. The Care Certificate covers 15 core standards and informs induction training for all carers. It was felt that the Care Certificate could be expanded to cover fundamental care needs to help prevent people being cared for deteriorating and requiring hospital admission.
The original idea was to provide training to carers working in care homes, both residential and nursing as well as home care sector within Brighton and Hove. Data from the local authority indicates that there are at least 156 Home Care, Care Home (with and without nursing), supported living, hostels, and in house providers in the city. Brighton and Hove’s demographics indicate that there is a population of 288,155, with a population profile which is younger than the rest of the UK, with 21% under 20 yrs, 62% between 20-59 yrs, 11% between 60-74 yrs, and 6% over 75 yrs of age. The City’s population is predicted to get older with the greatest increase expected in those aged between the 60-74 and 75 plus age groups (JNSA 2019).
We faced challenges with finance and governance which stopped the project progressing, but not wanting to give up, we became innovative and creative and instead of delivering training we designed a Stop Look Care Handbook. This easy to read handbook details, why different aspects of observation and care areimportant, what to monitor and what action to take
How did you implement the project
Following the setback with being unable to move forward with the original idea of training, we progressed with the development of the Handbook.
We developed the Handbook within our working roles, working with a number of organisations for both clinical expertise and evaluation of the handbook;
- Brighton and Hove City Council – IT support and encouragement
- Sussex Community Foundation Trust – clinical knowledge
Carers Centre (unpaid carers/service users) – suggestions on content and evaluation of handbook
- Brighton Sussex University Hospital – clinical knowledge
- Skills for Care – support, advice and encouragement
- Home Care Providers – expert advice regarding boundaries of care
- Sussex Foundation Partnership Trust – clinical knowledge
- Third sector organisations – expert advice
We relied on professionals supporting the project to research best practice and used NICE guidance and quality standards to ensure the correct information was being delivered.An application was made to the Better Care Fund for support with publishing and printing of the handbook, however eventually the funds were supported by our line manager at the Brighton and Hove CCG.
The cost of the 44 page handbooks was £1307.00 for 2000 copies in 2016.
It was hoped this Handbook would also be a passport for carers, so they could move between organisations within the city demonstrating they had Stop Look Care knowledge. At the time there was a reported estimated 30% turnover rate of carers within the City
We evaluated the impact of the Handbook by asking carers to complete a questionnaire prior to receiving the Stop Look Care handbook, a follow up questionnaire was sent out 4-10 weeks later.
We received 143 responses from the first questionnaire, and 40 responses from the second questionnaire. Engagement was difficult for the second survey as carers already had the handbook; initially the handbook was used as an incentive for people to engage.
Results from the second questionnaire indicated that 97% of carers reported that they found the Handbook a useful reference tool, with all carers finding they felt more confident in all topics covered after reading table 1. Carers reported that 5 people had been referred on, with two carers reporting they felt this prevented a hospital admission.
Table 1- Carers increase in confidence following receiving and reading the book (See supporting Material)
Five key outcomes and implications of the project
- Increased knowledge and confidence for carers in basic health needs
- Improved signposting to multidisciplinary agencies
- Admission avoidance
- Improved patient care
- Sharing of good practice Locally and Nationally
It is hard to determine if this an cost effective initiative, however by identifying and treating any health concerns at an early stage. By increasing the knowledge of carers from all sectors you are empowering them and improving the quality of care delivered therefore improving peoples outcomes, hopefully reducing the financial burden of poor health outcomes.
Locally our A&E and non elective admissions have dropped since the implementation of the Stop Look Care handbook, however this was one initiative of many being introduced in our area, so difficult to define if specifically related to the project.
Verbal and written feedback locally and nationally is that it is a useful tool that supports good quality of care.
The Stop Look Care project won the Nursing Times award for Care of Older People 2018.
The handbook has been adopted as good practice in many areas across the UK, please see table 2.
Table 2 – Areas around the UK who have asked to adopt the handbook (see supporting Material)
The Local Workforce Action Board are keen to introduce a Stop Look Care training package across the STP to bring together training and create a standard of education around clinical aspects of care to support the Care Certificate.
NHS South Kent Coast has adapted this into an electronic version and are in the process of developing a training app to support this.
Key learning points
We would advise that it is important to follow your conviction, if you believe something is right and should be changed or implemented then don’t give up and stick with it. When there are a lack of resources be innovative and creative.
Don’t have too many people involved when trying to create or implement something, as this can hinder the project with too many different ideas. Bring different people in as and when you need them.
The success of the Stop Look Care handbook has also been due to our willingness to share with others. We believe if something is useful and helps to improve someone’s care, or if it gives a care worker / carer more confidence in looking after someone, then we want it to be adopted and freely used elsewhere.
It was beneficial having service users involved in the development of the handbook. They were able to make suggestions on the content of the book /which we included.