Northern Ireland Nursing Home Quality and Safety Collaborative
The Northern Ireland Health and Social Care (HSC) Safety Forum, in keeping with its mission to support organisations in both the acute and primary/community health and social care sectors, met with the Regulation and Quality Improvement Authority (RQIA) in July 2011. It was agreed that the Safety Forum would commence a project to support quality improvement and safety within the independent nursing home sector. The project, the first regional quality and safety initiative, outside a hospital setting in Northern Ireland, would use the Institute of Healthcare Improvement (IHI) quality improvement collaborative model. This is a short-term learning system, run over 12-18 months that brings together a number of multidisciplinary teams to see improvement in a focused area.
- All nursing homes in Northern Ireland (>20 beds) were sent a letter of invitation in September 2011, asking for expressions of interest in the project. They were also asked about perceived areas of risk and potential subjects for quality improvement. Replies were received from 17 homes.
- In October 2011, a Collaborative Advisory Group (to steer and support the collaborative), was established, with representation from Public Health Authority, Health & Social Care Board, RQIA, general practitioners, Carers NI, AGENI, Independent Care Homes and HSC Trusts. Key areas of safety were identified and a decision was made to focus initially on falls prevention. Other areas identified for work later in the life of the collaborative included (i) the interface with secondary care, (ii) nutrition/hydration, (iii) pressure ulcers and (iv) medicines management.
- From the original cohort of 17 nursing homes expressing interest, 8 nursing homes were chosen to participate. Selection criteria included geographical area, type of home and whether the home was a single provider or part of a commercial group of homes.
- It is proposed that this collaborative will include 4 learning sets spread over 12 months (from February 2012). Conference calls and site visits will also take place between learning sets.
- Teams from each Nursing Home will begin by gathering baseline data on the number of falls within their respective nursing homes.
- As part of the work of the collaborative, monthly data also be collected in relation to compliance with risk assessment for falls (on admission to the home) and risk assessment review. These process measures, and the monthly falls rate, will be the key improvement measures.
- Teams will choose a range of interventions known to improve safety and test these at local level. These include the use of safety crosses, intentional rounding and safety briefings as well as other more specific interventions when indicated.
As well as sustaining and spreading the falls prevention work, the Advisory Group will decide on the next strands of the project.
Nursing home teams are currently collecting data on transfers of their residents to secondary care. We will build on this, in partnership with the Northern Ireland Ambulance Service Trust (NIAST), by linking data from nursing homes with the NIAST database. This data will help build a picture of the “journey” of residents from nursing home to emergency department/hospital ward and onwards through the HSC system. The intention is to identify opportunities to improve by asking questions such as; Are all transfers to secondary care timely - and necessary?
- Could some of the treatments and interventions be provided in a different way with less stress to residents?
- Who does/should decide on the need for transfer to hospital?
- Would advanced care-planning be advantageous in some situations?
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