From: Multidisciplinary residential home intervention to improve outcomes for frail residents
 | Cycle 1 | Cycle 2 | |
---|---|---|---|
 | Care Home 1 | Care Home 2 | Care Home 3 |
Presenting complaints | Stealing other residents’ food in context of dementia Worsened cough and breathlessness Cognitive decline and refusal of medications including warfarin Aggression and paranoia Breathlessness and ankle swelling Weight loss, day time drowsiness Uncommunicative, decline in mobility, decline in oral intake Pain and poor mobility Falls | Sleeping in chair, leg pain and swelling Anxiety, agitation Recurrent UTI, generally unwell and has been in bed for a no. of weeks Rash, hallucinations and delusions | Weight loss Difficulty breathing Challenging behaviour Swollen legs Refusing medication General decline possible depression Reduced oral intake Reduced mobility Low mood, insomnia Slowing and movement disorder Falls Depression in context of dementia New patient needing CGA Loose stool, anaemia |
Number of GCA reviews held | 9 | 4 | 21 |
Mean change in number of medications (range) | −1.4 (−3 to + 1) | −0.3 (− 1 to 0) | −2.1 (− 18 to + 1) |
Change in BPSD (staff report) | 3/3 improved | 1/4 improved 3/4 no different | Data not collected in this cycle |
Change in BPSD (family report) | 3/3 improved | 2/4 improved 2/4 no different | Data not collected in this cycle |
Number of reviews attended by relatives (% of total participating residents) | 1 (11.1%) | 0 (0%) | 1 (4.8%) |
Number of residents with ACP initiated or reviewed (% of total participating residents) | 7 (77.8%) | 3 (75%) | 16 (76.2%) |
Number of DNAR forms completed or reviewed pre- and post- MDT (% of total participating residents) | 6 newly initiated (66.7%) | 2 newly initiated (50.0%) | Pre-MDT = 4 (19%) Post-MDT = 19 (90.5%) |
Number of patients with Coordinate My Care record created (% of total participating residents) | 0 (0%) | 0 (0%) | 8 (38.1%) |
Project period (months) | 7 | 3 | 10 |
Actual number of admissions to hospital during the project period in intervention residents (no. per month) | 1 (0.16) | 0 (0.0) | 0 (0.0) |
Number of admissions among participating residents in 12 months prior to reviews (mean per person over 12 months) | Data not collected in this cycle | Data not collected in this cycle | 25 (1.19) |
Number of admissions among participating residents in 12 months post review (mean per person over 12 months) | Data not collected in this cycle | Data not collected in this cycle | 6 (0.29) |
Reduction of admissions among participating residents over 1 year (mean per person over 12 months) | Data not collected in this cycle | Data not collected in this cycle | 19 (0.9) |
Costs of hospital admissions for the whole care home | Data not collected in this cycle | Data not collected in this cycle | 12 months prior to intervention £55,678 During year of intervention £49,653 |
Number of educational sessions | 5 | 2 | 9 |
Topics of half hour educational sessions | Polypharmacy and medication errors Challenging behaviour in dementia Nutrition Pain in dementia Difficult ACP discussions | Dementia pre-diagnosis counselling Cardiovascular complications in geriatrics | Skin care in the older patient Advance care planning Nutrition and weight loss Morbidity and mortality meeting End of life in the care home Old age psychiatry Behavioural symptom management Rationalisation of medications Communication between primary and secondary care |