Keeping your care home healthy this winter – Part 2

Following on from our article ‘Keeping your care home healthy this winter – Part 1‘, here’s more tips on minimising the impact of the cold season’s challenges.

Recognise and report any outbreaks

As Robert Burns said ‘the best laid schemes o’ mice an’ men gang aft a-gley. For those of you not fluent in old Scots language, what it means for your care home is that even with the most resilient plans in place you may still have residents who catch the ‘flu, winter vomiting bug or another seasonal infection.

Given the mix of a hot environment, close proximity to others and weaker immune systems, bugs can readily spread from one resident to another. An infection outbreak is usually defined as ‘two or more people within 48 hours with the same infection caused by the same organism who probably acquired the organism in the same place.’ So, in addition to preventative measures you also need to be able to recognise and know what to do if an outbreak occurs.

Points to consider:

• Are you confident in your ability to spot deterioration in your residents? If not, is there additional training that you require?
• How effective is the handover from one shift to another in relation to residents conditions? What additional communication procedures would help.
• You have a duty to report outbreaks to your local health protection team. Would you know who to contact?
• Do you keep your care notes up to date? If an outbreak occurs your records may be used to help identify the source of the infection so make sure you document the date symptoms started for each resident, frequency of symptoms and who has been in contact with the resident(s).
• Who is responsible for informing residents and their relatives?
• Do you know how to get medical advice for your residents? Are you clear when you would call 999, 111 or the resident’s GP?

Management of outbreaks

Once an outbreak has been identified in your care home your main goals will be:

• To treat the residents involved and minimise complications. Elderly residents may get confused and disoriented so as well as treating symptoms you will need to offer reassurance and manage any increased risks, e.g. falls, dehydration or malnutrition.
• To prevent further spread of the infection.

Local medical staff will advise you what treatment your residents need so make sure care plans and documentation is kept up to date. You will also get guidance from the health protection team regarding specific infection control measures. These will depend on the type of outbreak and can include temporary measures such as:

• Use of protective equipment, e.g. masks, gowns.
• Allocating staff to care for a specific group of residents only.
• Restrictions on admissions and transfers of residents.
• Suspending visiting: if this happens its vital that you keep key contacts up to date. Be mindful of data protection though if people call asking after someone’s condition.
• Change in cleaning procedures, e.g. ‘deep cleaning’ of rooms.
• Reducing where and when residents can socialise within the care home.

Communication within the care home team is vital throughout this period so consider adding in extra times throughout the day where you gather to discuss your residents, even if this is for brief periods of time. Ensure all documentation is up to date and remember to cancel any non-emergency hospital / clinic visits that residents had.

If a resident’s condition deteriorates further its important that you get appropriate. medical advice – make sure you know who to call and when.

Multidisciplinary team

Regardless if you work in a small independent care home or you are part of a larger organisation its important that all staff know that you are part of a wider multidisciplinary team.

Normally you may only come into contact with a small group of health professionals, such as district nurses, GPS, podiatrists etc. However, when an outbreak occurs you will be liaising with a wider network of people.

Sometimes residents conditions may deteriorate to the extent where they need an acute hospital admission. This can be traumatic for all concerned, especially at this time of year when here is so much awareness regarding overcrowded hospitals and long waits etc.

Partnership working is vital to ensure smooth admissions and discharges into acute hospital settings. This isn’t a time for ‘we know better than they do’ type thinking. This is a time for putting your resident’s needs at the forefront of all communications.

If you don’t use it already you may want to consider implementing the red bag scheme also known as the ‘Hospital transfer pathway.’ Part of the NHS’s ‘Framework for enhanced health in care homes the red bag scheme aims to provide a prompt, safe and efficient transfer of clinical care. The initiative involves care home residents having a ‘red bag’ for when they need to go to hospital in an emergency. The bag stays with the resident throughout their hospital admission and contains:

• Standardised information about the resident’s current and general health, any existing medical conditions and medication. This is therefore readily accessible to paramedics and hospital staff.
• Personal belongings (including clothes for discharge as well as any glasses, hearing aid, dentures etc.)

When the resident is discharged home a copy of their discharge summary will be added to the red bag. This means that you and other staff members can understand what has happened in hospital and any changes to treatments.

Reflection

No care home wants to have an infectious outbreak at any time of the year – it’s potentially deadly for residents, unpleasant and time consuming for staff. However, it’s important that, once your home gets the ‘all clear’ you take some time to reflect on how you, as a team, managed the outbreak. This information can help you prepare and manage any future outbreaks in a more efficient way.

• What went well and what could you all do better in future?
• Has this situation identified any training needs? If so, what courses do you all need to attend and when can you do this?