Digital Care Homes Blog by Fiona McDonald, Health Call Clinical Lead (Primary & Community Care) on 30th April 2020
Covid-19 has caught our care homes in the spotlight of media attention this week. Funding streams, ownership, governance and the availability of basic IT equipment such as wifi, PC’s, tablets or email is variable. As we approach more than four weeks of lockdown, and the increased reporting on death in care homes from Covid-19 not being included in the numbers reported daily by the government, on the 28th April 2020, they announced the death toll figures in care homes would start to be included in the daily death toll. They also announced, that testing would be available to ALL residents and staff, regardless if they are symptomatic or not.
But if we take a step back to April 2nd 2020, when the first ‘Admission and Care of Residents during Covid-19 Incident in a Care Home’ guidance was issued by cross-government agencies, the advice within some of the guidance is impossible to follow without available and accessible equipment, data and easy to refer digital pathway solutions. Some elements within the report asked the staff to ‘assess the appropriateness of hospitalisation: consult the residents Advance Care Plan/Treatment escalation plan’. Many care homes have one ancient desktop computer, that often only the care home manager has access to. Paper files are kept for residents, but these are often not up to date, relevant or contain little end of life care plan or record the resuscitation wishes of the residents. Despite the first pilot in 2015, NHS mail has only just been rolled out at scale to provide basic communication between the NHS and the care homes.
I have attended several regional and national meetings around the digital tools available to the care home sector, but the ability to use them and uptake has been patchy, at best. If we examine what the NHS Healthcall digital care home package offers, we start to take a more holistic view on which to build.
Health Call Digital Care Home (HCDCH) is a digital application that has been developed, in partnership with the care homes, GP Federations, County Durham and Darlington Foundation Trust and NHS Health Call to have a dual function. Primarily it is a method for care homes to refer to District Nurses, Advanced Nurse Practitioners or Community Service Providers, but it is also used for routine monitoring and earlier identification of deterioration by capturing regular observations to determine ‘the norm’ for residents.
When a resident requires a clinician referral, the care home staff complete a form either on an App or on a web portal. The form is a digital version of SBAR (Situation, Background, Assessment, Reporting), originally developed by the United States military for communication on nuclear submarines. Observations are provided and NEWS2 score is calculated in the background. Once this information is submitted by the home it is sent to the appropriate clinical team who triage for priority, pull the information into the clinical record and inform the nursing clinician who can assess, prioritize and task to whoever is appropriate (see Diagram below).
SBAR has been adapted for use in a variety of industries and more recently has been adopted by the NHS, to produce a National Early Warning Score (NEWS2) which provides quality clinical information for triage and assessment by the receiving clinician. The digital referral replaces the need for the care home staff to wait to get through, often in a long queue on the telephone channel, to explain their residents’ symptoms, with no framework, baseline information such as blood pressure or temperature for the clinician to assess whether further treatment is required. And no audit trail!
The HCDCH app has the resident’s details pre-recorded on the tablet, is two factor authenticated for individual access and has the benefit of resident PDS authentication. The DNR and End of Life Care information is recorded once and is retained in the resident information, which can provide vital treatment pathway decision making for the receiving clinician.
HCDCH allows care homes to interact with the health care system in a more efficient way using a digital platform rather than over the phone and allows data that they have provided to be pulled into their EPR and available to appropriate clinicians, reducing the duplication of work. The single sign-on and integration with the receiving clinical system aspect of any digitisation of healthcare, has long been known to the informatics community to be the biggest barrier to adoption. Unless the information comes into the workflow, in a smart alert format, uptake will be poor to negligible.
As the COVID-19 pandemic broke and General Practice were instructed to conduct a full remote triage model of care, our work at NHS Health Call, increased rapidly with the rollout of the HCDCH solution across areas of our region. The ability of our developers to move rapidly to respond to the requirement of remote video functionality, if the receiving clinician wishes to put their eyes on the patient, in the context of the referral has been astonishing. The additional development of the application of the wound assessment tool, allowing photographs to be taken and sent and viewed by the clinician, in a structured format, has provided further excellent quality clinical information for ongoing assessment and treatment.
We have had to be creative and adaptable with the installation of applications on the tablets for care homes. Our recent rollout across South Tyneside Care homes, saw the installation of the care home generic NHS mail account added, allowing basic digital communication channels to be available for interaction between care homes and the NHS. Our previous preferred model (though that depends on local requirements) of face to face training on the basic kit of digital blood pressure, temperature, oximeter readings, respiration and completion of the free text information has had to rapidly change to digital training. The digital training package and framework is short but effective and is now installed on the tablets we distribute across the sector. If we provide the basic ‘kit’, we suggest installing MDM security software, which renders the tablet an unusable brick should it leave the geographical location. This also allows us to remote in for any problems and push out automatic software updates, so the care home does not need to worry.
The hidden benefits of the portable smart tablets have also allowed residents to have video calls with family and loved ones once care homes initiated the social isolation advice. The variety of video consultation solutions that have been deployed across general practice has also meant the tablets can be portable to take to the resident’s bedside for whichever e-consultation solution the GP is using.
We have been asked several times, both locally and nationally what are our key learnings.
Take a holistic approach, make sure the solution is single sign-on for receiving clinicians, keep it simple, build upon care home and NHS requirements, be flexible and responsive. At NHS Healthcall, our mantra is that solutions must pass” the 3 U’s test”. They must be useful, usable and used. The solution must also be future-proofed for developments coming down the track.
If you need any further information or would like to talk to us about using our Digital Care Home solution, please drop us an email.