Action Area Three: Delivering High Quality Care and ... · Linda Nazarko Consultant Nurse . Integrated Care Organisation Incorporating the Community Services of Brent, Ealing and

Integrated Care Organisation

Incorporating the Community Services of Brent, Ealing and Harrow

Action Area Three: Delivering High Quality Care and Measuring Impact

Linda Nazarko Consultant Nurse



High quality care How to deliver & demonstrate effective outcomes

Ensure data collection is effective and simple

Enable staff to develop skills and knowledge to

interpret data



Intermediate Care Ealing (ICE)

Aims to enable people to avoid acute hospital admission

Average 85 year old X14 more likely to be admitted to

hospital than younger adult

Provides a bridge between hospital and community

based care



Population ageing

110,000 people aged 100 by 2035

Older frailer population more in need of care and

support

Will require more resources and staff with ever

higher skill levels

0 20000 40000 60000 80000 100000 120000

1961

2012

2035



Key facts about older people

By 2033 ¼ of population will be 65+

By 2030 the number of people with dementia will

have doubled to 1.4 million

Around 52% of over 65s have a long-term

condition

Approximately 72% of those receiving social care

are 65+.

NHS spends 43% or £16.47bn of the NHS’ total

budget on 65+

People over 65 consume 50% of the total drugs

spend



ICE Services



Community based rapid response

Team of medical, nursing and therapy staff

Seven day a week service

Response within two hours

Patient seen within four hours

Intervention normally 3 days but can be

extended to 5 days



Magnolia Intermediate Care Ward

Twenty bed nurse & therapy led ward

Team of nurses including those with

advanced assessment skills and non

medical prescriber qualifications

Physiotherapy, occupational therapy

and assistant practitioners

Led by consultant nurse

Shortlisted 2011, 2012, 2013 General

Practice Awards in:

Nursing Team of the year, clinical team

of the year, long term condition and

nurse of the year categories



Presenting problems

Falls

41%

Fall & #

26%

Immobile

11%

Infection

22%



Cognition

Intact

27%

Impaired

73%



Effective simple measurement of outcomes

Modified Barthel measures functional ability in a

range of domains:

Presence or absence of faecal incontinence

Presence or absence of urinary incontinence

Help needed with grooming

Help needed with toilet use

Help needed with eating

Help needed with transfers (e.g. from chair to bed)

Help needed with walking

Help needed with dressing

Help needed with climbing stairs

Help needed with bathing

https://en.wikipedia.org/wiki/Fecal_incontinence

https://en.wikipedia.org/wiki/Urinary_incontinence



Reliability

The Barthel index has been shown to have

portability and has been used in 16 major diagnostic

conditions.

The Barthel index has high interrator reliability (0.95)

and test re-test reliability (0.89) as well as high

correlations (0.74–0.8) with other measures of

physical disability

O'Sullivan, Susan B; Schmitz, Thomas J (2007). Physical Rehabilitation, Fifth Edition. Philadelphia, PA: F.A. Davis Company. p. 385



0

10

20

30

40

50

60

70

80

90

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Changes in modified Barthel

On admission

On discharge



Interpreting data and shaping services

Services predominately

used by older people

High levels of dementia and

cognitive impairment

High level of falls

Educate staff in care of older

people

Educate staff in assessing

cognition

Educate and enable staff to

care for people with

dementia and impaired

cognition

Community bedded unit

environment modified to

enable older people and

those with dementia



Patient vignette

Mrs Doris Smith, fell at home, found to have a severe chest infection. Attended A&E and IV antibiotics prescribed. Transferred to community bedded unit. IV antibiotics administered, patient switched to oral as condition improves. Full assessment, medication reviewed, anti-hypertensives causing hypotension and falls discontinued, therapy provided, occupational therapy assessment, home environmental modifications made. Discharged with care and support



Patient vignette

Mr Milligan normally in good health, cares for

wife who has dementia. Falls, develops knee

pain and reduced mobility. ICE rapid

response provide analgesia, environmental

modifications, carers to care for Mr Milligan

and his wife and therapy to enable him to

regain ability. Admission avoided, ongoing

support organised



Take home messages

Every patient should be treated

with kindness and compassion

and respect.

Good care is about enabling the

person to maintain personal

identity and self esteem

Its about listening to the voice

of the person and providing

kind compassionate care

Its about showing that the

services we do provide are

effective and make a difference



Thank you for listening

Any questions?

Documents

Action Area Three: Delivering High Quality Care and ... · Linda Nazarko Consultant Nurse . Integrated Care Organisation Incorporating the Community Services of Brent, Ealing and