Remote monitoring in care homes
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Amanda Ricchiuti of Blackpool Care Home Support Team presneted the work of this team who have been monitoring local care homes using telehealth equipment to prevent admissions to hospital.
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Remote monitoring in care homes
- 1. People Centred Positive Compassion Excellence Remote monitoring in care homes for preventing conveyances and admissions to hospital
- 2. People Centred Positive Compassion Excellence Key Aims and Objectives • To avoid ambulance call out and admission to hospital where safe to do so • Reduced need for hands on medical attendance i.e. GP visits • Faster awareness of pre-existing care plans • Faster, more informed decision making regarding treatment • Improved patient care through better compliance with their rehabilitation programme
- 3. People Centred Positive Compassion Excellence Progress To Date • Scaled Up Existing Project – Maximise value • Care Homes selected based on challenges faced • Project Plan developed based on lessons learned from previous • Launched 28th January 2016 • Ended May 2016
- 4. People Centred Positive Compassion Excellence Key Challenges • IT Issues • Reporting Issues • Challenges with the Devices
- 5. People Centred Positive Compassion Excellence Key Successes and Outcomes • Video – conferencing • Enhanced Clinical Triage • Partnership Working • Positive feedback from users
- 6. People Centred Positive Compassion Excellence Feedback How easy is it to record the blood pressure, temp and SPo2 onto the tablet via Bluetooth once the reading has been taken? Very easy 7 Easy 6 Neutral 1 Not very easy 1 Not easy at all 1 How beneficial has the monitoring been at increasing your knowledge of falls and UTIs? Very beneficial 4 Beneficial 4 Neutral 4 Not very beneficial 1 Not beneficial at all 3 How often do you think residents should be monitored if there is an identified concern to their health? Daily 9 Mon-Fri 1 Mon/Wed/Fri 3 Weekly 3
- 7. People Centred Positive Compassion Excellence Feedback In your opinion do the resident alerts proactively highlight residents who are deteriorating? Very proactive 1 Proactive 8 Neutral 1 Not proactive at all 5 Not completed 1 Have you had any experience of using the video call button on the tablet? Yes 10 No 4 Not completed 2 How easy was it to link up to the other person? Easy 10 Don’t know 3 Not completed 3 How useful do you see the video call option in the future if shared with all nursing and GP practices? Very beneficial 12 Beneficial 2 Not completed 2
- 8. People Centred Positive Compassion Excellence Next steps • Vanguard Telehealth • Lessons Learned • Consider time and resource input vs clinical outcomes • Integration of systems
Editor's Notes
- Implementation of new developments commenced in late Sept using the same project plan from original telehealth project. Amended to reflect lessons learned. The additional funding from Innovation Agency enabled continuation of the existing project along with some scaling up to include 3 nursing homes as well as some smaller scale development work. As a result of this funding we were able to run the project until the end of May 2016. These homes have been selected as they already had IT infrastructure in place from a previous Speech & Language project operated by the Trust. In addition, each home faces challenges with admissions, supported by Trust data. Further to this, the management of the homes are keen to embrace new ways of working to improve the care provided to their residents. As of 28th January 2 of the 3 homes went live with the new solution, with the 3rd home live on the 9th February.
- N3 access was a necessity for representatives monitoring patient data access. Once agreement was received additional challenges in connections meant that IT remedial and locality upgrade was a requirement to resolve connection issues. In addition a number of ongoing issues were noted with the reporting elements of the solution such as “false” red alerts which required significant clinical time to investigate as each alert was treated as genuine until confirmed otherwise. Our partner, FCMS, found this time consuming especially as they had to duplicate data due to the unreliability of the reports. The patient alerts are often not reflective of any clinical need and this has been demoralising for both the care home staff and FCMS staff who have all invested a huge amount of time to the pilot. The equipment has been challenging at times and we would encourage the commissioners to explore options for telemedicine in the future e.g. reporting function; alert challenges; sound/image challenges; option for care home staff to view patient data.
- The opportunity to utilise video-conferencing with patients within the pilot care homes. If a call is received from the care home e.g. a care coordination call, our clinicians can request (for the patients that are participating in the pilot) that the patients observations are taken using the SPS system and these will then be sent through for our clinician to view thereby assisting in the clinical triage process. The partnership working between BTH and FCMS has been a real pleasure and beneficial to both organisations. Weekly meetings have been invaluable. Our regular clinicians have developed an affinity with the care home staff and patients participating in the pilot. However, during evaluation we have concluded that it is hard to state improvements are due to the technology. We saw improvement in quality but not necessarily in admission rates. Some examples of the feedback received from care home staff is included on the next slide.
- The project was supported by the Trust Care Home Team and by Fylde Coast Medical Services. Owing to reconfiguration of the Care Home Team by our commissioners they no longer provide support to the care homes involved in the pilot. As such a decision was taken to cease the remote monitoring pilot but the learning from it will be utilised in future projects and has been fed into the Vanguard Telehealth Group for the Fylde Coast. Processing alerts may have improved practice and awareness within the care homes but we have no evidence that this produces clinical outcomes for this cohort of patients. The time and resource needs to be considered against the possible outcomes for the care home patients. This provision is possibly more viable for primary care. Care Home staff and FCMS call handlers and clinicians have often found that the call back (from FCMS to the care home) is untimely and inconvenient impacting on care homes routine and the FCMS clinicians’ time. This is something to consider for future provisions. As the equipment is linked to a patient rather than a care home, the potential value of being able to teleconference with the carers and patients and get up to date patient observations is only valuable for the patients participating in the pilot rather than being available to all the patients in the care home. If generic equipment could be utilised this would be more viable. Accessing SPS has required our staff and clinicians to log into another system with a different login and password (FCMS are also part of an AVS telemedicine pilot and other pilot schemes that require different logins). It would make sense that the implications of telemedicine are considered as part of a wider Fylde Coast Telemedicine strategy ensuring that multiple logins and systems are minimised wherever possible.