Hospital admissions, for NCL care home residents are higher than comparator areas and scaling-up of remote monitoring in care homes represented an opportunity to implement a consistent approach to identifying signs of deterioration using digital technology, to provide better care for residents and to reduce avoidable admissions and poorer health outcomes. We implemented a remote monitoring solution that works for the care homes in our area. The aims of the programme were to reduce London Ambulance Service (LAS) call outs, A&E attendances, and support staff to identify deterioration. Reducing digital exclusion for our staff and residents, we wanted to ensure that staff and residents had opportunities to learn how to use technology to communicate with others in a safe, non-threating, fun way. The team developed virtual meaningful activities such as art, gardening, and quizzes, which improved mental wellbeing for staff and residents, along with developing the skills necessary to use technology. Residents reported that they felt less isolated and more confident in using technology to communicate with friends and family, pursuing their interests and meeting health care professional online. Relatives reported that their family members were more relaxed and engaged in communicating virtually allowing them to have less stressful and more meaningful interaction. Staff reported that they now had the confidence in using technology to support residents and access their own virtual training opportunities. They also reported that they encouraged others to engage with technology at work and in their personal life.

Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities, Both older and younger people

Health, Long-term care, Social protection

Older People's Association, Academia, Health Care, Social Care, Private Sector

Older people were part of the process at multiple or all stages

The nurse education team have collaborated with staff working in Adult Social Care. The team have created an environment where staff can share concerns (both professional and personal), continue to learn, and celebrate success by listening to staff and working with them to ensure their needs are met. This has fostered a cultural shift where staff in social care increasingly feel valued, respected, and supported to provide the best care to residents and their relatives. It has also led to more leadership emerging in social care, as demonstrated by the care home digital champion roles. Additionally, the team has worked hard to increase student nurse placements in adult social care by 86% and has collaborated with Middlesex University in London to make this happen. Not only do the students feedback very highly on their placements but they also take forward an awareness and enthusiasm for ASC which should contribute to growing this much needed workforce. Furthermore, we are working in partnerships with the Local Authorities from the 5 boroughs and monthly updates are provided to them where we highlight and exchange information to support the homes, to access the digital technology when appropriate for them and address training needs. This ensures a cohesive approach that supports but does not overwhelm the homes. We are working closely in partnership with UCLP (University College London Partners), an Academic Health Science that brings together different sectors through innovation and research.

The digital technology and the team have impacted on the care provided in the care homes by upskilling staff to undersand the complexities of the care home residents they care for and what to do when someone is showing signs they may be unwell. Residents in the care homes feedback, “I am blind and before Whzan, I did not feel I was part of my health care as often care staff would not tell me what my observations were. As the technology talks back, I can hear and ask questions, I know now what is normal for me.” Another resident said “This kit is saving me money, if I’m not feeling well, the staff take my observations we talk to the GP on the phone and make a plan, before I would have had to take a cab to the GPs.” Feedback from relatives, “Having the technology in my mum’s home, give me reassurance that staff can take observations and share this quickly with the GP or other health professional, so she only goes to hospital when she needs to. Before Whzan she had many unnecessary trips to A&E, which was stressful for us all.” Another relative said, “Now if I’m worried about mum, the staff come and take a set of observations, and this give me reassurance and confidence in the staff team, and I know mum is getting the right care.”

The technology was rolled out during covid, where it became evident during the implementation that some staff struggled with using technology and the team had to ensure that our training and support did not make these individuals feel embarrassed or frustrated. Historically training in ASC had been face to face, however during covid, most training stopped, or was delivered virtually. It became apparent during the implementation that some staff were struggling with using technology and accessing the computer to take part in training and were therefore digitally excluded. We wanted to ensure that staff and residents had opportunities to learn how to use technology to communicate with others in a safe, non-threating, fun way. The team developed virtual meaningful activities such as art, gardening, and quizzes. These improved the mental wellbeing of staff and residents and developed the skills necessary to use technology. Residents reported that they felt less isolated and more confident in using technology to communicate with friends and family, pursuing their interests and meeting health care professional online. Relatives reported that their family members were more relaxed and engaged in communicating virtually allowing them to have less stressful and more meaningful interaction. Staff reported that they now had the confidence in using technology to support residents and access their own virtual training opportunities.

Although we supported staff to use the technology and spot deterioration, we observed during the roll out that, staff were asking for support and knowledge with other clinical skills due to the increased complexities of residents that were being admitted into their settings. We responded to this need by developing virtual bite size training opportunities. To maximize staff attendance the same topic was delivered at a set time and day during a one-month period. This enables managers to manage their workforce and get maximum involvement, develop a routine, and support upskilling all staff. Increased knowledge has made staff feel more confident in both delivering care and identifying when to ask for help. It has been reported that increased skills have made them feel more valued in the workplace. So far, we have delivered training on 24 clinical subjects with attendance ranging between 100 – 350 staff over a month period. Attendance is increasing as staff and management are witnessing the benefits. During training in the care settings, staff learned and gained confidence on practicing on each other. We noted that in non-nursing settings staff were struggling to remember normal ranges of adult vital signs. The team developed a laminated prompt card for their pockets to refer to. Which was given to everyone on completion of training. Feedback from staff that these prompt cards were helpful both in and out of work.

In NCL we now have 127 care settings that are using Whzan, to take observations and 48,000 NEWS2 scores uploaded on the portal which is being shared with health care professionals and allowing changes/deterioration to be picked up earlier and acted on. The team have trained and upskilled 4,800 staff to be more aware of long-term illness and deterioration in their group of residents. This is evident from the data collected and feedback. Data collected from April- November 2019 & 2021 showed that care homes without remote monitoring had a 14% reduction in London Ambulance service (LAS) call outs. Care homes with remote monitoring had a 28% reduction in LAS call outs. We also looked at non elective admissions over one year January -December 2019- 2021. We saw that care homes without remote monitoring had a 27% increase in cost of non-elective admissions, while care homes with remote monitoring only had a 4% increase in unplanned admissions. The average cost of a non-elective admission when a resident had access to remote monitoring was £663.00 less. The reduction fin non-elective admissions is likely due to deteriorating residents being recognized earlier, leading to less complex admissions as well as remote monitoring supporting early discharge and monitoring residents in their own homes. Feedback from staff shows the positive impact “ We have felt that the digital technology has empowered us to provide better care for our residents” Another staff member said “It’s been helpful in identifying a case of sepsis and getting our resident into hospital quickly” “As a lone nurse in a care home, having access to Whzan is like having another health care professional working with you, you are never alone and they are helping you to make the right decisions for your residents based on clinical information.” Together we have developed a new clinical pathway with 111, an urgent care provider.. Homes that are recording NEWS2 scores regularly and have a steady workforce have been trained to be able to access 111 via the tablet if they have a resident with a NEWS2 score of 4 or above. The early feedback from the homes indicates having this access gives them more confidence and reassurance to know they will have a call back from a clinician within 15 minutes. This helps teams manage their workload and ensure someone can stay with the residents awaiting the call back. But most importantly, this gives reassurance to the resident and their relatives/friends that they are getting clinical support quickly. Relative feedback, “I have seen this in action when my dad was unwell, the staff used it to call 111 and we had a response and plan in place that we all agreed to in 20 minutes, normally we had to wait many hours, and this caused unnecessary anxiety for everyone. All homes should have this technology”.