Recognizing and responding to deterioration in care homes: a scoping review protocol

Hodge, Sevim; Ali, Mohammad R; Gordon, Adam L

doi:10.11124/jbisrir-d-19-00413

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…, 2016). Emergency department referrals from nursing homes depend on early identification of changes in residents, existence of prior planning and support received by the nursing home in managing sick individuals during crises (Hodge et al. , 2021).…”

Section: Discussionmentioning

confidence: 99%

Health care model for people living in nursing homes based on integrated care

Espaulella-Ferrer,

Morel-Corona,

Zarco-Martinez

et al. 2023

JICA

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PurposeOlder people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.Design/methodology/approachA real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.FindingsThe integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.Originality/valueThis case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

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Section: Discussionmentioning

confidence: 99%

Health care model for people living in nursing homes based on integrated care

Espaulella-Ferrer,

Morel-Corona,

Zarco-Martinez

et al. 2023

JICA

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“…Due to growing concerns of an increased incidence of avoidable hospitalizations of residents (Australian Royal Commission into Aged Care Quality and Safety, 2021) and associated risks, the impetus to detect acute deterioration of residents early and to provide them with more appropriate management in‐house is growing (Carter et al, 2020) with further work pending (Hodge et al, 2021). The Australian Commission on Safety and Quality in Health Care (2019) states that “recognising deterioration relies on detecting, understanding and interpreting abnormal vital signs and other observations” (Intention of – Responding to Acute Deterioration Standard), therefore, it is imperative that all care staff of residential aged care facilities can accurately identify early indicators of clinical deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Due to growing concerns of an increased incidence of avoidable hospitalizations of residents (Australian Royal Commission into Aged Care Quality and Safety, 2021) and associated risks, the impetus to detect acute deterioration of residents early and to provide them with more appropriate management in-house is growing (Carter et al, 2020) with further work pending (Hodge et al, 2021) changes that are frequently used in residential aged care as an indicator of acute deterioration. This was an interesting finding as these categories have few physiological indicators that are commonly used in the early warning scoring system but highlight several health status changes, such as the resident's mood and behavior (Ashcraft & Owen, 2014;Boockvar et al, 2000;Boockvar & Lachs, 2003;Little et al, 2019;Ouslander et al, 2016aOuslander et al, , 2016bStansfield, 2012;Tingström et al, 2010;Unroe et al, 2018) and functional decline (Ashcraft & Owen, 2014;Boockvar et al, 2000;Boockvar & Lachs, 2003;Ouslander et al, 2016aOuslander et al, , 2016bStansfield, 2012) which can be detected without specialized skills or equipment.…”

Section: Discussionmentioning

confidence: 99%

Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Chambers

Spooner

Parker

et al. 2022

J of Nursing Scholarship

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Purpose: To identify the clinical indicators of acute deterioration in residents and the factors that influence residential aged care facility staff's identification of these.Design: Rapid review and narrative synthesis. Methods:The WHO and Cochrane Rapid Review Methods Group recommendations guided the review processes. CINAHL, Medline, PubMed, and the Cochrane Library were searched from 2000 to January 2022. Data related to clinical indicators of deterioration were categorized using the Airway, Breathing, Circulation, Disability, Exposure assessment framework, and factors influencing detection were grouped as consumer (resident and family), aged care workforce, and organization factors. Results: Twenty publications were included of which 14 informed clinical indicators; nine highlighted factors that influence staff's identification of these and three informed both. Included article were collectively below moderate quality. Most clinical indicators were grouped into the 'Disability' category with altered level of consciousness, behavior, and pain identified most frequently. Few studies reported more traditional indicators of deterioration used in the general population -changes in vital signs. The most common factors influencing the detection of acute deterioration were organizational and workforce-related including resource, knowledge, and confidence deficits. Conclusion:Findings suggest subtle changes in resident's health status, rather than focusing primarily on physiologic parameters used in early warning tools for acute care settings, should be recognized and considered in the design of early warning tools for residential aged care facilities.

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“…We conducted a systematic scoping review in accordance with Joanna Briggs Institute (JBI) methodology and used the PRISMA-SCR reporting checklist [ 20 ]. The review was registered with JBI Evidence Synthesis, and the full protocol published [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Recognising and responding to acute deterioration in care home residents: a scoping review

et al. 2023

Self Cite

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Background Acute deterioration describes a rapid change in physical and/or mental health resulting from an acute illness – e.g., heart attack or infection. Older people in care homes are some of the frailest and vulnerable in society. They have complex health needs, experience multiple long-term conditions (MLTC) and have weakened immune systems due to the ageing process. They are more susceptible to acute deterioration and delayed recognition and response, is linked to poorer health outcomes, adverse events and death. Over the past five years, the need to manage acute deterioration in care homes and prevent hospital admissions has led to development and implementation of improvement projects, including the use of hospital derived practices and tools to identify and manage this condition. This is potentially problematic as care homes are different from hospitals—options to escalate care vary throughout the UK. Further, hospital tools have not been validated for use in care homes and have shown to be less sensitive in older adults living with frailty. Objectives To collate the available evidence on how care home workers recognise and respond to acute deterioration in residents using published primary research, non-indexed and grey literature, policies, guidelines and protocols. Methods A systematic scoping review was conducted following Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted using: CINAHL (EBSCOhost), EMCARE (OVID), MEDLINE (OVID) and HMIC (OVID). Snowball searches of included studies’ reference lists were conducted. Studies that featured care homes with or without nursing and provided 24/7 care to residents were included. Results Three hundred and ninety-nine studies were identified. After reviewing all studies against inclusion criteria, n = 11 were included in the review. All studies used qualitative methods and were conducted in Australia, UK, South Korea, USA and Singapore. Four themes were generated from the review: identifying residents with acute deterioration; managing acute deterioration, care home policies and procedures, and factors affecting recognition and response to acute deterioration. Findings Recognition and response to acute deterioration in residents is determined by multiple factors and is context sensitive. There are several interrelated factors within and external to the care home that contribute to how acute deterioration is recognised and managed. Conclusions and Implications The available literature on how care home workers recognise and respond to acute deterioration is limited and often subtends other areas of interest. Recognising and responding to acute deterioration in care home residents is reliant on a complex and open system encompassing multiple interrelated components. The phenomenon of acute deterioration remains underexplored and further research is required to examine contextual factors that accompany identification and management of this condition in care home residents.

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Recognizing and responding to deterioration in care homes: a scoping review protocol

Cited by 5 publications

References 13 publications

Health care model for people living in nursing homes based on integrated care

Health care model for people living in nursing homes based on integrated care

Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Recognising and responding to acute deterioration in care home residents: a scoping review

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