Quality in Care
Happy New Year from the Quality in Care Team!
SPECIAL
POINTS OF
INTEREST:
Eventbrite Book-
J A N U A R Y
2 0 1 7
QiCT Featured Provider– Swarthmore
ings for Study
Days
New Activities
Workshop
Good Night Care
Practice and Vitamin D
Spray for Angina
Correct Use of
Inhalers
New Policies and
Guidance
Dignity Awards
2017
The Management at Swarthmore recognised that improvement was needed in regards to record
keeping; to make all care staff aware of the importance of recording including any legal implications.
Also, what needs to be recorded and how to remove content which could be open to interpretation.
QiCT carried out workshops in “Record Keeping” and “Person-Centred Approach” in summer 2016.
Positive changes were noted in a following visit from a DoLs review officer, who praised Swarthmore
for their excellent recording and practice in regard to Person-Centred Care. The home was also highly
praised for the delivery of varied activities, professionalism and helpfulness of staff.
QiCT Study Days
Study days are available to care workers and nursing staff. Some may be available to health and
social care professionals, please ask for details
NEW The Quality in Care Team are now using Eventbrite for our study day bookings
and future Nurses Forum registrations!
Booking online via Eventbrite brings along quite a few advantages! You will now be able to book directly without having to wait for confirmation from QiCT and you can also see more information on
the event page, including number of spaces available and directions to the specific venue. Everything
we would usually address on the flyer will also be on the Eventbrite page, including an agenda, location and booking terms and conditions.
These events will be set up privately and sent via an Eventbrite email invitation to avoid the events
being listed publically. The person receiving this information will be the home manager/deputy or
administrator, depending on the contact information we have been provided with. Please note that
you are free to book on any of your staff members, regardless of who gets the invitation. Please contact [email protected] for any queries or if you would like somebody added to our mailing
lists or added as a one-off invite. For a list of study days please visit our website . Thank you!
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QiCT Workshops
2
Workshops are available to residential or nursing, domiciliary, day opportunities, and supported living
services. We welcome health and social care professionals to refer on behalf of providers as well
NEW Person-centred Activities Workshop - 2 hour session
The Quality in Care team is pleased to announce its launch of a new workshop for all Care Staff
and Activity Coordinators in Buckinghamshire working with older people and/or adults with
Learning Disabilities. The aim of the workshop is to understand the benefits of person-centred activities, enabling staff to think outside the box when supporting clients with individual needs. The workshop emphasises
the benefits of including day-to-day activities. It also helps staff to identify challenges and restrictions and
consider possible solutions.
Information on this is available on the QiCT website. If you would like further information, please do not hesitate to contact the team on 01296 387087, email [email protected] or send in a referral
Good Night Care Practice
Topics
of the
Quarter
Study from Joseph Rowntree Foundation: “Supporting Older People in Care homes” in 2008 found
that routine, indiscriminate over-checking led to unnecessary disturbance of residents in Care
Homes. This study offered recommendations such as implementation of night-time key worker systems; individual risk assessments for night-time care; and greater involvement of management. The
study also stressed that practices that are intrusive, such as checking and changing pads, should be
done with minimal disruption, be gender appropriate and be sensitive to communication needs. It
should especially only be carried out in response to each individual needs, not part of a group
'round', and recorded in the individual’s care plan.
CQC has developed a guidance for inspectors following this study, which included questions such as:

“...over-checking
[leads] to



unnecessary

disturbance of

residents in Care
Homes.”






Are people able to make choices about?
when they go to bed and when they get up in the morning
their routines when going to bed and getting up
their bed and bedding (for example, height of bed, number of pillows, type of mattress)
their personal care and the level of support they want at night
their preference for male or female carers?
Are night time staff made aware of the importance of helping residents to have a good night’s
sleep by:
opening and shutting doors quietly
talking quietly in corridors or near bedrooms
avoiding unnecessary trips up and own corridors
only checking or waking people if necessary and as described in their care plan
keeping lights low
Vitamin D
Vitamin D helps to regulate the amount of calcium and phosphate in the body. These nutrients are
needed to keep bones, teeth and muscles healthy. In the UK, sunlight-induced vitamin D synthesis
is only effective between late March/early April and September and not from October onwards
throughout the winter months. Dietary sources are essential when sunlight containing UVB radiation is limited (e.g., during the winter months) or exposure to it is restricted (e.g., due to lack of
time spent outdoors or little skin exposure).
QUALITY
IN
CARE
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3
Now that winter is here it remains vitally important that your residents continue to get their
Vitamin D. In the UK, the main dietary sources of vitamin D are foods of animal origin, fortified
foods and supplements. Rich sources include egg yolk and oily fish such as salmon, mackerel,
herring and sardines. Animal products such as meat, fat, liver and kidney also contain vitamin
D. Older people may need a Vitamin D supplement which is prescribable by their GP.
Medicine Matters
GTN (Glyceryl Trinitrate) Spray for angina – available OTC (Over The Counter)
Are you aware that GTN spray (or tablets) can be purchased from a pharmacy if a patient
were to run out and required one urgently? We are still advocating that under normal circumstances this is prescribed, but under winter pressure and with patients visiting relatives over
Christmas and not being at usual places of residence this knowledge could prevent an out of
hours call out or a trip to A&E.
Correct Use of Inhalers
“...75% of
hospital
admissions for
asthma are
What is an inhaler? An inhaler is a device holding a medicine that you take by breathing in
(inhaling). Inhalers are the main treatment for asthma and COPD. There are many different types
of inhaler, which can be confusing. This is to give information on the medicines inside inhalers,
the types of inhaler device, and some general information about inhalers.
Introduction: Care home staff need better training on the use of inhalers. According to Asthma
UK, an estimated 75% of hospital admissions for asthma are avoidable and as much as 90% of
deaths from asthma are preventable. Further, the NHS spends around £1bn a year treating and
caring for people with asthma. Undoubtedly, correct technique in using medicine delivery devices, such as metered dose inhalers, is key to managing asthma and COPD effectively. The medicine inside inhalers can be grouped into relievers (short-acting bronchodilators), preventers
(steroid inhalers) and long-acting bronchodilators.
avoidable.”
Reliever inhalers - contain bronchodilator medicines. You can take a reliever inhaler as required
to ease symptoms when you are breathless, wheezy or tight-chested. The medicine in a reliever
inhaler relaxes the muscle in the airways. This opens the airways wider, and symptoms usually
quickly ease. These medicines are called bronchodilators as they widen (dilate) the airways
(bronchi). The two main reliever medicines are salbutamol and terbutaline. These come in various brands made by different companies. There are different inhaler devices that deliver the
same reliever medicine. Salbutamol brands include Airomir®, Asmasal®, Salamol®, Salbulin®, Pulvinal Salbutamol® and Ventolin®. Terbutaline often goes by the brand name Bricanyl®. These
inhalers are often (but not always) blue in colour. Other inhalers containing different medicines
can be blue too. Always read the label.
If you only have symptoms every now and then, the occasional use of a reliever inhaler may be
all that you need. If you need a reliever three times a week or more to ease symptoms, a preventer inhaler is usually advised
Preventer inhalers - may be steroid inhalers and/or long-acting bronchodilators. These are taken
every day to prevent symptoms from developing. It takes 3-7 days for the steroid in a preventer
inhaler to build up its effect. Inhaler technique should be checked at every opportunity and before changing or increasing a patients’ medication.
Rinsing the mouth after using a steroid preventer inhaler helps to stop any medicine being left
behind in the mouth or on the lips.
Everyone with asthma OR COPD should have a review with their doctor or respiratory nurse at
least once a year. *N.B: In COPD a preventer inhaler will only be used in some patients.
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4
Inhaler devices
Different inhaler devices suit different people.
The Standard MDI (Metered Dose Inhaler): The standard MDI is the most widely used inhaler.
However, many people do not use it to its best effect. Common errors include:
• Not shaking the inhaler before using it.
• Inhaling too sharply or at the wrong time.
• Not holding your breath long enough after breathing in the contents
Breath-activated inhalers: These are alternatives to the standard MDI. Some are still pressurised
MDIs, but these don't require pressing a canister on top. These would be useful for patients who
have difficulty breathing and pressing the inhaler at the same time.
E.g. autohaler is a breath-activated MDI.
N.B: For further details on how to use inhalers refer to Asthma UK animated videos
“Spacers...help
Spacer devices
A spacer is usually a plastic container, with a mouthpiece at
one end and a hole for the inhaler at the other. Spacers only
work with a metered dose inhaler. Spacers are important beasthma
cause they help to deliver asthma medicine to the lungs. There
medicine to the are different types of spacers available. An example is volumatic device .There are several different brands of spacer that fit different metered dose inhalers and are available on prescription
lungs.”
(including Volumatic, Aero Chamber and Able Spacer). Spacers are very important because:
• They make metered dose inhalers easier to use and more effective.
• Allows more medicine into your lungs than when just using the inhaler on its own.
• They are convenient and compact and work at least as well as nebulisers at treating most asthma attacks in children and adults.
• They help to reduce the possibility of side effects from the higher doses of preventer medicines
by reducing the amount of medicine that is swallowed and absorbed into the body.
Handy Hints for Using a Spacer:
• Care home staff should be appropriately trained on how to use an inhaler and spacer properly
• Ensure that the spacer prescribed fits your inhaler
• Advise patient to put one puff of the inhaler into the spacer
• If the patient finds it difficult to take deep breaths, breathing in and out of the mouthpiece several times for at least 10 seconds is just as good.
• Repeat the step above for each dose/puff needed and allow 30 seconds between each puff.
• Wash the spacer once a month - leave it to drip-dry as this helps to prevent the medicines sticking to the sides. Do not put through a dishwasher.
• Spacers should be replaced at least once each year, especially if it is used daily
to deliver
FURTHER HELP & INFORMATION
Asthma UK: Summit House, 70 Wilson Street, London, EC2A 2DB Tel: (Adviceline) 0800 121 62 44,
(Admin) 020 7786 4900 Web: www.asthma.org.uk
• British guideline on the management of asthma; Scottish Intercollegiate Guidelines Network - SIGN
(Oct 2014)
• Asthma; NICE CKS, June 2011 (UK access only)
• Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years
and over; NICE Technology Appraisals, March 2008
• Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years;
NICE Technology Appraisals, November 2007
• Global Initiative for Asthma (GINA)
What we Do
NEW POLICIES AND GUIDANCE
Workshops
Workshops tailored to your service are
available for FREE including:
Check out our new section on Policies and Guidance on our website!
We have added the following new documents:
Record Keeping, Well-being, Dementia
Awareness, Pressure area Care and more… Clinical- Standards of Catheter Care in Adults Summary Guide
Interested in workshops? Please use our
Nutrition- Food Record Charts – How to use
referral form on our webpage.
Study Days
These are available at a small cost & include:
DIGNITY AWARDS 2017
Medicine’s Study Day (Jan 2017), Foot &
Toe Nail Care (Feb 2017) Infection Preven- Our Dignity and Respect Awards Showcase is set for 19th May
tion Control (Mar 2017), End of Life Study 2017 so please put the date in your diaries.
Day for Carers (Apr 2017) and more...
Please visit our Training Section on our
webpage for details on how to book
Nurses’ Forum
Meetings are held quarterly. Next meeting
3rd Feb 2017 at Green Park, Stablebridge
Road, Aston Clinton, Bucks HP22 5NE. All
nurses welcome!
Email [email protected]
to book your place
Nomination forms will be going live in February 2017 so watch
out for further notices in the NEW YEAR.
Again, we are looking for individuals, teams and organisations that
have gone that extra mile in supporting people in Buckinghamshire
in ways that promote dignity, respect and well-being.
So get ready to celebrate your dignified achievements!!
Please visit our webpage under the Training Section
for a full list of Workshops and Study Days
The Quality in Care Team is jointly funded by Health and Social Care
in Buckinghamshire. We are a key resource for providers, offering
support and advice to health, social and learning disability services.
We will work with you to build up relationships with your commis-
Quality in Care Team
Buckinghamshire County Council
sioners, care management, GP’s, pharmacies, community and specialist nursing and therapy services across Buckinghamshire. We are
5th Floor
a small team including professional nurses, pharmacists and adult
County Hall
social care staff whose aim is to support domiciliary, care home
Aylesbury
(residential or nursing), day opportunities, and supported living pro-
Bucks
viders to deliver quality care in today’s challenging environment.
HP20 1YU
Phone: 01296 387087
E-mail: [email protected]
Twitter: @BucksQiCT
We’re on the web!
www.careadvicebucks.org/qict