Developing a care pathway for Ambulatory Care Sensitive conditions in care homes A Blighe, C Powell & M Downs Background Early detection and intervention for ill health in residents in care homes (with nursing) is problematic [1]. People living in care homes can end up being admitted to hospital for conditions which, if noticed and treated earlier, could have been managed in the care home [2]. The Better Health in Residents in Care Homes (BHiRCH) research programme aims to develop and test a complex intervention to reduce rates of hospital admissions from care homes. Two key components of the BHiRCH intervention are: An early warning tool A care pathway These components will facilitate the early detection and intervention of four key conditions (UTI, CHF, dehydration and lower respiratory tract infection) that commonly lead to unplanned hospitalisations. Aim Identify an early warning tool to assist care home staff in detecting early signs of deterioration. Develop a care pathway to aid in the diagnosis (and inform referral and treatment) of four common health conditions. Outcomes Our early warning tool is an adapted version of Florida Atlantic University’s Stop And Watch [3]. This highlights simple signs and behaviours to identify common, but nonspecific, changes in a resident’s condition. The BHiRCH Care Pathway is a clinical guidance and decision support system, comprised of several assessment steps, to screen and provide a more detailed assessment of the resident. Following a literature review, the Stop And Watch was modified and the Care Pathway designed in consultation with NHS colleagues, care home staff and family members of care home residents. Next Steps Development of our intervention materials is now complete. The early warning tool and care pathway will form part of a complex intervention, including comprehensive implementation support, aimed at improving health and reducing hospitalisations from care homes. We will shortly begin a feasibility study in two West Yorkshire care homes. This study will assess the acceptability and ease of implementation of our intervention and will inform a cluster randomised controlled trial involving 14 care homes. The trial is due to finish in 2018. References Bardsley M, Blunt I, Davies S, et al. Is secondary preventive care improving? BMJ Open 2013; 3(1). Krüger K, Jansen K, Grimsmo A, et al. Hospital admissions from nursing homes: Rates and reasons. Nurs Res Pract 2011;2011:247623 INTERACT. Stop And Watch Early Warning Tool. Florida Atlantic University, 2014. BHiRCH PI: Professor Murna Downs. Researchers: Dr Alan Blighe (Research Programme Manager, University of Bradford), Dr Catherine Powell (Research Fellow, University of Bradford), Alexandra Feast (Research Associate, University College London), Co-applicants: Dr Liz Sampson (University College London), Prof Katherine Froggatt (Lancaster University), Prof Brendan McCormack (Queen Margaret University), Mrs Shirley Nurock (Alzheimer's Society, PPI), Dr Greta Rait (PRIMENT/University College London), Prof Louise Robinson (University of Newcastle), Dr Barbara Woodward-Carlton (Alzheimer's Society, PPI), Prof John Young (Bradford Institute for Health Research). Collaborators: Ms Caroline Baker (Barchester HealthCare), Prof Clive Ballard (Kings College London), Prof Heather Gage (University of Surrey). This presentation is an outcome of independent research funded by a National Institute for Health Research Programme Grant for Applied Research – “Reducing rates of avoidable hospital admissions: Optimising an evidence-based intervention to improve care for Ambulatory Care Sensitive conditions in nursing homes” (RP-PG-0612-20010). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. email: a.blighe@Bradford.ac.uk