Red Bag Hospital Transfer Pathway: Sutton Homes of Care Vanguard, Sutton CCG Viccie Nelson, Vanguard Programme Director Christine Harger, Quality Assurance Manager

Sutton Homes of Care: The Programme NEW MODEL OF CARE Our vision is to have vibrant, high-quality care homes in Sutton delivering care that embraces the national nursing values of patient care – Care, Compassion, Competence, Communication, Courage and Commitment (the ‘6Cs’). NEW MODEL OF CARE Integrated Care Care Staff Education and Development Quality Assurance and Safety The vision is implemented through the three ‘pillars’

What were the issues? Care home managers forum with our partners revealed there were several issues with the admission/discharge of care home residents from all organisations

How we achieved this? Issues identified No standard paperwork Lost documents Loss of residents’ belongings Medicines disappear No system in place to track residents through the hospital Care homes find it difficult to get information from hospitals Care homes receive lots of phone calls about the residents’ clinical ‘situation’ Poor communication between hospitals and care homes on discharge Residents staying in hospital for longer periods than necessary Solutions proposed Transfer bag Standard paperwork to assist ambulance staff and A&E staff Baseline information about the resident Better communication between care homes and hospitals at all points of the resident’s journey Senior staff from care homes to visit residents in hospital within 48 hours of admission

What were the results? A pathway Short film: https://www.youtube.com/watch?v=FH1ui_Z07AY If possible please could you have loaded the video below that explains the pathway Hospital Training video: https://www.youtube.com/watch?v=FH1ui_Z07AY

What were the results? A set of principles Every resident has a red bag that contains their personal information documents, their medications and their belongings and clothes for travelling home in Every point of contact in the resident’s journey from care home to hospital knows their personal information (who they are, what their health and social care needs are when they are well, and what their wishes and preferences are). Every person who meets the resident knows what the reasons are for them going into hospital Every care home manager or nominated deputy is available to support the resident whilst in the hospital, visits within 48-72 hours of admission and is involved in the episode of care Every resident, or if they don't have capacity, their lasting power of attorney or a best interest decision, consents to their personal information being shared between the care home, the hospital and the ambulance service Every relevant hospital and ambulance service staff communicate all relevant information about the resident with each other and with the care home

What were the results? Training resources and films

What were the results? Consent - hospital and care homes talk! “I didn’t know the patient was on thickener [for drinks] until I looked through the red bag” “Before the red bag we would spend ages on the phone trying to get information about the patient, now the information and their medicines are all in one place, its saved our time immensely” Consent - hospital and care homes talk! Highlights specific and holistic care needs Smoother – quicker handover Care homes visit their residents Nursing summary for continuity Timely and appropriate interventions NICE Guidance (NG27) “The documentation gives me all the information I need to ensure the patient has the best chance of making an excellent recovery after their surgery”

“Definitely helpful for the acute take” Great feedback “Patient can be aggressive but tips included about talking to him about his wife and has been so much easier to care for him. Might usually take 2 hours to find out this information and sometimes might never find out!” “A good organised comprehensive approach enabling clinicians to obtain a complete picture, especially in cognitive impairment.” “I didn’t know the patient was on thickener [for drinks] until I looked through the Red Bag” “Definitely helpful for the acute take”

Impact to date 179 residents of care homes have been tracked through our local hospital in the last nine months Average length of stay with a bag was 13.4 days, compared to 17.4 days without a bag Residents with a red bag spent 4 days less in hospital than those without a red bag Note: Data kindly collected by Integration and Transformation Team and Older People Nurses at our local hospital

Great care for our residents Sarah on at 02:05 – 05:21 A care home residents perspective https://youtu.be/MP03jUtBXmA

Where do we go from here? Sustainability GREATER LONDON NORTH AMERICA   NORTH AMERICA   GREATER LONDON SINGAPORE Simple idea- people think its theirs- ownership hopefully leading to sustainability

Great care is a partnership Sutton Homes of Care Great care is a partnership http://www.suttonccg.nhs.uk/vanguard/Pages/default.aspx