1. Robert Barker
GP partner, Corbridge Medical Group
NIHR In-practice fellowship, Newcastle University
Good NEWS for care home residents? A mixed-methods study exploring the impact of the National Early Warning Score in care homes.
Barker R, Russell S, Stocker R, Liddle J, Adamson J, Hanratty B

2. NEWS intervention ‘Common language’ ‘TRACK’ & ‘TRIGGER’ ‘Blue box’
47 care homes in Sunderland CCG
from August 2015

3. Methods Quantitative Qualitative Nomad survey
Every reading from Sept 2016 – Aug 2018
De-identified at patient and care home level
Qualitative
Purposive sampling to achieve variation, and convenience sampling.
Semi-structured individual face-to-face interviews
Thematic analysis
Nomad survey
4 copies to each care home
Impact on care home staff/whether it could form a routine part of their work, identify areas for improvement

4. RESULTS
18,015 NEWS scores were produced over 24 months for residents aged ≥65.
Mean age = 84
Clinical context
Count %
Baseline
3930 62
Clinical concern
1255 20
Not recorded
1160 19
18015
100.0
On 787 (4%) of occasions, one or more of the components of the NEWS was not entered at the time of generating the score.

5. Patterns of use across different sites

6. RESULTS Care Home staff Senior carer/ Carer 8 Nurse 1 Deputy Manager 3
Senior carer/ Carer 8
Nurse 1
Deputy Manager 3
Manager
Healthcare Professionals
Older Persons Specialist Nurse
Urgent Care
General Practice Manager
Family Members
CCG Employees
Total 24

7. Apparent simplicity of intervention vs. actual complexity
“…I think that is a common problem, they sometimes get the sats, the oxygen saturations and heart rate, around the wrong way”
Recovery at home team
“If you could use a mobile phone, then you can use this kit… But, going onto the interpretation and the understanding of what you’re actually doing is a completely different question which would lead me to a different answer..”
Specialist Nurse
When asked about the quality of the training…
“Very low, very low … if they [fellow care home staff had additional training or more quality of training, they may feel more amenable to actually engaging with it.”
Carer

8. Complex setting
“I thought it was going to be playing chess and helping people up and down but the amount of work actually involved, is ridiculous. I think it’s underestimated and it’s certainly undervalued.”
Carer
“…staff who are in the homes on minimum wage and we are expecting them to do more within their role and within a short space of time”
Recovery at home team
“One of my homes has had a different manager every year. The turnaround can be very rapid … so there can be a lot of unsettlement…”
Specialist Nurse
“The residents we have now coming to us are much more complex, much more dependent than even ten years ago.”
Care Home manager

9. A ‘common language’ & ‘shared understanding’
“…when I finally spoke to the manager, she said, “Oh, it’s because we’ve had paramedics out who told us that it’s useless and we shouldn’t be using it anyway because it gives such wrong readings…”
Specialist Nurse
“We’ve done the NEWS and sometimes they’ll say “what’s the NEWS?”… it frustrates the paramedics when they come out and we say we’ve tried to explain things … And I think receptionists at GPs … you would ring and say “we’ve done a NEWS score” and they’d be like “what does that mean?”
Dyadic interview with deputy managers
“[it is] a useful resource … you can look at a resident and think “they’re not quite right, but I don’t know why”. It seems silly phoning a doctor to say … “they’re just not themselves”. But if you’ve done their NEWS and their NEWS is indicating, you can obviously relay that information to the GP and say “their score is normally this, but it’s gone up to this so there is obviously something going on somewhere”.
Care home manager
“It is reassuring to know that they have the equipment, and they have used it on my mam … it can’t be anything but a good thing…”
Daughter of female resident with dementia

10. Technological issues
“We’ve got homes that say they’ve got issues with WiFi … WiFi access, broken equipment, faulty equipment…”
Specialist Nurse
“We’ve had quite a few issues and we’ve reported them several times, where some of the kit doesn’t work. We were told, originally, that the thermometer went behind the ear and we were having issues, it wasn’t recording accurately… So, we’ve reported it a few times now and we’ve been told to use it in the ear. “
Care home manager

11. NoMAD survey 42 surveys were returned across 22 care homes
General views:
67% (28) - intervention was worthwhile
88% (37) - could see the potential value of the intervention
Fit with current work:
83% (35) - a normal part of their work & a legitimate part of their role
76% (32) - staff had a shared understanding of the purpose
88% (37) - would continue to support use of the tablets
24% (10) - disrupts working relationships
Support and training
86% (36) - management adequately supported the intervention
81% (34) - sufficient training provided
86% (36) - work is allocated to people with the skills to use the equipment
67% (28) - had confidence in other people’s ability to use the tablet

12. DISCUSSION Mismatch between perceived and actual complexity
VERSUS
Mismatch between perceived and actual complexity
Constraints on care home staff
Use increasing but variability remains
A challenge to roles
Survey respondents were generally positive about the intervention

13. CONCLUSION
Complex setting + complex intervention = very complex implementation Requiring context-specific training and implementation Some evidence to support the wider implementation of NEWS measurement in care homes