1. Introducing The Hydration Toolkit for Care Homes
Lesley Spall
Care Home Effective Support Service
Lancashire Care NHS Foundation Trust
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

2. The Hydration Toolkit for Care Homes
Background to the Hydration Toolkit and the development
of the Hydration Toolkit
Implementation & Evaluation of the Hydration Toolkit
A look through the resources within the Hydration Toolkit
Next Steps and Questions
Thank you all for coming
Thank you to LCC for providing the venue and tea and coffee.
Don’t want this be death by powerpoint – so keep it informal and just fill you in with regards to the toolkit and how it has come about……….
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

3. Hydration Toolkit for Care Homes – Background
“Identify an area of practice/service need that requires development/enhancement”
Why Dehydration?
It is a common problem among older adults - associated with increased morbidity and mortality (Remington and Hultman 2007)
Often a reason for hospital admission
There is concerning evidence of failure to deliver care that meets older peoples’ most basic hydration needs
Why the focus on care homes?
In 2012
17806 residential care & nursing homes
463,287 beds (CQC, 2012)
There are almost three times as many beds in care homes than in the NHS!
Within the Central Lancashire Locality there are over 2500 care home beds
So, last year….. As part of my masters course, had to think about an area in your practice that needs development, improvement or enhancement…… set about thinking ……… …… the chess team was working in care homes and it well recognised about the increasing complexity and vulnerability of older people living in our care homes….. Multiple ltc, multiple meds, increased dependency ………
Decided to consider a hydration toolkit – too late when our older people are admitted to the acute hospital setting – what can we do to prevent this
Looked at the resources available – heavily focussed on malnutrition and the acute setting – yes, there are some care home resources, but not really bespoke, or that informative…….
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

4. Hydration Toolkit for Care Homes – Design and Construction
Stakeholder meetings
Steering groups
Identification of Early Adopter Care Homes x 3
Hydration Toolkit Champions
Review of Local Practice
Searching for National good practice and evidence
So, formed a small steering group quickly identified 3 early adopter homes – the volunteers!!! Nominated champions and met with the champions to look at what works and what doesn’t work in relation to hydration in their care homes and pulled this together along with picking out the best bits from the national guidance and resources……….
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

5. Hydration Toolkit for Care Homes – Early Adopter Implementation
Testing all of the contents of the Hydration Toolkit
It took patience - Version 4 of a number of resources
This was the interesting bit! - a big thank you needed to Val and her staff at Banksfield for their perseverance and honesty !
The powerpoint presentations have all be “tested” at Banksfield, and all of the poster resources have been on display and now on, version 4 of the 7 day booklet!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

6. Hydration Toolkit for Care Homes – Evaluation.
Hydration Toolkit for Care Homes – Evaluation
Evaluation was considered throughout every phase of the project
The Context, Input, Process and Product Framework (Stufflebeam, 2003) was utilised to evaluate of the Hydration Toolkit for Care Homes
This was the interesting bit! - a big thank you needed to Val and her staff at Banksfield for their perseverance and honesty !
The powerpoint presentations have all be “tested” at Banksfield, and all of the poster resources have been on display and now on, version 4 of the 7 day booklet!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

7. Hydration Toolkit for Care Homes – Evaluation.
Hydration Toolkit for Care Homes – Evaluation
Context Evaluation
Local and National Drivers for change
Review of evidence in relation to improving hydration
Baseline audit and quiz within local care homes
Cause and effect diagram -> Exploration of the Environment within Local Care Homes
Input Evaluation
Stakeholder Analysis
Steering group formation
Early Adopter Care Homes and Hydration Champions identified
Review of best practice within local care homes
Process Evaluation
PDSA cycles within Pre Pilot and Pilot implementation phase
Formative evaluation of Pilot Implementation
Launch event evaluation
Product Evaluation
Repetition of Baseline audit measures within Pilot Implementation Care Home
Feedback from Pilot Implementation Care Home - Manager, Staff , Residents and Families
Post Launch event feedback
This was the interesting bit! - a big thank you needed to Val and her staff at Banksfield for their perseverance and honesty !
The powerpoint presentations have all be “tested” at Banksfield, and all of the poster resources have been on display and now on, version 4 of the 7 day booklet!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

8. Hydration Toolkit for Care Homes – Evaluation.
Hydration Toolkit for Care Homes – Evaluation
The project evaluation considered the following questions: 
What progress has been made?
Were the desired outcomes achieved?
Did the project results justify the project inputs?
This was the interesting bit! - a big thank you needed to Val and her staff at Banksfield for their perseverance and honesty !
The powerpoint presentations have all be “tested” at Banksfield, and all of the poster resources have been on display and now on, version 4 of the 7 day booklet!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

9. Hydration Toolkit for Care Homes –Evaluation.
Hydration Toolkit for Care Homes –Evaluation
KEY FINDINGS
The evaluation data demonstrates that the homes have utilised the resources within the Toolkit, as planned, as a bespoke, “pick and mix” toolkit to meet the needs of the staff and residents
100% of respondents considered that using the resources from the Toolkit has raised awareness of the need for adequate hydration & 100 % of Care Home Managers/Hydration Champions consider that the Toolkit has raised awareness of the sign and symptoms of dehydration in older people
Whilst it has been recognised that that only a small number of care homes have received the Toolkit it is apparent that the project aims and objectives have been met therefore justifying the inputs
This was the interesting bit! - a big thank you needed to Val and her staff at Banksfield for their perseverance and honesty !
The powerpoint presentations have all be “tested” at Banksfield, and all of the poster resources have been on display and now on, version 4 of the 7 day booklet!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

10. Hydration Toolkit for Care Homes – The Resources
Reources – powerpoint presentations – for new starters or as a refresher
Background, learning from francis report, signs and symptoms, benefits, opportunites
Adobe voice
Resources – poster displays, can drink cant drink wont drink, hydration boosters, resident info leaflets. GULP assessment tool and the newly devised 7 day booklets with a cumulative chart to record the daily intake, with care planning guidance
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

11. Hydration Toolkit for Care Homes – The Resources
Let’s introduce the Toolkit The Animation
The national and local drivers for developing a hydration toolkit for care homes.
A short adobe voice presentation about why the hydration toolkit has been developed or a more detailed PowerPoint presentation is available
Developing a Hydration Toolkit for Care Homes
The National and Local Context including learning lessons from the Francis Report
The Education Components available in PowerPoint and Adobevoice Presentations
Dehydration in older people
Signs and Symptoms of Dehydration in Older People
Strategies to improve hydration in YOUR care home
What are the benefits of promoting hydration in YOUR care home?
The Assessment, Care Planning and Monitoring Resources
GULP Assessment Tool
How much have you had to drink today? The 7day booklet
How to use guides
Introduction to the toolkit –ANIMATION
The national and local drivers for developing a hydration toolkit for care homes.
A short adobe voice presentation about why the hydration toolkit has been developed
A more detailed PowerPoint presentation
Developing a Hydration Toolkit for Care Homes - The National and Local Context including learning lessons from the Francis Report
A Base line assessment audit - Try this in your care home, but use it before you to use any of the contents of the Hydration toolkit. This will demonstrate if your current fluid assessment charts and fluid balance charts are being completed in your care home
A Self Assessment Knowledge Quiz for care staff. This quiz has been adapted from the Water UK Campaign. This is a shorter version. Test your knowledge on hydration!
Educational components of the toolkit – there are a number of PowerPoint sessions available
Dehydration in older people
Signs and Symptoms of Dehydration in Older People
Strategies to improve hydration in YOUR care home
What are the benefits of promoting hydration in YOUR care home?
There are a number of adobe voice presentations too – NEED TO LIST
Resources to Download
The hydration risk assessment chart, GULP. This is a tool that has successfully been implemented within a NHS Trust. The GULP has been used with the permission of South Essex Partnership University NHS Foundation Trust.
GULP
How to use guide the GULP
How much have you had to drink today? The 7day booklet – This has been developed to record your resident’s intake over a period of 7 days, along with a cumulative chart and care planning guidance
Strategies to boost hydration in the care home – these are ideas from the evidence and local best practice and can be printed, laminated and displayed in your home.
The cause and effect of dehydration
The potential consequences of dehydration
Learning lessons from the Francis Report
Hydration in Your care home
Hydration Boosters
Measurements in Your care home
Urine colour chart – A4
Urine colour chart – Postcard size
Patient information leaflet
Can, can’t and won’t drink
STOP!
Resource library – references, national guidance and local contacts
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

12. Hydration Toolkit for Care Homes – The Resources!
Hydration Toolkit for Care Homes – The Resources
Strategies to boost hydration in the care home –
These are ideas from the evidence and local best practice and can be printed, laminated and displayed in your home.
Please do not photocopy the urine charts in black and white
The cause and effect of dehydration
The potential consequences of dehydration
Learning lessons from the Francis Report
Hydration in Your care home
Hydration Boosters
Measurements in Your care home
Urine colour chart – A4
Urine colour chart – Postcard size
Patient information leaflet
Can, can’t and won’t drink
STOP!
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

13. Hydration Toolkit for Care Homes – Next Steps
Hydration Toolkit to be available on Lancashire Care’s website
To discuss with the Clinical Commissioning Group and Local Authority developing a Best
Practice Event
Explore linkage to workstreams, groups and events
To prepare the 3rd Hydration Toolkit Newsletter
To explore funding streams for the rollout of the Hydration Toolkit
© 2014 Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.