Hydration. simple but effective. Emma Sneed Commissioning Infection Prevention Nurse Worcestershire CCG s

Transcription

1 Hydration simple but effective Emma Sneed Commissioning Infection Prevention Nurse Worcestershire CCG s On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 1

2 Commissioning Excellent Nutrition and Hydration Malnutrition and dehydration are both causes and consequences of illness, have significant impacts on health outcomes Malnutrition affects more than three million people at any one time in the UK The scale of dehydration is unknown but is associated with a number of known causes of harm to people Poor recognition despite numerous reports that outline the benefits and improved health outcomes (NHSE, Oct 2015) On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 2

3 Hydration The medical evidence for good hydration shows that it can assist in preventing or treating ailments such as: pressure ulcers constipation urinary infections and incontinence kidney stones heart disease low blood pressure diabetes (management of) cognitive impairment dizziness and confusion leading to falls poor oral health (RCN,2007) On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 3

4 Implications for Practice Early recognition of dehydration in community settings before admission Early recognition of dehydration on admission to hospital to inform appropriate treatment plans Recognition that dehydration affects people across all care settings Hydration plays a role in the prevention of avoidable harm Nursing Times(2013) Vol 109,No 26. On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 4

5 Urinary Tract Infections UTI S are responsible for 10 million Dr visits each year in the UK. Over 1500 people attended Worcestershire A&E s 2016 with a UTI On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 5

6 National Initiative Schemes CQUIN Reducing the impact of serious infection Quality Premium Reducing Gram Negative Bloodstream Infections (GNBSIs) and inappropriate antibiotic prescribing in at risk groups 10% 10% E coli BSI 2016 baseline Trimethoprim (>70yrs) On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 6

7 Health Economy Strategy 19/06/2018 7

8 UTI Summit Pledges On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/2018 8

9 UTI Summit Pledges 19/06/2018 On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 9

10 Urine sticker Check Your Urine On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

11 Urine Colour Urine that is plentiful, odourless and pale in colour (pale straw) generally indicates that a person is well hydrated. Dark, strong-smelling urine, in small amounts could be a sign of dehydration. Certain foods, medications and vitamin supplements may cause the colour of urine to change even though you are hydrated. On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

12 Hydration On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

13 Pharmacies and GP Practices On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

14 Info-graphics 19/06/

15 Dental and Oral Hygiene 19/06/

16 @UTIAware On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

17 New Media Messages On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

18 Other Resources On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

19 UTI Leaflet On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

20 Hydration leaflet 19/06/

21 19/06/

22 Arial Bold On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

23 Urinalysis Guidelines On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

24 Infection Prevention and Control Resources Available at: 19/06/

25 Testing for UTI in adults over 65yrs Recommendations are that: Adults aged 65 years and over have a full clinical assessment before a diagnosis of urinary tract infection is made. DIP sticks Not an indication alone for diagnosis of UTI- DO NOT DIP stick catheterised patients Refrain from treating asymptomatic bacteriuria and therefore giving inappropriate antibiotic treatment limit antibiotic resistance

26 Urinary Catheter Passport A patient held passport aimed at supporting the reduction of urinary infections, reducing the number of unnecessary catheter related hospital visits, empowering patients too live healthily with their device and improved communication and information sharing between health and social care professionals about the management of patients catheters. On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

27 Urinary Catheter Passport This collaborative approach across both our hospital and community services will enable staff to work together. It allows the sharing of patient catheter care plans between health and social care professionals in hospital and the community, ensuring there is an upto-date record that is easily accessible. The passport will be carried by all patients with catheters to ensure that healthcare professionals have access to relevant information about their condition, regardless of where they are seen. On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 19/06/

28 Outcomes Standardised guidelines/information Improved quality of care Improved communication Documented reason for catheterisation Increased knowledge Catheterisation competence Improved hydration Reduced CAUTI/reduced antibiotics 28

29 A whole health economy approach Bugs don t differentiate between primary and secondary care or between hospital, patient s in their own home and care homes. Need for a whole health economy approach for the prevention & management of UTIs if quality of care is to be improved. Control measures to prevent HCAI must look at the whole patient pathway in which ever setting. Collaborative working- much can be achieved

30 Thank You /

31 1 Ageing well - Oral Health in Worcestershire Julie Northcott Senior Public Health Registrar Worcestershire County Council

32 [Slideshow Title - edit in Headers & Footers] 2 What is Oral Health. Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity. World Health Organization (WHO)

33 [Slideshow Title - edit in Headers & Footers] 3 Oral Disease is. Not inevitable! It is Preventable Prevention is more effective and cost effective than curative treatments!!! An ounce of prevention here really is a pound of cure! Has wide impacts Important role in general health (eat smile socialise without pain discomfort or embarrassment) Mental wellbeing (64% main reason for being unhappy) Infection and antibiotic prescribing Impacts are not felt equally

34 [Slideshow Title - edit in Headers & Footers] 4 Overall oral health is good in Worcestershire but.

35 [Slideshow Title - edit in Headers & Footers] 5 The most vulnerable to poor oral health outcomes in Worcestershire Children Looked After Children (LAC) Children living in and/or going to school in Worcester City and Wyre Forest Children from some ethnic backgrounds Adults Adults with diabetes Adults who are homeless Adults who misuse substances Heavy drinkers Smokers People living in deprived areas Adults with physical and learning disabilities Older age Older adults from more deprived backgrounds Older adults with multiple medical co-morbidities Older adults with diabetes Older adults who smoke Older adults who consume alcohol at riskier levels Older Adults with learning disabilities Older adults experiencing dementia

36 [Slideshow Title - edit in Headers & Footers] 6 Older people specific Retaining more teeth as they age Mix of own teeth and dentures High level of filled or damaged teeth requiring maintenance Dry mouth issues Sugar intake Ability to self care Access to dentistry

37 [Slideshow Title - edit in Headers & Footers] 7 Impact of poor oral care delivery and support to older people Can lead to malnutrition frailty pain a lack of dignity and poor quality of life as well as diabetes, aspiration pneumonia and cardiovascular diseases

38 [Slideshow Title - edit in Headers & Footers] 8 NICE recommendations on oral care in care homes care home policy on oral health providing residents with support to access dental services; oral health assessment and mouth care plans; daily mouth care; Supply of oral hygiene products; and care staff knowledge and skills..

39 [Slideshow Title - edit in Headers & Footers] 9 CQC just a few that OH can contribute to E1.1 Are people s physical, mental health and social needs holistically assessed, and is their care, treatment and support delivered in line with legislation, standards and evidence-based guidance, including NICE and other expert professional bodies, to achieve effective outcomes E5.1 How are people's day-to-day health and wellbeing needs met? E5.2 How does the service make sure that people can understand the information and explanations about their healthcare and treatment options, including medicines, and their likely outcomes? E5.3 How are people involved in regularly monitoring their health? E5.4 Can people access care, support and treatment in a timely way and, where the service is responsible, are referrals made quickly to appropriate health services when people's needs change? R1. How do people receive personalised care that is responsive to their needs

40 10 Barriers to overcome (1) Understanding of oral health importance What is good oral hygiene Frequency of dental care Care of dentures vs own teeth Pain vs no pain

41 [Slideshow Title - edit in Headers & Footers] 11 Barriers to overcome (2) Access - real and perceived Understanding the dental system How to meet the needs of those who find attending a dentist difficult Capacity of community dental provision

42 [Slideshow Title - edit in Headers & Footers] 12 Action to improve oral health Consistent messages Embedding OH into care planning Monitoring to ensure OH is being delivered by staff Identifying challenges to access (if they exist) Working together to overcome barriers

43 Hear to Care Supporting People with Hearing Loss Emma Holmes

44 Who are we? Our purpose is to help people confronting deafness, tinnitus and hearing loss to live the life they choose. We enable them to take control of their lives and remove barriers in their way. Information & Advice Care & Support Campaigns Research Equipment & Communication support Membership Fundraising Hearing aid support 2

45 Deaf and Hard of Hearing (HoH) people in the UK Hearing Loss is a major public health issue that affects more than 11 million people across the UK Hearing Matters (Action on Hearing Loss, 2015) 3

46 Did you know? 80% of care home residents have some degree of hearing loss 330,000 older people living in care homes in England. Of these, around 250,000 have a hearing loss (World of Silence Report, 2012) Evidence in relation to unaddressed hearing loss - mild hearing loss = double dementia risk, moderate x 3, severe x 5 Misdiagnosis between dementia & h/loss Issue of increased confusion 11 million people have hearing loss one in six of us By million One in five On average it takes people 10 years to address their hearing loss Hearing aids can help Not always and only to a certain extent 4

47 Levels of hearing loss Hearing loss is usually described in terms of severity: mild, moderate, severe or profound Mild may have some difficulty following speech, mainly in noisy situations Moderate difficulty following speech without a hearing aid Severe reliance on lipreading even with a hearing aid Profound British Sign Language may be their first or preferred language (esp. if congenital) May also communicate by lipreading 5

48 Causes of hearing loss & deafness Many reasons can be born deaf or hard of hearing or can lose hearing later on Temporary e.g. with medical treatment or permanent Causes of permanent deafness and hearing loss Presbycusis also known as age related hearing loss, most common type of deafness and affects many older people Certain diseases, e.g. mumps or meningitis Certain drugs, e.g. aspirin in high doses, antibiotics or cancer treatment drugs Frequent exposure to loud noise, serious head injury If a mother has rubella (german measles) while she is pregnant If a baby is born prematurely or labour is difficult Medical conditions, e.g. Ménière s disease Repeated infections of the middle ear 6

49 How to identify if someone may have a hearing loss They may comment that other people seem to mumble rather than speak clearly People often have to repeat things for them Its very difficult for them to follow conversations in noisy places or when in a group They may be watching your lips when talking to you Other people comment that they ve turned the television too loud They may be shouting when in conversation and don t realise 7

50 Aims of the Hear to Care project Hear to Care Improving long-term care and support for older people with hearing loss in care settings (funded by the Department of Health s Innovation, Excellence and Strategic Development Fund, ) Key aims: Involve 8 care settings in the project Provide staff training and support to residents Pilot practical changes in each care setting to improve the recognition and management of hearing loss Produce good practice guidance for all care settings Share with CQC and the Department of Health Supports the Accessible Information Standard (legal requirement for health and social care providers from August 2016) and the Equality Act (2010) 8

51 Key outcomes For Residents: Increased use of hearing aids and better communication Increased social interaction and reduced isolation Enhanced engagement with treatment and management of other conditions For Care settings: Earlier identification of hearing loss, improved communication with people with hearing loss Improved knowledge and skills for staff in relation to hearing aid management and hearing loss awareness Increased knowledge and use of equipment Why? More effective communication in shorter time, make daily tasks easier Reduced frustration due to improved communication Empower residents to address their hearing loss Evidence from previous research supports this approach 9

52 Key achievements Worked with 7 care settings Trained 114 staff in 18 on-site training sessions Supported over 160 residents After training 97% of staff felt better able to support someone with hearing loss 65% of staff trained said they had changed the way they communicated with residents with hearing loss The percentage of staff trained that had knowledge of assistive equipment increased from 18% to 92% Of staff trained, knowledge of how to check a hearing aid increased from 3% to 85% Guide: Supporting older people with hearing loss in care settings, a guide for managers and staff available on Action on Hearing Loss website and as a hard copy: 10

53 Real life stories 1 A male care home resident felt his hearing had deteriorated and his wife was also keen for him to be screened using the Siemens Hear check Screener. This showed he had a loss and we advised what steps he could take next. He has since been seen by his doctor and received treatment for wax and a referral to Audiology. After a hearing test by Audiology he now has hearing aids. This has also had a further impact as his wife decided to get her hearing checked and also now has hearing aids. On our first coffee morning held at a care home involved in the project, we met a lady whose mother could not get out of bed and therefore her daughter came to meet us. The mother is over 100 and was struggling to hear staff and communicate. We gave the mother a Sonido Personal Listener to try. The listener works by blocking out background noise and can amplify the voice and the tone of a person s voice by just pressing a couple of buttons. A month later the daughter ed to say her mother was using the listener and could hear staff really well again. 11

54 Real life stories 2 A care home resident in her 90 s was having problems with her aids and it was clear to see the tubing needed replacing as they were blocked and brittle meaning they were no longer working. Due to mobility issues the resident wasn t able to access the local Hub so we made contact with Audiology. Through several s they agreed a volunteer would visit the care home. The volunteer took the aids back to Audiology, re-tubed and checked the aids, and returned them on the same day. 12

55 Real life stories 3 One lady who had quite severe dementia was unable to recognise a fork or a spoon coming towards her mouth and therefore did not know when to open her mouth for food. Once she started to use the personal listener she was able to hear and understand the carer when she was asked to open her mouth. This has resulted in a significantly improved dining experience for the resident and it is likely to have also increased her consumption of food thus contributing to her overall health. 13

56 Real life stories 4 One lady who is bedridden liked to listen to the radio but often did so in silence. However since wearing the personal listener she has started signing along to songs and staff have realised that she likes Elvis Presley. This has not only had a positive impact on the resident herself by stimulating early memories but has also resulted in more conversation between the resident and staff. 14

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58 Tinnitus Tinnitus is a medical term to describe noise, such as ringing, buzzing or whistling, that people can hear in one ear, both ears or in their head when there is nothing around them making the sound Causes of Tinnitus Exposure to loud noise, hearing loss, ear or head injuries, some ear diseases, problems with blood vessels, emotional stress, medication side effects, or a combination of any of these Often there is no obvious cause, is rarely linked to any serious condition, although advisable to see GP is distressing or in one ear only 16

59 Coping with Tinnitus Referral to ENT to establish cause and possible treatments Different therapies and counselling services are available to help reduce Tinnitus No cure for Tinnitus but therapies can help to remove negative thoughts & associations to reduce problems. Wearing hearing aids can also help Sound Therapies many devices exist enabling people to focus on pleasant sounds Counselling helps to correct misunderstandings & develop a better attitude, Cognitive Behavioural Therapy also helps Complimentary therapies and relaxation techniques helps with stress management which is an important part of managing Tinnitus Information on Action on Hearing Loss, and British Tinnitus Association websites 17

60 Communication Tips (1) Find a place a talk that has good lighting, away from noise and distractions (if possible) Check if the person needs to lipread you, even if they wear hearing aids (most people lipread to some extent) Before you start speaking make sure you have the person s attention Face the person so that they can easily see your lip movements Speak clearly, not too slowly, and use normal lip movements, facial expressions and gestures Body language helps to convey meaning Avoid shouting: it may be uncomfortable for a hearing aid user and it can look aggressive, keep your voice at a normal level Avoid negative terminology 18

61 Communication Tips (2) If they do not understand what you ve said, try saying it in a different way Get to the point: use plain language and avoid waffling Use of equipment, e.g. Sonido Personal Listener Be patient and take time to communicate properly Writing can help avoid capital letters and use a thick pen if sight problems British Sign Language (BSL) Most widely used method of signed communication (recognised as a language by UK Government in 2003) Structured very differently to English Qualified Interpreters must be used for medical appointments 19

62 Summary of important points Everyone s hearing loss will be different Importance of hearing aid maintenance Hearing Aids can only do so much and do not restore a person s hearing fully communication techniques still very important Time is needed to get used to a hearing aid, the brain needs to adjust Some people may choose not to address their hearing loss The personal listener is a very effective aid to communication between staff and patients Please contact us for advice and support 20

63 Any Questions Contact Details: Emma Holmes, Lead Development Projects Manager Tel: Patron: His Royal Highness The Duke of York, KG Action on Hearing Loss is the trading name of The Royal National Institute for Deaf People. A registered charity in England and Wales (207720) and Scotland (SC038926). Registered as a charitable company limited by guarantee in England and Wales No Registered office: 1-3 Highbury Station Road, London N1 1SE.