The Care Home Continence Improvement Project

Applying the principles of Realistic Medicine at NSS – continence care case study

The Care Home Continence Improvement project, developed by NHS National Procurement, part of NHS National Services Scotland, is a great example of a project which used the principles of Realistic Medicine to improve outcomes for not only patients but the wider health and social care landscape.

Unwarranted Variation

Alice Macleod, Senior Nurse in NHS National Procurement and her colleagues noticed a year-on-year rise in the purchasing on incontinence products, and began investigating areas where improvements could be made. They began looking at unwarranted variation. The team started digging deeper to look at how the various products in selected care homes were being used to try and find out why the variation existed. They found that care home staff were confused about which products to use and there was no systematic approach to choosing the right one.

Shared Decision Making

National Procurement developed the Care Continence Improvement project in partnership with NHS Lanarkshire. Shared decision making was achieved through the collaboration between National Procurement, NHS Lanarkshire, those working in the care home and the residents and family members themselves.

Managing Risk Better

The project found that by introducing a bundle of care (from the available evidence) they could reduce harm in the care homes. They incorporated improvements for example, encouraging people to drink more. Steps like this seemed like a ‘risk’ to effectively managing incontinence and were understandably initially challenging for care workers as it felt like they would end up doing more work. But, when they delivered this step alongside the other improvements, the team found there were fewer accidents.

Reduce Harm and Waste

Over a year the project was able to: promote continence in care home residents, improve patient safety and reduce patient distress . The pilot care homes also saw a significant reduction in falls, skin damage and hospital admissions for falls and urinary tract infections. In the projects first year product usage and waste was reduced, contributing to £250k of savings for the NHS.

Personalised Approach to Care

Because there were so many fewer accidents, the frontline staff were able to spend more time doing higher value activities like talking to patients and delivering personalised care. The latter was also delivered by the fact that carers were able to ensure they were choosing the right product to meet the needs of the individual.

Become Improvers and Innovators

NHS Scotland Chief Executives have recommended roll out across all health boards and a team in NHS Highland are currently implementing the bundle in two care homes. NSS are continuing to develop work in this area across both Acute and Primary Care services as well as care homes.

The success of this project has been widely recognised with the team winning a number of awards since completion of the pilot project.