12 actions to help manage winter pressures

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              <p class="larger-text">The 12 actions that follow are intended as a guide to focus our minds on the possible. We hope to encourage our non-specialist colleagues to join us as allies in providing the best care possible for this population in very challenging circumstances.</p>\r\n
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              <div>This guide, put together by the BGS Policy Committee, represents the core components of safe, high-quality care for older people that are transferable between care settings. Making these changes will help both the individual in front of you and the system around you. We hope they will also enable you to speak to colleagues and operational managers about the kind of services we need to preserve, even in the most challenging times.</div>\r\n
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              <p class="larger-text">Encourage&nbsp;everyone in your service to equip themselves with the skills they need to care for older people with frailty, including generalist staff and those delivering other specialist services.</p>\r\n
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              <p>The <a href="/elearning/frailty-elearning-course">BGS frailty e-learning module</a> provides free training at Tier 3 level. <a href="https://www.bgs.org.uk/sites/default/files/content/attachment/2024-10-31/BGS%20frailty%20elearning%20poster.pdf">Download a poster </a>to display in a prominent area of your hospital or office to promote this to colleagues.</p>\r\n
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              <p>Frailty training for Tiers 1, 2a and 2b is available from <a href="https://www.e-lfh.org.uk/programmes/frailty">NHS England&rsquo;s elearning for Healthcare</a>.&nbsp;&nbsp;&nbsp;</p>\r\n
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              <p class="larger-text">Implement proactive care plans and advance care plans (known as anticipatory care plans in Scotland) in primary and community settings, especially care homes, to consider future health needs including end of life care. Those based in the acute setting may be able to do this as part of the discharge process.</p>\r\n
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              <p>Proactive care plans, centred around individuals&#39; specific wishes for the future and preferred place of care, including advance care planning, can improve the use of available services. Care plans, once developed, must be shared with relevant family members and added to healthcare records to ensure that they are followed when necessary. Those updating healthcare records may also wish to ensure that next of kin details are recorded, especially for older people living on their own in the community.</p>\r\n
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              <p>Continuity of care in primary and community settings can also help to avoid admissions. For some patients who do need hospital treatment, attending hospital earlier in the day may mean that they can be treated by a Same Day Emergency Care (SDEC) service and avoid being admitted to hospital.</p>\r\n
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              \t<li><a href="chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.england.nhs.uk/wp-content/uploads/2022/03/universal-principles-for-advance-care-planning.pdf">Universal principles for advance care planning</a></li>\r\n
              \t<li><a href="https://www.malnutritiontaskforce.org.uk/sites/default/files/2024-10/Age%20UK%20Advance%20Care%20Plan%20booklet.pdf">Let&rsquo;s talk about our wishes for our future health, care and treatment</a></li>\r\n
              \t<li><a href="https://www.health-ni.gov.uk/publications/advance-care-planning-now-and-future">Advance care planning &ndash; for now and the future (Northern Ireland)</a></li>\r\n
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              <p>In addition, people aged 75-79 will be offered a vaccine for RSV for the first time this year. Increasing vaccination uptake is considered to be a high priority to protect people from serious illness and support the NHS and adult social care.</p>\r\n
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              \r\n
              <p class="MsoListParagraph" style="text-indent: -18pt;">Forging strong relationships can improve quality of care and enhance individualised person-centred care. Working collaboratively around a common goal can lead to better outcomes in mental, physical and emotional wellbeing. You might achieve this by inviting your local social worker to your next team meeting or arranging shadowing between your teams to enable staff from both sides to understand each other&rsquo;s work better.<o:p></o:p></p>\r\n
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              <p class="larger-text">Make better use of technology available through social care to support people at home.</p>\r\n
              \r\n
              <p>These might include smart devices that help people to carry out day-to-day tasks or devices to help healthcare professionals to monitor someone&rsquo;s health remotely. Digital apps can be used to help people to record daily pulse oximeter and pulse rate readings which are then automatically transmitted to the hospital digital care hub with abnormal readings triggering an alert and prompting a follow-up with the patient. One example of such an app is the MyCare24 app, used by NHS Airedale: <a href="https://www.airedale-trust.nhs.uk/service/digital-care-hub/mycare24/">https://www.airedale-trust.nhs.uk/service/digital-care-hub/mycare24/</a>.</p>\r\n
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              <p><strong>Resources include:</strong></p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="/resources/agenda-issue-93-technology-and-sustainability">May/June 2024 issue of BGS <em>AGENDA </em>magazine&nbsp;(BGS members only - sign-in required to access)</a></li>\r\n
              \t<li><a href="https://www.carersuk.org/help-and-advice/technology-and-equipment/smart-tech-and-handy-devices-for-the-home/">Digital tools for self-management&nbsp;</a></li>\r\n
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              <p class="larger-text">Address polypharmacy and waste by asking patients to &lsquo;show me your meds please.&rsquo;</p>\r\n
              \r\n
              <p>Community staff on routine home visits can ask to see a patient&rsquo;s medications and, if they have any concerns, can contact the primary care team who can then follow up with a full review.&nbsp; Medication-related complications are thought to contribute to up to 30% of admissions in older people.<sup><span style="background:yellow">1</span></sup>&nbsp;Deprescribing reviews should be completed as part of routine inpatient care for older people. Medication accounts for 25% of carbon emissions in the NHS<sup><span style="background:yellow">2</span></sup> so reducing unnecessary prescribing throughout the patient journey not only reduces the risk of medication-associated harm but also contributes to reducing the carbon footprint of the NHS.</p>\r\n
              \r\n
              <p><strong>More information <a href="https://www.bgs.org.uk/bgs-green-issues-show-me-your-meds-please">here</a>.</strong></p>\r\n
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              <p class="larger-text">Seek to minimise use of temporary care environments (also known as &lsquo;corridor care&rsquo;) for older people &ndash; this includes &lsquo;boarding.&rsquo;</p>\r\n
              \r\n
              <p>Ensure frailty scores are included in any Trust policies or Standard Operating Procedures (SOPs) around the provision of care in a temporary setting to allow better risk stratification. Ensure bed management teams understand that these environments increase the risk of delirium, falls and pressure area damage for older people with frailty and that low National Early Warning System (NEWS) scores should not provide false reassurance in this cohort. Wherever an older person is cared for, continue to advocate for the key components of quality care outlined below. Trusts should consider how these can still be provided in temporary care environments.</p>\r\n
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              \r\n
              <div>The Acute Frailty Network have developed an app to help staff to determine a patient&rsquo;s clinical frailty score (CFS) and therefore ensure that the patient accesses appropriate pathways and care such as front door frailty services. Once a patient has had their CFS assessed, this should be recorded to make further decision-making easier.</div>\r\n
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              \t\t<li><a href="http://www.bgs.org.uk/FrontDoorFrailty">BGS Front Door Frailty</a></li>\r\n
              \t\t<li><a href="https://www.acutefrailtynetwork.org.uk/Clinical-Frailty-Scale/Clinical-Frailty-Scale-App">Acute Frailty Network CFS app</a> &ndash; available free on Apple and Android.</li>\r\n
              \t\t<li><a href="https://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/07/GIRFT-BGS-Six-Steps-to-Better-Care-for-Older-People-FINAL-V2-July-2023.pdf">GIRFT Six Steps to Better Care for Older People in Acute Hospitals</a></li>\r\n
              \t\t<li><a href="http://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/06/Hospital-Acute-Care-Frailty-Pathway-FINAL-V1-June-2023-1.pdf">GIRFT Hospital Acute Care Frailty Pathway</a></li>\r\n
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              <p>This is a real risk for older people in hospital &ndash; hospital inpatients have muscle strength reduced by up to 10% in the first seven days of admission.<sup><span style="background:yellow">3</span></sup> There may be voluntary groups locally who can support patients to move around safely in hospital. Welcoming carers and family members into the acute hospital setting can also help to avoid deconditioning as they can help their loved ones to get out of bed and mobilise.</p>\r\n
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              <p><strong>Useful resources:</strong></p>\r\n
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              \t<li><a href="https://fabnhsstuff.net/fab-stuff/31362-national-reconditioning-games">National reconditioning games</a></li>\r\n
              \t<li><a href="https://endpjparalysis.org/">End PJ Paralysis</a></li>\r\n
              \t<li><a href="https://johnscampaign.org.uk/">John&rsquo;s Campaign</a></li>\r\n
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              \t<li><a href="https://www.the4at.com/">4AT</a></li>\r\n
              \t<li><a href="https://gedcollaborative.com/topic/sqid-30-seconds/">SQiD</a></li>\r\n
              \t<li><a href="https://www.bgs.org.uk/elearning/delirium-in-older-people-elearning">BGS Delirium e-learning</a></li>\r\n
              \t<li><a href="https://www.sign.ac.uk/our-guidelines/risk-reduction-and-management-of-delirium/">SIGN Risk reduction and management of delirium</a></li>\r\n
              \t<li><a href="https://www.nice.org.uk/guidance/cg103">NICE Delirium: prevention, diagnosis and management in hospital and long-term care</a></li>\r\n
              \t<li><a href="https://www.alzheimers.org.uk/get-support/publications-factsheets/this-is-me">Alzheimer&rsquo;s Society &lsquo;This is me&rsquo;</a></li>\r\n
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