My heart sank as I received a text message from a dear friend. “Grandpa is in hospital with sepsis. He was vomiting, high temperature with pus around his catheter.” The next day my friend informed me Grandpa was “on IV antibiotics and slowly coming round, but he’s not out of the woods yet.”
This Grandpa was admitted to hospital from a nursing home, and this nursing home was 300 miles from my ‘patch’. But oh, how familiar the scenario was. One of the most common reasons for hospital admission from care homes is a UTI. By the time the patient is admitted many are well on the way to having acute kidney injury. This is distressing for the individual, their family and staff as well as being costly to the NHS. I believe many of these UTIs could be prevented, and the place to start is hydration.
Part of our quality monitoring within Birmingham Cross City CCG homes, we ask the question “is the fluid balance chart up to date and accurate?” then a follow up question “is poor fluid intake recorded and escalated?”
Our results have found at least 80% of our homes have needed support in documenting an accurate record of fluid intake, and encouragement in knowing how to effectively escalate or highlight when residents have received a low fluid intake. Which is why I was pleased to be part of a working group with the Think Kidneys programme to explore the design of some resources specifically promoting hydration and education in care homes.
Nursing homes are in a unique position because they are classed as community based, have nursing input, yet at the same time they have to wait for primary care consultations just as any member of the public! Nurses in nursing homes often don’t have the same access to training or resources as hospital based nurses, and certainly don’t have the access to frontline medical interventions as hospitals do, so considering the ‘Sheffield surgical care resources’ as an educational tool for nurses in nursing homes is inappropriate. The Think Kidneys team is now in the process of addressing that problem, by designing a care home specific education tool. This should be invaluable in highlighting the value of hydration and continence care in a nursing or residential home setting.
Anecdotally we know good things come from such education and emphasis. When we returned to a large home following a quality monitoring visit that had originally found poor fluid charts; we were told that the manager had emphasised the need to both encourage fluids, to document fluid intake accurately, and to escalate any poor fluid intake to the rest of the team. On inspection of the new charts, we found she had done a good job of ensuring timely documentation. As a result of timely documentation, the residents were being encouraged to drink more, which was seen in the evidence of increased fluid intake since our previous visit. Any reduced fluid intake had been documented and highlighted to the following shift. Nurses had been tasked in ensuring regular monitoring of the charts, and it had been successful.
So it wasn’t a great surprise when the home manager informed me at the end of our visit, that since the increased emphasis on hydration and fluid accuracy had been implemented, the nursing home had not had any incidents of UTIs among their residents. Not a coincidence, but a positive outcome from a simple intervention to encourage and document fluid intake.
My friend’s Grandpa is now well and back in his care home. Let us look out for all the grandpas and grandmas out there by being informed and enthusiastic around the Think Kidneys agenda.
Paula Cashmore
Paula has been a registered nurse since 1986 and has always been passionate about care of the elderly. She immediately became aware of the importance of hydration in this vulnerable group of patients. After a long career break home educating her children, Paula returned to practice in private nursing homes where she was concerned to find the same situation in regard to the poor understanding and recognition of the dangers of dehydration to the elderly population.
In 2015 Paula became a clinical quality monitoring officer for Birmingham Cross City CCG, part of a team auditing quality in nursing homes across Birmingham. It didn’t surprise her to see the same issues reflected in many of the nursing homes visited. When Paula received an invitation from the Think Kidneys programme to be involved in developing resources specifically for care homes, it was an opportunity not to be missed.
Paula says that it has been a privilege to work with such passionate people developing the resources which will invariably lead to reduction in harm and distress to many individuals.