Dimension: Integrated Care Network

From November 2021, RCSI Hospital Group and 16 Residential Care Facilities (RCFs) established a Care and Support Framework, designed to support requirements to RCFs across key areas of endeavour, within the geographical catchment area pertaining to the RCSI Hospital Group. This resulted in 4 Residential Care Facility Hubs, namely Beaumont RCF Hub (4 RCFs / 568 beds), Cavan RCF Hub (4 RCFs / 245 beds), Connolly RCF Hub (4 RCFs / 445 beds) and Drogheda RCF Hub (4 RCFs / 394 beds).

Selection of RCF was based on consideration of 4 criteria markers:

  1. number of RCF attendances to ED and
  2. number of hospital admissions
  3. type and themes of hospital presentations
  4. number of new RCF admissions from hospital

This outreach model aimed to provide an integrated model of care that will create robust and enhanced clinical interfaces between the acute services and Residential Care Facilities.

The purpose of the Integrated Care Framework was to develop a structured and proactive Care and Support Framework designed to enhance quality of care for RCF residents. Overall objective of the framework is to support the resident to be managed within their care setting, and reduce the requirement for transfer to a hospital’s Emergency Department, as well as supporting successful transition of the resident from the acute setting to the Residential care setting.

The relevant hospital works in close collaboration with each of the selected residential care facilities and offers enhanced support across 4 key dimensions:

  • Clinical Leadership
  • Quality Assurance and Control in regard to patient safety
  • Training and Upskilling of staff
  • Staff provision

The Residential Care Facilities and RCSI Hospital Group are providing this data for the purpose of quality assurance and improvement as part of the Integrated Care Framework programme. A comprehensive overview of quality care metrics is included, as well as training compliance with key requirements and standards.

SKIN INTEGRITY ASSESSMENT IN RCFS ON ADMISSION / TRANSFER

Rationale for measurement

Older skin is subject to drying due to co-morbidities, drinking less and reduced mobility generally. This renders the skin vulnerable to infection or wounding resulting from trauma, such as a knock or bump, or from sustained unrelieved pressure over bony prominences, shear and friction. Acute illness, high temperatures consequent to fevers and moisture from diaphoresis and incontinence can add to the vulnerability of aging skin. Therefore it is vitally important to know the condition of resident’s skin and to monitor for skin changes. Following assessment, treatment goals should be agreed with the resident and a time frame for their achievement set.

Measurement methodology and data sources

The following metric measures if (1) a skin integrity assessment was completed using a validated tool, immediately before or on the resident’s admission to the Residential Care Facility and (2) a care plan was documented, no later than 48 hours of admission or transfer.

Reference

Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013

Target

90% compliance of all new admissions and transfers

Performance

RCSI HG Hub Total

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  • Beaumont RCF Hub did not achieve target
  • Cavan RCF Hub, Connolly RCF Hub and Drogheda RCF Hub achieved target

 

DEVELOPMENT OF NEWLY ACQUIRED GRADE 1-4 PRESSURE ULCERS (DECUBITUS ULCER) WITHIN RESIDENTIAL CARE FACILITY

Rationale for measurement

Pressure ulcers can cause pain and lead to serious infections. Pressure ulcers are graded Stage 1 to 4 Prevention of Grade 3 and Grade 4 pressure ulcers are a marker of good care.

Measurement methodology and data sources

  • number of Stage 1 and Stage 2 pressure ulcers per month (newly acquired in RCF) per 10,000 RCF bed days
  • number of Stage 3 and Stage 4 pressure ulcers per month (newly acquired in RCF) per 10,000 RCF bed days
  • local data from Residential Care Facility

 

Reference: European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers (2009)

Target

No grade 3/4 pressure ulcers (RCSI Hospital Group target)

Performance

The graphs below demonstrate the rate of residential care facilities (RCF) acquired Grade 1/4 Pressure Ulcers within the Integrated Care Framework Hubs. Due to the total volume of bed days used (BDU) within the 4 RCFs per Hub, the rate of measurement is per 10,000 BDU.

RCSI HG Hub Total
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  • number of grade 3 and 4 pressure ulcers in RCSI HG Hub total YTD 2024 (n=4) vs YTD 2023 (n=2) demonstrating a 100% increase

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  • number of grade 1 and 2 pressure ulcers in RCSI HG Hub total YTD 2024 (n=19) vs YTD 2023 (n=8) demonstrating an overall increase

 

NUTRITION & HYDRATION ASSESSMENT

Rationale for measurement

Adequate food and hydration is fundamental to a person’s health and wellbeing. Nutrition and hydration in the residential care setting is an important element in the provision of safe quality care. Therefore, nutrition and hydration screening followed by an appropriate plan of care are seen as essential factors in recognising, managing and promoting improved nutritional and hydration status for residents in our care.

Measurement methodology and data sources

The following metric measures if (1) a nutrition and hydration assessment was completed using a validated tool, immediately before or on the resident’s admission to the Residential Care Facility and (2) a care plan was documented no later than 48 hours of admission or transfer.

Reference: Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013

Target

90% compliance

Performance

RCSI HG Hub Total
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  • Beaumont RCF Hub did not achieve target
  • Cavan RCF Hub, Connolly RCF Hub and Drogheda RCF Hub achieved target

FALLS ASSESSMENT

Rationale for measurement

Falls particularly in the elderly can lead to significant health decline and admission to hospital. As well as physical injuries suffered, the psychological and social consequences of falling can have a huge impact. Consequently, prevention and injury management is a key priority in healthcare. All Residents should be should be assessed for falls risk screening.

 

FALLS RISK ASSESSMENT ON ADMISSION / TRANSFER

Measurement methodology and data sources

The following metric measures if (1) a falls risk assessment was completed using a validated tool, immediately before or on the resident’s admission to the Residential Care Facility and (2) a care plan was documented, no later than 48 hours of admission or transfer.

Reference: Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013

Target

90% compliance of the key indicators identified. Quality Care Metrics KPI set is identified as ‘areas of good practice’ are demonstrated 90-100%; ‘areas requiring some improvement’ 80-89%; ‘areas requiring immediate attention and action plans’ 0-79%.

Performance

RCSI HG Hub Total
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  • Beaumont RCF Hub did not achieve target
  • Cavan RCF Hub, Connolly RCF Hub and Drogheda RCF Hub achieved target

 

RATE OF SERIOUS FALLS PER 10,000 BED DAYS USED (BDU)

Measurement methodology and data sources

This metric measures the number of falls reported to HIQA within the reporting month. Reportable falls include any falls that result in serious injury to a resident that requires immediate medical and / or hospital treatment. Local data from Residential Care Facility.

Reference: Health Act 2007 (Care & Welfare of Residents in Designated Centres for Older People) Regulations 2013

Target

No incidents of serious falls

Performance

Graphs below demonstrate the rate of Serious Falls within the participating Integrated Care Framework residential care facilities (RCF). Due to the volume of RCF bed days used (BDU), the rate of measurement is per 10,000 BDU.

RCSI HG Hub Total
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  • RCSI HG Hub Total YTD 2024 (n=20) vs YTD 2023 (n=19) demonstrating a 5% increase

 

CONTINENCE ASSESSMENT

Rationale for measurement

Urinary incontinence in the elderly can lead to distress, infection and health decline. Continence assessment, promotion and management can significantly reduce the risks associated with incontinence, prevent hospital admission and protect the dignity of the resident.

Measurement methodology and data sources

The following metric measures if (1) a continence assessment was completed using a validated tool, immediately before or on the resident’s admission to the Residential Care Facility and (2) a care plan was documented no later than 48 hours of admission or transfer.

Reference: Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013

Target

90% compliance

Performance

RCSI HG Hub Total
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  • Beaumont RCF Hub did not achieve target
  • Cavan RCF Hub, Connolly RCF Hub and Drogheda RCF Hub achieved target

RESIDENT PRESENTATIONS TO EMERGENCY DEPARTMENT AND HOSPITAL ADMISSIONS

Rationale for measurement

Resident transfers to ED negatively impacts on both dignity and privacy for patients and the ability of staff to deliver fully effective care / treatment can have a significant impact on the overcrowding within ED. Related international studies have also demonstrated extended length of stay within overcrowded EDs leads to poorer clinical outcomes for concerned patients. The objective of the Outreach Teams is to provide enhanced clinical support as well as targeted training to support the management of the resident within the Residential Care Facility, avoiding transfer to a hospital Emergency Department.

Measurement methodology and data sources

The following metric measures the number of Resident presentations to an Emergency Department and hospital admissions between the first and last day of the month. Local data sets extrapolated for analysis and publication

Performance

RCSI HG Hub Total
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  • 30% increase YTD 2024 v YTD 2023 in presentations to a RCSI HG ED from RCFs

 

EMERGENCY ADMISSION RATE

Rationale for measurement

Sláintecare has identified a requirement to shift the balance of care from hospitals to primary and community care so as to deliver timely access to health and social care. Through the support provided by the Integrated Care Framework to participating Residential Care Facilities, RCSI HG are progressing measures to enable timely discharges of residents back to their home care setting. This helps to avoid lengthy inpatient stays in hospital, and helps to reduce delayed transfers of care (DTOC).

Measurement methodology and data sources

The following metric measures the volume of emergency admissions from a participating Residential Care Facility to a RCSI HG hospital vs the volume of resident discharges from hospital back to their home care setting.
Local data sets extrapolated for analysis and publication

Performance

RCSI HG Hub Total
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  • 30% increase YTD 2024 v YTD 2023 in admissions to a RCSI HG hospital from RCFs

 

DIAGNOSIS OF RESIDENTS ON ADMISSION

Measurement methodology and data sources

Data extracted from HIPE and categorised using ICD-10, international statistical classification of diseases and related health problems

Rationale

Extended length of stay within overcrowded ED leads to poorer clinical outcomes for concerned patients. The objective of the Outreach Teams is to

  • reduce inappropriate emergency admissions from RCFs to Hospital EDs
  • ensure residents discharged from Hospital to RCF receive appropriate safe care
  • ensure care delivered in the home

Performance – Jan-Dec 2023

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Note: 33 cases are not coded on HIPE at the time of report publication

 

COVID-19 CASES IN RESIDENTIAL CARE FACILITY

Introduction

COVID-19 is a worldwide pandemic caused by a newly discovered coronavirus. Most people who are diagnosed with COVID-19 will experience mild to moderate symptoms and recover without specialist treatment. Approximately 15% of patients diagnosed with COVID-19 will require hospitalization and 2% of patients will require admission to an Intensive Care Unit (ICU).

Rationale for measurement

This metric provides information on numbers of residents who have acquired Covid-19.

Measurement methodology and data sources

Data extracted from weekly ADON Outreach check-in reports

Performance

RCSI HG Hub Total
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  • n=13 cases of Covid-19 identified across all Hubs for January 2024

HAND HYGIENE AUDIT IN PRACTICE

Rationale for measurement

Improving healthcare workers hand hygiene compliance has been described by the WHO as a key measure to reduce healthcare-associated infections. Poor hand hygiene practice can result in an increased risk of cross infections from one person to another by hand contact. It is best practice of all staff working in the healthcare facility washing their hands frequently including (1) before touching a patient, (2) before clean/aseptic procedures, (3) after body fluid exposure/risk, (4) after touching a patient, (5) after touching patient surroundings (WHO, 5 moments).

IPC CNS provide targeted education and training as well as audit support in each Hub

Measurement methodology and data sources

The proportion of healthcare workers who comply with hand hygiene protocols. This is measured monthly.

Target

90% target proportion of healthcare workers who comply with hand hygiene protocols (HSE National target)

Performance

RCSI HG Hub Total
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  • overall RCSI HG Hub achieving ≥90% compliance (January 2024)

 

PERCENTAGE OF STAFF UPTAKE OF ‘FLU’ VACCINATION

Rationale for measurement

Influenza (flu) can be a serious disease that can lead to hospitalisation and even death. Anyone can get very sick from the flu, including people who are otherwise healthy. By getting vaccinated, healthcare workers help protect themselves and their patients.

Measurement methodology and data sources

The proportion of healthcare workers who get vaccinated each year. Data source HPSC.

Target

HSE target increased for 2020-2021 to 75% proportion of healthcare workers who get vaccinated each year RCSI HG target 95%

Performance – January 2024

RCSI HG Hub
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  • Flu vaccination programme runs from October to March

COMPLIANCE WITH MANDATORY TRAINING

STANDARD PRECAUTIONS TRAINING

Rationale for measurement

Standard Precautions form part of the minimum infection practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect healthcare workers and prevent healthcare workers from spreading infections among patients.

Measurement methodology and data source

Local data extracts from local training records including HSELanD submitted monthly and extrapolated for analysis and publication.

Numerator

Monthly total number of staff trained (who have completed Standard Precautions in the last 2 years).

Denominator

Monthly Headcount (Average paid headcount on the first and last day of the month).

Target

99% compliance

Performance
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  • Cavan RCF Hub not achieving target
  • Beaumont RCF Hub, Connolly RCF Hub and Drogheda RCF Hubs achieving target
  • data for one RCF in the Beaumont RCF Hub not available for January 2024

 

PPE TRAINING

Rationale for measurement

PPE Training forms part of the minimum practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect healthcare workers and prevent healthcare workers from spreading infections among patients.

Measurement methodology and data source

Local data extracts from local training records including HSELand submitted monthly and extrapolated for analysis and publication.

Numerator

Monthly total number of staff trained (who have completed PPE training in the last 2 years).

Denominator

Monthly Headcount (Average paid headcount on the first and last day of the month).

Target – 99% compliance

Performance
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  • all RCF Hubs achieving target
  • data for one RCF in the Beaumont RCF Hub not available for January 2024

 

HAND HYGIENE TRAINING

Rationale for measurement

Hand Hygiene Training forms part of the minimum practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect healthcare workers and prevent healthcare workers from spreading infections among patients.

Measurement methodology and data source

Local data extracts from local training records including HSELanD submitted monthly and extrapolated for analysis and publication.

Numerator

Monthly total number of staff trained (who have completed Hand Hygiene Training in the last year).

Denominator

Monthly Headcount (average paid headcount on the first and last day of the month).

Target – 99% compliance

Performance
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  • Beaumont RCF Hub not achieving target
  • Cavan, Connolly and Drogheda RCF Hubs achieving target
  • data for one RCF in the Beaumont RCF Hub not available for January 2024

 

FIRE SAFETY TRAINING

Rationale for measurement

The aim of fire safety training is to reduce, so far as is reasonably practicable, the risks associated with fire. The Health and Welfare at Work Act 2005 states that employers must ensure so far as is reasonably practicable, that sufficient information, training and supervision is provided to ensure the safety of employees.

Measurement methodology and data source

Local data extracts from local training records including HSELand submitted monthly and extrapolated for analysis and publication.

Numerator

Monthly total number of staff trained (who have completed the online component of Fire Safety Awareness Training in the last year).

Denominator

Monthly Headcount (average paid headcount on the first and last day of the month).

Target – 99% compliance

Performance
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  • Beaumont, Connolly and Drogheda RCF Hubs not achieving target
  • Cavan RCF Hub achieving target
  • data for one RCF in the Beaumont RCF Hub not available for January 2024

 

MANUAL HANDLING TRAINING

Rationale for measurement

The aim of manual handling training is to reduce, so far as is reasonably practicable, the risks associated with manual handling and people handling tasks. Manual handling training can help to reduce instances of injury while performing manual handling and people handling tasks. Training is provided to ensure the safety of employees.

Measurement methodology and data source

Local data extracts from local training records including HSELanD submitted monthly and extrapolated for analysis and publication.

Numerator

Monthly total number of staff trained in Manual Handling in the last two years.

Denominator

Monthly Headcount (average paid headcount on the first and last day of the month).

Target – 99% compliance

Performance
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  • Beaumont, Connolly and Drogheda RCF Hubs not achieving target
  • Cavan RCF Hubs achieving target
  • data for one RCF in the Beaumont RCF Hub not available for January 2024