Jacqui Croxford is a Care Home Manager with Darbyshire Care. In the summer of 2020 she completed our free online Train the Trainer programme for RESTORE2 and has been an advocate of this evidence-based tool ever since. In this blog, Jacqui explains why.
I have been a mental health nurse since 1996 and had the privilege of working in the NHS, community, ASC and abroad. I was a care assistant through my nurse training and a child carer. Prior to my current role managing a family run group of care and nursing homes, I was a CQC inspector for seven years.
I am always looking for the next thing out there to improve the quality of care we provide that has a positive impact on the people we care for and love.
It was during one of these afternoons googling, I came across the West of England AHSN’s RESTORE2 Train the Trainer Programme. A few weeks later in June 2020 on a hot, sunny afternoon we met Sandra and another lovely nurse virtually for our first RESTORE2 Train the Trainer virtual session. I think I signed up to about 20 and kept thinking I would be kicked off but no one ever noticed!
RESTORE2 is a no-brainer
Evidence-based research (NICE Guidance) indicated the use of RESTORE2 and NEWS2 could help services identify early deterioration in residents with COVID-19. To me this was a no-brainer, why would we not want to do this?
I made the decision with managers to train staff across the homes in this tool. I had no strategy, just me, a laptop and 200 staff. I did buy a projector. An hour’s training for all staff plus competency assessments did require persuasion. All teams were stretched and drained due to COVID and the guidance changing regularly, new PPE, new audits etc, I could hear the sighs of exasperation when managers and staff already felt so tired.
Hurdles to overcome
In some teams there was resistance to new ways of working. There were also other hurdles to overcome, for example staff access to IT to support virtual learning, space and distancing rules to support training large numbers of staff and the staff resources required to support competency checks. Explaining the purpose and potential benefits to people were key to staff involvement. Several staff undertook the Train the Trainer Programme.
Unfortunately, one home had an outbreak during the rollout. The NEWS scores were invaluable in helping staff identify early clinical deterioration, particularly the drop in oxygen levels some people experienced. The clinical observation checks supported care staff to escalate concerns quickly based on this evidence-based tool.
Backing up our gut instinct
We had about 75% of our residents affected in our outbreak and 90% of our staff – the only person left at the service at one point was the provider (non-clinical!) when my test came back positive.
When our gut instinct indicated people were not well, agency staff video called me and we did virtual observations with me guiding them through. As our regular staff returned to work I encouraged them to always take another staff member with them and teach them how to use it.
I absolutely, 100% believe in RESTORE2 for all staff, residential and nursing.
Most of our residents did not have a cough, often no temperature or a fluctuating temperature, but we knew they weren’t quite right.
Importance of clinical observations
The clinical observations showed people’s deterioration. We noticed people’s oxygen levels dropped, their pulse was higher, temperature spikes and they became more confused. The change in people was often so quick. We couldn’t always manage 15 minute observations as we had so many poorly people but we did our best.
When I was positive and couldn’t be in the service with them, I would join morning handover for a ‘virtual’ ward round.
We had a spreadsheet and discussed people’s NEWS scores. Those who were unwell with high scores were first. We colour coded them according to need. When we communicated with the surgery in advance of our daily ward round during the outbreak, we were able to tell them clinical observations, NEWS scores, any advance care plan and treatment escalation plan (TEP) information.
Communicating with external healthcare professionals
There were times we had to bypass the GP due to it being out-of-hours or the person being unwell very quickly. We had to be firm with external professionals that we were following an evidence-based tool and our escalation policy. If people were end of life, we stopped all observations and just gave comfort care.
I raised the training at my one-to-ones and every manager meeting, booked multiple sessions and carried my laptop around enticing staff to attend with goodies and a chance to put their feet up for an hour!
I chose staff to do the train the trainer programme who I knew would be passionate about taking on a new role and teaching others. I gave lots of positive feedback and thank-yous. If staff were isolating, well and on full pay I asked them to do the training.
When I also got COVID during the outbreak, I set up WhatsApp groups and shared the Health Education England short videos and bite size learning, used short YouTube videos to keep people it in people’s mind whilst I was not there. I added the training to our COVID audits, my staff supervisions and our service action plans. I was like a dog with a bone.
Learning from experience
However, there has been learning. The project and rollout was not complete when our one home had an outbreak. This resulted in large numbers of our core staff group being in isolation (over 90% were positive or isolating). The manager was also off sick. This delayed implementation. Not all staff had been competency tested.
Although our experience of this was largely positive, however on reflection, it seems that in view of the challenges experienced with the roll out, the staff could have benefitted from an extended period of practice with the tool in order to allow it to be fully embedded. Going forwards, we plan to adopt this strategy to enhance staff competence and confidence in RESTORE2 and its respective components.
I cannot say how much I would recommend investing in this training. Staff will feel upskilled, more competent and I truly believe our use of RESTORE2 saved lives.