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A case study: RESTORE2 in residential care

Fessey House is a residential care home in Swindon which provides care for people with dementia, learning disabilities and various other enhanced needs. In response to the home identifying that using NEWS2 could be an area they could excel in locally, Chris Turner (a local GP) and Soghra Bi (Swindon Intermediate Care Centre Liaison Nurse Assessor) have been supporting Fessey House to introduce RESTORE2, in collaboration with the local CCG. Free RESTORE2 training is available to care homes across the West of England AHSN region.  RESTORE2 is a tool that enables homes to recognise and promptly respond to the signs of deterioration in residents.

Below we share two care studies which illustrate how implementing RESTORE2 (following the training) in Fessey House has led to swifter response to the signs of deterioration and efficiencies in the use of GP appointments:

A case study from Soghra Bi, Swindon Intermediate Care Centre Liaison Nurse Assessor, Fessey House

“The carers in Fessey House were enthusiastic from the outset and worked hard to complete the RESTORE2 training, the majority had never taken physiological observations before but quickly became competent in the use of RESTORE2. They found the educational material very helpful.

Feedback from the carers who underwent the training was unanimously extremely favourable, they reported feeling empowered and confident in recognising deteriorating patients and felt better equipped to communicate their concerns to healthcare professionals to ensure that their residents got timely medical care. The key takeaway message was to keep calm.

Fessey House reports that the RESTORE2 tool has already identified a resident with soft signs of deterioration and staff believe that the use of the tool allowed for earlier identification of deterioration and the need for medical intervention, and that treatment commenced sooner than would have occurred previously. This resulted in the patient recovering sooner with less of an impact on their functional ability and avoided hospital re-admission”.

A case study from Dr Christopher Turner, General Practitioner, Swindon Community Health Services, Great Western Hospitals Foundation Trust

“On the 7th September I was informed that the RESTORE2 toolkit which Soghra Bi, Senior Community Nurse and I implemented in Fessey House had saved 2 GP visits that day.

The first patient was an elderly gentleman who looked unwell and carers identified that he was showing soft signs of deterioration, the carers used the RESTORE2 toolkit and calculated that his NEWS2 score was 7 and so called an ambulance as per the NEWS2 escalation. When the paramedics arrived they were very complementary and impressed with the use of the RESTORE2 tool and after conducting a further assessment of the gentleman, conveyed him to hospital.

The second patient was seen by a community nurse who was visiting to dress a wound on the gentleman’s leg, she took a set of observations and identified that his NEWS2 score was 3, she discussed this with the carers who explained about the RESTORE2 toolkit and that the escalation for such patients was to repeat the observations in 30 minutes. The carers repeated the observations in 30 minutes whilst the community nurse went on to see other patients, and it was found to have returned to zero so no escalation was required, the patient was observed and required no further escalation.

The carers informed me that prior to RESTORE2 being in place they would have contacted the GP to see these patients, so would have resulted in 2 GP visits from separate practices. RESTORE 2 prevented 2 GP visits from being required and more importantly ensured that one patient was promptly conveyed to ED avoiding the delay of waiting for a GP visit.

As a GP I can clearly see how RESTORE2 would benefit patients through the earlier identification of deterioration and treatment commencing earlier. When I am triaging home visits, having a NEWS2 score and soft signs of deterioration available allows me to ensure that a visit is prioritised within an appropriate timescale, and would avoid unnecessary visits where the most appropriate response is an emergency ambulance.

As more care and nursing homes start using the tool, I anticipate that there will be a reduction in unnecessary 999 calls, a reduction in hospital conveyance and a reduction in hospital length of stay for my patients, and a reduction in GP workload“.

Do you support services in the West of England that could benefit from our free training?

If so, you can sign up for free RESTORE2 training here.

Would you like to know more about the West of England Learning Disability Collaborative?

Please visit our dedicated webpages.