Whole Health Economy Working

1
Whole Health Economy Working

• Sarah Bellars Head of Infection Prevention and
  Control, Associate DIPC BWPCT
• Leeanne Pitt Specialist ICN Nursing Homes BWPCT

2

• Engagement With General Practice
• Engagement with Nursing Homes
• A holistic approach to Cdiff

3
Phase 1 ENGAGEMENTNo buy in from General
Practices
Phase 2PLAN New approach
Phase 3 EngagementBuy in from general
practice
Phase 4 ImplementationThe practices commit to
reducing antibiotic prescribing, MRSA screening
and handwashing
Phase 5 EvaluationPayment
Infection Prevention and Control LES Project
Implementation Model
4
Nursing Home Project Model rationale

• Empowerment Vs Inspection
• Promotion of Ownership
• Use of recognised and established tool

5
Nursing Homes Project Essential Steps current
status

• Implementation process being followed (see next
  slide)
• Pilot site nearing evaluation/progression
• Process longer than anticipated due to variables
  additional IC support requirements/Resources/Requi
  rement for IC Policies and Care Pathways
• Scoping exercise completed
• 22 NH in Berkshire West (7 Newbury, 5 Reading, 10
  Wokingham)
• Data used to tailor approach (ownership/CSCI
  ratings)
• Engagement Group approach waves of homes
  working through implementation model concurrently
  -see Projected Project Plan
• Currently 9 homes involved (including Pilot
  site). Project on target for completion year end
  Initial perceived risks, such as lack of sign up
  not realised.

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Phase 1 ENGAGEMENTNursing Home signs up to
Project Agrees to implement Essential Steps
Phase 2 ASSESSMENTSICN completes ES
Self-assessment tool with Nursing Home Balance
scorecard generated and results fedback. Any
other IPC issues/needs identified at this stage
Phase 3 PLANFrom results of Self-assessment
SICN and NH Manager formulate NH specific Action
Plan including time scale for delivery. Future
interventions, training/audit sessions booked
Phase 4 IMPLEMENTATIONAction Plan
implementation includes implementation of ES
care bundles, but may also involve use of other
audit tools depending on issues identified in
self assessment (e.g. ICNA community audit
tools). This part may involve more than one cycle
of audit relating to ES care bundles. SICN moves
NH staff towards independence
Phase 5 EVALUATIONThe SICN undertakes overall
evaluation of the Project in individual homes.
The Self-assessment tool is used again to
demonstrate improvement in overall IPC practice.
Any final assistance from SICN identified
Phase 6 PROGRESSIONNursing Home is ready to
work independently with the Essential Steps
programme. All necessary resources are in place
and assurance mechanisms are active (feedback,
onward reporting and action responsibilities are
in place)
Essential Steps Project Implementation Model
7
Nursing Home Project Projected Plan
8
C.diff Holistic Approach Example Data
9
C.diff Holistic Approach

• Drill down to more detailed data
• Overseas travel
• No obvious cause (? Artefactual cases D due to
  other causes, but intestinal carriage picked up)
• Contact with acute HC (more distant than rules
  but relatively recent)

10
C.diff Holistic Approach

• Actions already taken
• GPs contacted re antibiotic prescribing
  specimen taking
• LES..
• Individual cases acted on
• Patients now contacted directly by IPCN
• This has led to better quality data and also
  feedback from patients that they appreciate
  information and that they feel very supported