25 November 2020

At the height of the first wave of the pandemic, CNWL’s Milton Keynes Home 1st Rapid Response Team were supporting residents and staff in Nursing and Residential Care Homes every day.

It was a hard and emotionally challenging work, but the end result has been improved relations with the 27 care homes across Milton Keynes that the team support.

This support includes education and training, notably to raise staff awareness and knowledge of Advance Care Planning.

The Lead Link Nurse for care homes within the Home 1st Rapid Response Team is Catherine Perry.

“Our team was really busy, it was emotionally and physically draining for everyone”.

 “We’ve been supporting these care homes for several years now to ensure that the residents receive care when they are acutely ill in order to prevent avoidable hospital admission. The support was continued relentlessly through the pandemic. Care homes staff are appreciative of the support as we take referrals directly from staff.

“What we recognised very early on was that, the care homes staff appreciated having a face to face visit to see their residents and staff for support as most services were offering virtual support. That was really key and helped us to build relationships with the homes” she said.

“A big positive from us providing a physical presence is we were able to have those difficult conversations face-to-face with the patient or staff or family members about what was happening rather than via a link or over the phone. It meant we could be there to offer emotional support. Moreover, for the family member it was important that they know somebody was there.”

At the height of the pandemic, admissions from care or nursing homes to acute hospital setting emergency department could only be for the most critical.

But by having rapid access to a nurse with advanced assessment skills, medical treatments could be started sooner for those residents that do not require admission to the Emergency Department Rapid Response Staff would formulate a plan in conjunction with the patients, next of kin and the resident’s GP. Sometimes this could be about pain relief for palliative care or starting oral antibiotics for an infection.

The team also encouraged care homes staff to think about a second spike and how to support their residents.

“Rapid Response Team offers seven to eight different training sessions to care homes prior to the pandemic. As the situation with COVID 19 has eased down we have contacted care homes in order to get their opinion on re-starting the training sessions. Most care homes have expressed that they wanted the session on deteriorating patient – who to call, when to call and what to do.

“We hope to roll this out from September, which will support the care homes if the second spike occurs,” she said.

One other aspect the team is proud of is utilising the skills of two nurses redeployed to the team from the Neurological Conditions Clinical Specialist Team, Anna Kent and Jane Hurrell who worked with care homes and with GPs in talking about care planning and patients’ wishes.

Anna said: “We realised early on that our skills in terms of Advance Care Planning could really complement the care being provided by the Home 1st Rapid Response Nurses, so during our first week we rang through all the care homes in Milton Keynes and talked them through these providing them with information and also highlighting available resources and when we went out , with our colleagues from the Rapid Response service, we would talk to people about these. It was about supporting and upskilling people and highlighting their importance to staff and GPs. We were also able to offer support in relation to the really difficult and challenging conversations and supporting patients and families to express their own wishes in terms of planning ahead for care and treatment. Jane added “We were keen to make sure our teams were comfortable with the documentation that came out of those conversations, so that the teams followed the plan about an individual’s wishes for their care.

“We found that as the pandemic continued more and more care homes and staff were receptive and wanted to find out more and have recognised that practice has changed.”