Assuring Quality of Care in Nursing Homes: Hydration Monitoring Solution

Dehydration is associated with poor outcomes such as falls, constipation, urinary tract infections, increased hospitalisation and mortality. Dehydration in older people is one of the top 10 common reasons for hospital admission and has a significant financial impact on the healthcare system. Yet dehydration in older people can be easily prevented or treated with an appropriate hydration programme. In 2011, the NHS Institute identified that proper hydration nationally could save nearly 1 billion pounds annually and lead to a reduction of 83,000 bed days per year.

Admissions from nursing homes account for the majority of admissions aged 65+ to Northumbria Healthcare Trust Hospitals. 36% of these 65+ admissions are due to dehydration and gastroenteritis.

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Following a review of their nursing homes, North Tyneside CCG and North Tyneside Local Authority concluded that improving the management of hydration was a key priority.

Older people are vulnerable to dehydration due to physiological changes that occur as part of the ageing process and age-related diseases. Common problems associated with dehydration include constipation, UTIs, low blood pressure, dizziness, falls and pressure ulcers. It is generally recognised that dehydration in older people can be easily prevented or treated, with prevention being the most cost effective approach. Common risk factors for dehydration include: residing in long-term care, needing assistance with food and fluids, cognitive impairment and taking multiple medications. These risk factors are highly prevalent in a care home population.

Most care homes have nutrition policies, but hydration policies vary significantly. Hydration status needs to be monitored regularly in order to prevent dehydration. However, current monitoring systems are time consuming, labour intensive and vary in different care homes.

In the Hydr8 hydration monitoring system, each resident has their own profile on the Hydr8 app. where their fluid intake is recorded. The cumulative total can be viewed at a glance, with an infographic displaying the percentage of hydration status attained. Residents at risk of becoming under or over hydrated can be easily identified and a standardised protocol then guides staff as to the appropriate response. Data from all residents is relayed back to a central data store and is then accessible to the care home manager, care home provider, CCG and authorised clinicians.

2014/2015

  • A standardised hydration policy was introduced across all 18 care homes in North Tyneside CCG.
  • A mobile hydration monitoring app. (Hydr8) was developed, in collaboration with local software company ‘Nine’. Using the app. on hand-held tablets enables care home staff to accurately record, monitor and communicate hydration status.
  • The Hydr8 app. was trialled in 5 nursing homes in North Tyneside CCG (n=244 residents).
  • Using the app had a positive impact on nursing home staff’s knowledge and understanding of the importance of good hydration.

 

The small size of the pilot makes it difficult to identify whether the use of the Hydr8 app. has had an impact on hospital admissions from nursing homes with dehydration. Nonetheless, the introduction of a standardised hydration policy across all care homes in North Tyneside has had a positive impact. Emergency admissions from care homes in North Tyneside CCG with dehydration coded have decreased by 21% (comparing 2015/16 to 2014/15 cumulative data).

  • To patients: better care with fewer dehydration related problems, less time in hospital, more quality care time with care staff.
  • To staff: more time to care for residents, improved staff well-being and morale, improved coordination and communication with other healthcare professionals.
  • To Trusts and CCGs: ability to provide more appropriate and coordinated care, savings from reduced hospital admissions, improved patient and staff wellbeing.

AHSN NENC provided funding of £60,000 to support the project.