‘Is my resident unwell?’ Communication Tool

In response to the need to improve recognition, recording and communication of simple clinical signs and accompanying softer indications of possible deterioration of residents by care home staff.

The Academic Health Science Network for the North East and North Cumbria (AHSN NENC) Regional Well Connected Care Homes Steering Group commissioned development, testing, use, and refinement of a new tool, incorporating the NEWS2 score, and recording of relevant soft signs suitable for widespread use.

The “Is My Resident Unwell?” tool was developed by a group of educators, social care and clinical colleagues and it has:

  • already become routinely used in 100+ care homes in the Northeast of England
  • been readily understood and adopted by care home and NHS staff
  • been widely welcomed by those who use it
  • Allowed users to recognise the enhanced quality of care for care home residents because of improved record keeping, improved skills of staff and improved communication of possible deterioration.

These advances have been of particular benefit under the extraordinary stress of the COVID-19 pandemic.

It is now being adopted at pace within care homes in the North East and Yorkshire region.

Contact Details

Project Dates

Project Start 01/07/2019
Project End Ongoing


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“Supporting teams (NHS) all really like the tool and feel it helps at point of triage and gives the care homes some understanding of our expectations on handover when they need some support."
Adam Remmer, Charge Nurse, South Tyneside and Sunderland NHS Foundation Trust
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The massive impact of COVID-19 has shown the huge value of care home staff and underlined the need to upskill them. In this environment, “Is my Resident Unwell?” became stress tested within weeks of its launch.

Introduction of this new tool over the crisis period presented considerable challenges when staff already had so much to contend with. Nonetheless work of the dedicated team of educator/mentors of the Well Connected Care Home programme in each CCG area, with their established relationships with care homes and community NHS staff, enabled recognition of the value of “Is My Resident Unwell?” and its enthusiastic widespread adoption.  Rather than seeing this tool as “yet another box to tick” users have gained confidence in recognition of possible deterioration in residents and their ability to communicate and act appropriately.  This became particularly valuable during the second wave of COVID-19.

This new communication tool for care home use includes recognition of clinical changes via the (repetitive if necessary) NEWS2 score, together with a clear overview of relevant information concerning a resident via recording soft signs and using Situation-Background-Assessment-Recommendation (SBAR).  This may be used digitally via established platforms.

During development of the tool the development group worked with users to reduce repetition of some information (found in some other comparable tools), to make completion of the tool as straightforward as possible, not requiring judgements or clinical decisions.

The team has learned that merely circulating the tool and accompanying information to care homes and accompanying NHS services is, unsurprisingly a very poor way of promoting understanding and adoption.  This requires at least one dedicated FTE per CCG area to introduce and explain the tool in conjunction with the use of digital means of recording and communicating such information as the NEWS2 score.  Because of staff shifts and turnover, teaching and mentoring must be repetitive and ongoing.  Success in individual care homes is also critically dependent on the quality and commitment of the care home management.  The incorporation of learning and understanding of “Is my Resident Unwell?” into a wider learning package, delivered to small groups of staff via MS Teams, enabling easy, inexpensive repetitive delivery of the learning is proving very successful.  It is very economical with the time of the mentor/teachers. The use of “champions” – experienced and enthusiastic users of Is my Resident Unwell? to help adoption by more care homes and relevant NHS staff groups has also been useful.

The launch meeting of “Is my Resident Unwell?” in February 2020, attended by over 100 people, gave real impetus to the beginning of the programme.

Participation of Residents

The tool has given residents themselves an opportunity to express how they feel and enabled staff to communicate with them and record their information reliably.

The WCCH Education and Training Subgroup.

This is a group of representatives from each CCG area who are involved in delivery and support of the digital communication by and within care homes in general, now with promoting widespread use of “Is My Resident Unwell?”.  As new areas, within NENC and beyond (for example, in Yorkshire and Humber) become interested then they are invited to send a member to join the group which meets virtually by MS Teams.  Experience has already shown that this communication and support is valued.  Members of the group also interact with parallel “Research and Evaluation” and “Practical User” groups.  As a result of these discussions issues regarding terminology and language in the present “Is my Resident Unwell” format have been identified and an editorial group is shortly to offer possible improvements.  Issues regarding branding of the document (paper or digital) for local use have also been raised and are being addressed. (NB: . No IP issues have been identified).

Very Well Received by All Users

The feedback from care homes and their corresponding NHS colleagues (community nurses, GP surgery staff, ambulance staff) has been very positive.

Seen to be Fulfilling a Need

There is a clear appetite for a resource of this nature.  Users report the benefits it brings to them and their residents – both from service and time efficiency perspectives as well as by improving the care provided for care home residents.

Now Digital

This assessment and communication tool has now been incorporated onto WHZAN tablets (Solcom) and HealthCall Apps so this additional information about residents can be recorded and referred electronically. (The AHSN NENC WCCH programme is designed to empower care home staff to use digital means to record, store and communicate clinical information).

Part of New Training Package

A training package for care home staff using MS Teams has been developed, incorporating “Is my Resident Unwell?, falls, sepsis, hydration etc. This can be used repeatedly and is virtually cost free.

More Widespread Use

Already other NHS staff – groups of GPs, mental health services, and community frail elderly home care services are requesting to learn about and incorporate this tool into their practice.

Care home staff using the tool report that they increased their skills, became more alert to changes in health status of residents as they used “Is my Resident Unwell?”. This led to a huge increase in confidence and useability of information received by NHS staff from care homes. In turn this is leading to better clinical decision making, potentially reducing hospital attendances and admissions. (This is subject to evaluation by academics in the regional ARC.)

These achievements help better, less wasteful patient care and use of NHS resources.

Care and Quality

Health and Wellbeing

Funding and Efficiency

A subgroup of the AHSN NENC Regional Well Connected Care Homes Steering Group came together towards the end of 2019 to design and develop the tool and AHSN NENC provided programme and communication support.

A regional event was held to launch the Communication Tool in March 2020 to encourage uptake of the innovation and to encourage spread.

There is already interest from colleagues from the Patient Safety Collaborative (PSC) at West Midlands Academic Health Science Network.   They conducted a deterioration-based survey for care homes and reported interest was shown by a number of homes within one sustainability and transformation partnership (STP) to progress forward with the use of the ‘Is my resident unwell?’ Communication Tool.  The PSC Team hosted a virtual training webinar for that STP in October 2020 and used the training materials specific to ‘Is My Resident Unwell?’  Their Clinical Advisory Group are very impressed with the Communication Tool and are keen to roll it out across Hereford and Worcester.

A communication request was received from colleagues at East Midlands Academic Health Science Network who asked if they could use the soft signs poster with a minor adjustment.

In Durham and Darlington, the ‘Is my resident unwell?’ Communication Tool is being built into the SBAR tool and will have some different questions linked to it.  Current developments include adding context to it and care homes and resuscitation nurses have been involved in the process.

In North Tyneside, a practice supervisor has been appointed within the CCG.  This role involves contacting all care homes to undertake some retraining.   Part of the practice supervisor’s role will be to oversee the roll out of the ‘Is my resident unwell?’ Communication Tool.

The group remains committed to conversations with partner organisations to enable the use of ‘Is my resident unwell?’ in enhancing the quality of care.

Conversations are currently taking place about a possible recognised certificate for care home staff in relation to using the ‘Is my resident well?’ Communication Tool.

"It develops staff with the education around the tool with basic communication skills, helps keep the homes digitally connected."
Karen Hampshire, Clinical Educator, North Tees and Hartlepool NHS Foundation Trust