ETON HOUSE – Who are we? Independent privately family owned home

1. Eton House Residential Home SKINtelligence Project - Summer 2014 ETON HOUSE – Who are we? Independent privately family owned home Manager – Patricia Gooden-Husbands Deputy Manager – Abbas Abdeali Established in Slough, Berkshire since 198726 Residents and 25 Staff

2. Eton House Residential Home SKINtelligence Project - Summer 2014 Project Engagement Since the start of April 2014, Eton House has been part of the SKINtelligence Project. Attended the first phase of the IHI Quality Improvement workshops. The workshops have helped us to understand how to go about creating an improvement in any aspect of the service we provide here. We are hoping to send two more staff to the next phase of IHI Quality Improvement workshops.

3. Eton House Residential Home SKINtelligence Project - Summer 2014 Improvement methods introduced The main principle... SSKIN Skin inspection Surfaces Keep Moving Incontinence Nutrition

4. Eton House Residential Home SKINtelligence Project - Summer 2014 SKIN INSPECTION Regular inspection of skin (twice daily) from the staff whenever personal care is provided. This is recorded on care management system as skin inspection. This is then passed over during handover to ensure continuity of care. Any red areas are reported to the senior on duty, on discovery.

5. Eton House Residential Home SKINtelligence Project - Summer 2014 SURFACES We make sure appropriate pressure relieving equipment is being used. Referrals are made to district nurses wherever there is a need for pressure relieving equipment.

6. Eton House Residential Home SKINtelligence Project - Summer 2014 KEEP MOVING Residents are encouraged to walk and mobilise as much as possible. For bed bound residents, there is a need to ensure there is regular turning. INCONTINENCE Regular toileting is encouraged. Personal care is carried out regularly. Creams and moisturisers are used to keep skin moist.

7. Eton House Residential Home SKINtelligence Project - Summer 2014 NUTRITION Balanced diet and regular fluid intake. Appropriate monitoring of food/fluid intake in place where necessary. Introduced fruit option for all residents every morning and exotic fruit option for all residents, once a month. Weight monitoring.

8. Eton House Residential Home SKINtelligence Project - Summer 2014 What we are doing – care plan. In each care plan under the tissue viability section, we will have the skin bundle displayed with appropriate risks as per the residents needs and the necessary actions that need to be taken. This care plan is accessible to all members of staff and so the risk factors, action plan and general notes for that resident can be read by anyone on shift.

9. Eton House Residential Home SKINtelligence Project - Summer 2014

10. Eton House Residential Home SKINtelligence Project - Summer 2014 What we are doing – SSKIN posters. SSKIN posters are up in the office to remind staff and raise awareness of what they’re looking for – the key is to make sure they understand WHY they are looking for/to do these things.

11. Eton House Residential Home Skintelligence Project - Summer 2014 What we are doing – care records. When carers carry out personal care, they will put a skin inspection note in as well that will highlight whether there are any red areas or sores. This then appears in the handover report and can be passed over to the next shift for monitoring/action as appropriate.

12. Eton House Residential Home SKINtelligence Project - Summer 2014 What we are doing – measurement. We will measure how well we’re doing and have an A3 chart to display the number of days without avoidable pressure sores. This will have number of days in the y axis and dates of the year in the x axis. This graph will be displayed in the staff office as a praise for the staff (hopefully!) – or as a way to motivate the staff to improve.

13. Eton House Residential Home SKINtelligence Project - Summer 2014 One Self-care resident / grade 2

14. Eton House Residential Home SKINtelligence Project - Summer 2014 What we are doing – safety cross calendar. We will use a safety cross – however, it will be used for red skin, first and foremost. This is displayed in the staff office – with appropriate actions wherever possible for reference. This ensures that action is taken promptly and effectively whenever there is any report of red skin.

15. Eton House Residential Home SKINtelligence Project - Summer 2014 What we are doing – safety cross calendar.

16. Eton House Residential Home SKINtelligence Project - Summer 2014 Reviewing Actions for the Future We will continue to use different methods of measurement to ascertain whether we are preventing pressure ulcers effectively. When we think that improvement is needed, we will test on a small scale, measure the improvement/non-improvement and make the change if it will improve the quality. We will look at applying the same techniques to other areas e.g. falls prevention, medication error prevention. Important that we learn from any problems and continue to make improvements.

17. Eton House Residential Home SKINtelligence Project - Summer 2014 What I’ve learnt – Abbas’ perspective This programme was aimed at the prevention of pressure ulcers, but what I personally have learnt from the programme stretches farther and wider than just this area of care. Improvement is essential within the care field, and the fundamental understanding of quality improvement can be applied to any aspect of the care we provide at Eton House. With regards to pressure ulcers, this has given myself a great insight into their prevention, and given me the tools to ensure that Eton House stays pressure ulcer free for as long as possible! Many thanks to Annette for a wonderfully presented programme, as well as all the team involved in the setting up and running of the project.