we're going to start the presentation just a few minutes after after after one o'clock we said um uh two past just enough let's let's wait for another minute oh well our session today our webinar today is going to focus on a number of studies that we have done and in order to make um healthcare safer for all the people living in care homes we are all based in the safer care systems and transitions team at the nhr greater manchester patient safety translational research center i am i'm maria panagioti i'm leading the theme of safer case systems and transitions and sally who's going to follow natasha and claire are all working as researchers within within the team all they have personal awards and working on the topic and around patient safety and quality of patient care either in care homes or in other vulnerable statics such as mental health oh as an overview of our presentation today of our session today i will start with presenting the findings of um of metasynthesis that we did i'm sorry um of american synthesis that that we did around infection prevention and control in care homes and this will take about 10 to 15 minutes then around 10 minutes roughly and then sally giles is going to present the framework that we have developed for patient safety in care homes after that natasha building on framework that we have developed with sally is going to present a measure that we have developed the patient reported measure focused on on getting the views of residents and carers about safety and care homes and finally we will present a study about interventions for improving transitional care for people living in in care homes and claire planner is going to present these as well as some findings that we had that we some findings from qualitative interviews which focused again on how to improve healthcare transitions so our overall presentation is about quality of care and patient safety and we've got certain themes such as infection prevention control and developing a framework of safety measures of safety in care homes for particularly aiming to improve their safety from the perspectives of patients and residents and carers and finally we focus on a specific a specifically um vulnerable point which is transitions to from hospitals to care homes or the other way around so well the title of the mental synthesis is beyond the the control of care homes and and um it's a review of qualitative studies on prevention of infection prevention and control in in care in care homes and nursing homes well the government in pandemic has had a global impact on the care home sector in the uk rapid and mass discharges from hospitals have been have been the main explanation for failures in appropriate prevent infection prevention and controlling care homes it is widely recognized even before the pandemic that residential settings are vulnerable to a range of hospital and acquired infections and the previous scientists mainly based in the u.s have reported the variability in staff adherence to infection prevention and control there are a number of interventions quite variable and this might also include national care collaboratives the aim of this metasynthesis was to to synthesize the findings from qualitative studies on ipc in care homes in order to yell insights into factors affecting transmission of infections into in and within care homes we chose metaethnography as a method of review synthesis because it offers the opportunity to develop a conceptual conceptual insights which go beyond the findings primary studies our overall aim was to develop a conceptual model of the factors which influence infection transmission and in residence of care homes for older people apologies for this i just forgot to say that if you have any any questions please add this in the chat and we'll be able to respond to your questions at the end we have searched several databases four main key five key main databases including medline and bay cycling for cinahl and asean and then we also looked at google scholar as a source of wider grey literature we included studies we included published reports of studies using qualitative methods of data collection analysis the studies had to be presented in english and we included a range of participants staff presidents or managers of nursing or residential care homes for people aged over 60.

And then the studies have had to specifically focus on infection prevention control not just mention it at some at some point so it had to really be focused around this topic uh we identified five uh studies which were included in the meta synthesis uh five international studies most of them were actually based in in the us but we also found the number of a number of international studies very few from the uk though our findings our findings when mainly were mainly focused on porky themes the first was about staff knowledge and attitudes and practice of infection prevention control and also in relation to and how infection prevention controlling care homes interferes with workload and lack of time of resource or resource that the staff encounter then the second issue was about was about problems with enabling staff members to enact ipc procedures and staff motivations or attitudes around practicing um infection prevention and control and the third thing was that infection prevention control was sometimes seen as less appropriate in the careful home environment and the resident's views around ipc and ipc behavior were not always consistent with um uh with uh ipc practices and finally they were clinical issues including the transfer they transfer the transfer of clinical information between um um health sector in the get home sector so i mean roughly our key findings showed that one of the key challenges faced by care homes is uncovering how an outbreak begins then once an infection begins to spread identifying who is responsible for the necessary control measures it was not always clear a high staff turnover was also an additional challenge as well as the need to bring in external care professionals such as gps to diagnose or treat an infection which affects ipc overall we found that training staff repeatedly could support them in ensuring um ipc is effectively practiced within care homes and and overcome one of the key reasons why infection prevention controlling can forms has not been seen as as effective which is actually high staff turnover however the success of this measure depends upon managerial mana commitment and organizational improvements that need to be made within their homes overall this um this diagram shows the complexity of infection prevention and control in care homes so uh one key aspect is about ambivalence about the actual possibility of um of implementing ipc in the care home environment and the tension between um having a homely quality quality of life environment as well as doing a proper ipc practice and then the second is about the second theme is about the credibility of the information used for itc controlling care homes there were always delays and miscommunications between different sectors uh healthcare sector and social care sector as well as sometimes lack of information or suboptimal information flow between different sectors moreover and this is an important and important aspect as well because it was a bit different but still interface within the previous um the previous findings it is about the opportunities of for harnessing professionalism and care home staff um and this is perhaps the most uh the most important area that um can interventions that can inform interventions for improving um ipc controlling care homes more about improving um no knowledge and training of staff members but this again has to be done in a consistent way and supported by organizations rather than random or inconsistent training across um across airports so overall and in fact the key discussion findings are that uh an infection breakdown a breakout would likely weaken eyepiece in care homes due to exaggeration of workload and additional patience of monitoring idc practices can be almost antithetical to the notions of homely environment and create dilemmas for staff and patients a key control mechanism sometimes like outside of the care home environment and could underline the view that ipc is something that careful should should not worry about uh key issues about ipc practice relate to communication between different different staff members between different sectors and how to ensure organizational investment on staff training in relation to ibc thank you very much and and i'm going to pass um past the presentation uh to sign to dr seil giles who is going to present um a systematic review for developing a framework in a framework of safe thinking homes thank you maria i'm just um just going to show my screen and hopefully everyone can see see the screen clearly so i'm sally giles and i'm a researcher who works on the safety and transitions theme with maria and i'm going to present to you today the results of a systematic review looking at safety domains for residents in care homes okay so so why is it important so poor quality and unsafe care provided to care home residents can lead to significant patient harm and even mortality we also know that care home residents are twice more likely to experience emergency admissions than the rest of the population over the age of 75 and 40 percent of them experience adverse events within 45 days after hospital discharge and we know that studies in upstream health care systems indicate that team working factors communication information flow access care planning and patient characteristics as well as factors like task performance may contribute to patient safety incidents these factors have been used as an empirical basis for generating a framework of contributory factors to patient safety incidents in the hospital setting and there is also lack of consensus over the contributing factors to patient safety and care homes with aspects such as organizational residential characteristics and access to healthcare thought to contribute and we know that safety challenges are likely to be different in care homes where health and personal care is from multiple care providers with a lack of continuity and the residents themselves being largely unable to navigate the health system independently or express their concerns effectively there is also a lack of a framework to guide policy makers on which safety factors to target for improving patient safety in care homes so what we wanted to do was to produce a clearly defined framework which describes hierarchically ordered from the sharp end and proximal to distal latent contributory factors to patient safety incidents and care homes that feature more strongly in the literature so i just wanted to give a quick definition of what we mean by contributory factors so contributory factors were defined as any act of failure at the individual institutional or national level which threatened the provision of safe care to residents they could be also included environmental hazards and residential characteristics so they encompass um a number of things and the methods so as i said before we undertook a systematic review um and i'll just go through uh the search process briefly so we looked at various different um databases medline mba psycinfo and cinahl and we use three main blocks of search terms patient safety and system and contributory factors and care homes and we also look through the grey literature using um these search terms in google scholar our inclusion criteria so we focused on studies um looking at contributing factors to safety incidents for older residents so those over 65 in care homes nursing all residential and we included both quality quantitative using including randomized controlled trials cohort studies cross-sectional and quasi-experimental studies mixed methods qualitative assessments and systematic reviews okay so data selection and extraction um so screening was conducted in two stages and we managed it through a software package called confidence the eligibility of titles and abstracts were examined by independent pairs of four reviewers and the full text screening was completed by two reviewers based on criteria used in a previous review disagreements were resolved by discussion and the involvement of a third reviewer and for data extraction the key information we extracted were study designs settings participant demographics and contributing factors to resident safety and the domains or sort of areas of contributory factors to resident safety were first coded by two independent reviewers and then further validated using ten percent of the articles by two independent reviewers and clinicians who were experienced in the care of elderly and this was to ensure a consistent approach okay so the results um this is the prisma flow diagram that shows you how many studies we screen so we had uh 2713 after the duplicates were removed um and that was for the title and abstract screening and then we ended up with 180 to be for the full text screening stage and then eventually once we'd gone through this process we had 67 studies that we included in our review okay so these are the the main safety domains that we identified there were 18 i think that we um identified through the review the top four were task performance team factors training and education and communication and the there were two sort of new ones that came out of the literature that we hadn't um identified in previous reviews and they were leadership and family related factors um so the next slide gives you a definition of some of the main um contributing factor domains so our main one was um the most common one was task performance and that's the skill and competence of care home staff when carrying out a task and then obviously communication is self-explanatory family related factors are those that refer to features of the family that make caring for their family members more difficult and therefore more prone to error training and education is that relates to access to correct timely and appropriate training for for staff working in the care home both task related and organizational related i can obviously these slides will be shared afterwards if you want to look in more detail and the next slide is the um contributory factors framework diagram which shows you sort of a diagrammatic representation of all those factors um i realize it's probably not completely clear on the screen but we're going to send these slides afterwards and a full sort of clearer picture of the original for anybody that would like to just to see a a you know original copy okay so just now finally the few points for discussion so the synthesis of the contributory factors into 18 safety domains demonstrates the multi-factorial nature of resident safety ranging from national policy to individual resident and staff factors the five most common safety domains with past performance team factors staff training and education communication and organization and care planning so the framework can be used in real life practice to allow care home staff to examine and improve the safety of their home and promote effective organizational safety learning it could be utilized as the backbone of a tool for residents and informal carers to rate their safety in their care home it could be used to inform the development of an intervent intervention strategies to improve safety by targeting the most important contributory factors to patient safety incidents and also guide the measurement the measurement tools used to evaluate policy and service level interventions and natasha and claire are both going to tell you a little bit more about how we're using the framework um for the development of um a resident measure of safety and also um looking at the analysis of some qualitative interviews that we've um we've done around um president's um interventions for um improving safety and care homes around transitions and i'm going to finish then and pass over to natasha so i will stop stop sharing my screen and thank you i'll pass to natasha i'm just gonna share my screen okay um i think that should be working now i'm just gonna apologize now i'm not feeling very well so if anybody can't hear me then put it in the chat and i'll try and speak up a bit louder and so i'm going to present the study that followed on from sally's study and it's using consensus methods to develop a residence relative measure of safety which we've called the almost in care why is it important i think sally's already covered this old people in cairns are particularly vulnerable to experience the patient safety instance and most information recorded about safety is in the form of incident reporting or from the perspective of professionals but most residents and their key informal carers are able to provide feedback on patient safety and can play a vital role in the success and longevity patient safety improvements or in this case resident reported safety so our team's previous workers successfully developed patient reported measures of safety in primary care and hospitals using questionnaires so this is an example of our well i'll tell you's previous work which is the primary care measure of safety so just to give you an idea of the sort of thing that we're trying to develop so it'd be a questionnaire that looks like this with a like at scale ranging from strongly disagreed strongly agree and then a number of items um that the people would be completing it would complete so i was able to access out of our services when needed i had enough time during the consultation with the healthcare professional there are just a few examples to let you know what sort of thing we're trying to develop so the aims and the focus of this study was to develop a patient measure of safety as in a questionnaire for care homes obviously we've called it a resident measure of safety but um yeah there's a bit of a crossover in terms of terminology and to adapt the pcp must which is the primary care patient measure of safety so that it's more relevant to residents of nursing residential care homes in the methods we um this way it was based on the evidence synthesis of the contributor factors to safety so it was based on the work that sally's done um and what we did originally was scan the literature um and existing questionnaires to look for any potential factors that influence safety in in the um evidence then the second one was to present all them items from the evidence in two online delphi questionnaires to a um stakeholder panel which i'll describe in the next slide after that we did a consensus meeting with a smaller panel and just to discuss the outcomes of that and check if there's anything that wasn't necessarily captured online that we needed to discuss face-to-face so a few items from that were um we introduced a few items were removed and a few were reworded or combined at the moment we're just doing i think allowed method so that's um having participants go through the questionnaire in the current stage and think think out loud as they're answering it so we can understand if there's anything that needs changing or um how it might look in practice and then the final stage is to pilot the questionnaire and conduct statistical analysis to look for the items of the best psychometric properties so they that can then form the final version of the questionnaire so it'd be a much shorter questionnaire than what we're currently piloting so in terms of the delphi process we had five stakeholder groups we had health care professionals um then care home professionals researchers and carers relatives and so informal codes in this instance so they might be friends or relatives but not people who are paid to provide there and residents themselves and we'd ask them to rate um items in terms of how which one should be included in the questionnaire so we presented items like the ones on the left for example i'm aware of how to report a complaint if i am unhappy with the care i received we had a panel of 28 members in the second round there was two rounds of voting and items with low levels of consensus were removed in round one so i can show you the results so we began with 73 statements so 73 potential items to include in the questionnaire and the panel agreed that 30 of them should be excluded in round one so in round two we presented them again with uh 43 items that they uh that had higher levels of consensus and eight only eight statements were excluded in round two so then we presented 35 statements in the consensus meeting so that was to the smaller group on this room and i think there's about 10 people in that meeting and there was no change in the item numbers but some items were combined and removed so we ended up with 35 statements um which have gone through to the finca log process here's an example of questions that most of the panel agreed were good for things like i am given the option to involve my family or loved ones in my care i was always treated with dignity and respect and i've always felt that staff listened to me about my concerns these are the um items that would be included and have gone through the process now some items of examples that might have been excluded would be things um like care home staff were unable to get help from other caring staff when they asked for it i always knew the roles of the care home staff looking after me and i didn't know who to go to if i needed a question these ones had didn't have these weren't the lowest ones but these were ones that were sort of marginal in terms of exclusion and some preliminary findings from the think allowed study which we're currently in the process of doing um so the main concern as we got to the station it has been throughout is who will complete the questionnaire so initially we wanted to be um a really inclusive questionnaire we still do um and we plan for it to be a resident measure of safety completed by the resident with some help from relatives but a lot of the stakeholders work and think aloud has revealed that residents and their carers sometimes feel that this quite this kind of questionnaire might might be too complex or time consuming residents might not be motivated to complete it so we're currently in the process of discussing whether this should be a relative or care only tool or whether we should make adaptions to it to make it more resident friendly and it'd be great to get some feedback on that um in the question and answer the session after these presentations and so these were some questions that um relatives found difficult to answer so um evidence suggests that when people are receiving care if they have adequate knowledge and information about the care they feel safer but relatives struggle to answer questions about the information and knowledge of residents or professionals so the questions that they struggled with are things like information regarding my relative friends last hospital visit eg test results on medication changes were available to care home staff so a lot of people said it would be quite difficult for them to make a judgement about what kept what information care home staff have um another example might be my relative celestion has been informed of any outbreaks of infection in their care home and the action plans to control the further spread and so the people that we spoke to currently have obviously got um obviously got relatives who are in care homes during coverage and because the contact's been minimal so say a lot of people have been reporting only 30 minutes a week it's quite difficult to know what their relative has been informed about just due to that minimal contact and so that's what we're in the middle of discussing in terms of how to include these sort of items or whether we should be removed from the questionnaire and the future work as i've presented before is to do the pilot and statistical analysis so to find the questions with the most variability which will be most useful at um highlighting the differences between um questions and yeah i think that's the end of it so i'll just pass you over to claire that's not sharing my screen thanks natasha so i'm just going to pull up my slides now and share my screen okay hopefully everyone can see those okay um so for the final part of this webinar i'm going to be talking about transitional care interventions for older people that are living in long-term care facilities okay so um in terms of the background to this my colleagues have already done a really kind of good um uh given a lot of detail about why this work is important so just a very quick recap the long-term care facility residents are frequent users of hospital services so they are having um more transitions than people that are not in long-term care facilities and transitions are a particularly vulnerable time for people as we know in terms of exposure potential patient safety incidents but also in terms of the distress that people can experience when they're moving between hospital and and a long-term care facility and so we have a really good opportunity to look at ways to try and reduce the number of transitions that people are experiencing but also improving the quality of transitions when people do have them and it is a major challenge for healthcare systems but it's um something that's necessary for us to look at okay so in terms of the aims for this work the first aim was to examine the effectiveness of transitional care interventions for older people living in long-term care facilities and staff then to look at the factors that may impact how effective a transitional care intervention is or how easy or difficult it is to implement a transitional care intervention and then finally to try and identify the aspects of the transitional care pathway where safety and safety issues are potentially more acute okay so in terms of methods there are two aspects to this study um a systematic review and also um qualitative research study as well so i'm going to start by talking about the systematic review which was looking at um transitional care interventions for this population and this review is different from previous reviews in the sense um that it um previous reviews have tended to focus on that transition from hospital to um to home so home in the community rather than a long-term care facility so this is the first review and to look at um transitions involving long-term care facilities so in in terms of our approach to finding um relevant studies we did an extensive search of electronic databases the databases that are listed on the slide there from the inception of the database up until earlier this year in 2021 we also um searched google scholar and we used a cluster methodology which is a formal process for looking for qualitative studies and process evaluations the type of studies where you get that richer data around the factors that are likely to affect how an intervention is implemented for example in terms of our inclusion criteria we were focused on controlled intervention designs so interventions where you are comparing one group that receives um a transitional care intervention um with a group that doesn't we were interested in all types of transitional care intervention so where people were transferring from hospital to long-term care facility vice versa um or both ways um and we were our primary um outcome of interest was readmissions but again we took a broad brush approach to this and were interested in a whole range of different outcomes including things like length of stay quality of life satisfaction okay so in terms of extraction analysis we had a two-stage screening process and were and we managed data in confidence the eligibility of potential studies was assessed by independent pairs so we had three three reviewers in stage one and six reviews in stage two and any disagreements about whether or not a study should be included were resolved by discussion in terms of the analysis for this analysis for this we did a meta-analysis so we were pooling the results um across all of the studies that were included and then we also did a subgroup analysis so we wanted to look at whether or not involving primary care or community practitioners had any impact on the effectiveness of transitional care interventions and then we also wanted to look at whether or not an intervention that targeted multiple different areas of focus as opposed to one area had any impact on the effectiveness of transitional care interventions so in terms of the results so we um in terms of the quantitative studies that we were looking for we screened over 13 000 reports and from that we included 15 studies in the review and in terms of the qualitative studies that we were looking for we screened over 1300 reports and we included four studies in the review so what i've presented on the um right hand side of the slide are some examples and screen graphs from some of the studies that we included so you get a sense of the type of interventions that made it into the review so just in terms of some of the key characteristics two-thirds of the studies came from australia we didn't include any uk-based research um in the review six of the studies were rcts and in total so pulling across all of the stuff all of the 15 studies there were 32 and 722 participants or participant records um that were included in terms of the type of transitions um the majority were focused on that hospital to long-term care facility pathway um and in terms of the type of intervention six had a combination in terms of their focus um and five will focus primarily on uh systems level and three focused on on residents and one we're focused on staff okay so we found that transitional care interventions were associated with a reduction in readmissions to hospitals and reduced length of stay in emergency departments so older people allocated two transitional care interventions were 1.7 times less likely to be readmitted to hospital or an emergency department compared to those that allocated to a control group the findings from our subgroup analysis showed that interventions with a primary care element or or intervention that had a multiple focus did not influence the effectiveness of transitional care but we think this is probably due to the small number of studies that were included in that in those analyses okay so in terms of the qualitative synthesis that we did where we were looking at the factors that may determine the effectiveness and implementation of transitional care we um we have three main findings from that and and those are that the quality of communication and role clarity of staff is likely to affect um the effectiveness and implementation of transitional care along with the quality of information flow and referral pathways and the engaging community and primary care practitioners um is also likely to um to have an effect to have an impact on on the effectiveness of transitional care so these findings map nicely onto the domains that came up in sally's work on contributory factors so in terms of the qualitative research study um we have conducted semi-sucks semi-structured interviews with 25 participants from different stakeholder groups so we've spoken to 10 care home staff seven healthcare staff seven um carer and family members and a resident and these interviews have been carried out on zoom um due to kovid and we've transcribed them verbatim and we are conducting as we speak a framework analyses on these so we are using the contributory factors domains that have come from sally's review um as the framework to look at these interviews um but within that we are sort of taking a more inductive approach in terms of the sub themes that come up within those domains so some um some of the results um coming out of the qualitative reviews in terms of the type of interventions that people think will help to improve transitional care so in terms of information flow people are talking about having some sort of electronic record um a discharge summary that can be shared across providers making sure that discharge summaries highlight things like medication changes um and also perhaps having some sort of personal social information sharing cards or an about me card form and communication has been a strong theme that's been coming through so things like having improved communication through a more standardized discharge process and then there are sort of patient related factors as well so um for example involving carers more meaningfully in in the discharge process so this analysis is still going still ongoing so these are just some of the preliminary findings that are coming up from that and again they are sort of mapping um nicely onto some of the domains that sally's identified in her work so um in terms of sort of the next steps for this work we're holding a uh co-design event at the end of the month where we are going to present so i've presented the the short list of some of the short a short list of some of the interventions that people are suggesting but we'll present a long list to um the attendees of that co-design event um and sort of try and get um attendees to prioritize an intervention that we can help to develop further and finesse and then test through research so to test its effectiveness so if anyone um so you know if anyone has any ideas about transitional care interventions that you think we should be including in that discussion we would love to to hear your thoughts on that okay so in terms of the um final discussion points from this work um older people living in long-term care facilities experience fewer readmissions when they participate in a transitional care intervention compared to usual care and it looks like the effectiveness of transitional care interventions for older people living in long-term care facilities may be improved by promoting higher quality communication and role clarity among staff members building the infrastructure for better information flow and referral pathways and also potentially engaging primary care and for community practitioners as well um so in line with the um qualitative findings from the review um the stakeholder interviews are also suggesting interview um suggesting interventions that primarily target communication and information flow so these are this is um some acknowledgements of the other people that have been involved in the studies that we've presented today so our thanks to the to those and thank you for listening so over to questions and i'll stop sharing my screen well how should we do we should do this perhaps we start from the very start and uh reading out the questions and see if we should respond then would you like me to read out the questions maria would you like to go through them whatever suzanne if you if you prefer to read them out it might be more helpful if you if you read them yeah yeah i can i can read them out that's fine so first then maria we had um in your presentation just after your presentation kate byrne asked them can she double check and what analysis you used oh we use the metaethnography which is a seven-step approach for analyzing the findings i mean i can also share the months of the the published paper if um if you're more interested about the methods that we use that would that would be great if we can maybe put that on the event description afterwards yeah and i'll share that on the micro website fantastic um okay we then had them on second we then had um julie thomann who asked them what was the breakdown in the settings i.e how many nursing residential specialisms were considered um ld dementia or just old people well that's a bit difficult to say because these were qualitative studies and some of them they were using mixed samples so they were using both from residential and and nursing care homes but mostly in the u.s they used more um they had mostly mostly participants from nursing homes i have to say and we didn't do a huge split between um dementia care and non-dimensional care mainly because this is what we had available at the time and there was another question which i saw in the chat about whether there were any particular theme set of dimensions might be but i think um mostly staff members that responded from their perspectives about ipc conte i ipc practice and care homes and they had in their mind the the full pool of of residents rather than a subgroup of people with dementia but this is definitely worth exploring about whether these findings actually apply to people with dementia whether we need something different okay um we had a question from crystal walmart who asked has the safety framework being shared with the cqc not yet because we just finished it and we're waiting to develop the measure and then and then and then um disseminate them together but we're aiming to do within the next uh um a few months i'm sorry and i think this was not a question for me was mostly for natasha and uh and sally so if you have to add anything oh i think i think you've covered it maria actually yeah and we will obviously we'll plan to disseminate it as widely as possible once we've finished the work um as i think it will be quite useful for a number of different people and i outlined some of the ways it could be used in the presentation so if anybody wants to to look at it i'm sure we can share it at this point can we maria is that yeah definitely yeah can i basically respond to a question that i see i think we missed is from crystal who says whether what are the implications of the um the meta ethnography well they're a bit generic but i mean we come back to the same at the same points as each of the each of the each of these studies that we did as part of the presentations have found it has to do with the quality of the training and the organizational commitment in training of staff members and care homes and how they are and how they how well they're trained and how this is perceived as part of the culture rather than just random training for for some members it has to do with the the the information flow and how well um the clinical uh the clinical guidance is actually communicated to care homes and how staff from from other health and healthcare settings like like hospitals or primary care are actually able to communicate and develop partnerships with uh with care homes and finally it has it is there is an element about residents whenever they can make they can they can make um they can have input so it is it is also about residents and and family members in terms of um what they expect from infection prevention and control because there is a sense that care homes they should almost look like a home environment but then it's a bit difficult to apply measures around infection prevention control while someone feels that they're in there at their home so there is an element there about trying to to kind of co-design and agree about how an ipc practice would look in care homes which is quite different from a more hospitalized setting thank you maria and we have a question from janna m who asked do you have any tools available now which can be used for audits around safety and infection control i i think there are a few but they haven't we haven't used them yet and they were actually we're applying from some future work to see how they actually can be applied in care homes because i think there are but are more generic not specific for care homes thank you and kate burns also asked and there's still a questionnaire she said if it's a resident questionnaire you'll need to consider people who may not have capacity are people with learning disabilities who may really struggle to answer the questions yeah um there the discussions were sort of in the process of having and we're just trying to figure out what's going to be the best way to make that questionnaire work and one aspect we wanted to consider is actually involving more carers and trying to um to get their perspectives whenever they the residents cannot um cannot participate and uh this is going to be part of their um their empowerment actually to see how much they know and how and where where intervention should focus on making sure that carers have an active voice in the care that residents with learning disabilities or or dementia have and we also have amy clottworthy um asked are the tools and models that you're developing intended for other contexts such as other countries that might have different healthcare systems organizations of care homes and our provision of care and how much of the reviews in the delphi studies involve international research and perspectives can i say something about that um so the review around the contributory factors to maine was very much international um review i think i'm just looking at the results here actually so we had studies from the us australia uk and then one or two from some of the european countries um our previous work looking at primary care and contributory factors in primary care patient safety incidents has actually been a collaboration with some colleagues in australia so that the primary care patient measure of safety is very much an international tool i think going forward we'd have to look at because obviously care home settings are quite different in different countries but i would have thought there would be some commonalities and that we could um use the tool um internationally in the future i don't know anyone else has any thoughts on that yeah i mean what i wanted to say is that we used um i mean i think we have been quite balanced that basically the review was based on international perspectives but then the delphi was more like national because our primary aim was to develop a measure which also which mainly can meet the needs of the uk care homes first of all and then if this can be can be used more than if this can be useful internationally we will need more research to know but some of these factors will definitely be irrelevant because it's less about less about the organization it's more about the perspective of patients and carers and this tends to be similar across across settings yeah i think i think that's right and it seems to have worked well with our primary care version so there's no reason not to use it in in other countries um we had a question um towards the end and from alison and she said it's a question regarding transitions she works caring for older people in a community hospital and many patients are continually asking when am i going home yeah and i think that's a it's a you know it's a it's a really common issue and i think what we can do allison is um we can add that to the long list of um sort of issues and potential um target areas for a transitional care intervention that can then be discussed at our co-design event so that's when we're going to be looking to sort of and select an intervention that we help to develop and test in research so we can add your suggestion to that list so thank you for that um and probably finally because we're going to have to start wrapping up soon we had a last question from kate who asked well she said that she thinks it's really important to empower and support the person living in the homes and a lot of her research has involved people with them learning disabilities and there with me sorry do you want me to explain that because i've just realized that there's so many spelling mistakes in that message um pop on kate yes yeah sorry um just to highlight that i completely agree with you maria that it's about empowering not only the person and their carers but essentially a lot of my experience with research involving people with a learning disability is that it's seen as the easier option to discord the carers and i think in this instance what we need to be doing is really empowering the person to be involved in their care and highlighting well from my experience of somebody living in the home this is what my safety issues are and my concerns are um and i know quite a lot of other people have said about easy reads which is great for helping people understand but that also isn't an easy option some of the time um and if you have quite a long list of questions then an easy read booklet of 20 30 pages is more problematic potentially um so it's just something to to consider and even whether a questionnaire is the the right way to go for certain people um and i've just highlighted in the bottom that from experience ppi and doing a lot of ppi is probably the better way to do that um to get that really informed nature for the questionnaire that you're planning i think this is a very helpful suggestion because this is exactly what we wanted to achieve to make sure that this is first of all for residents but then we received a lot of resistance in terms of in terms of funding in terms of funding for the additional part of work in terms of feedback so at the end we're not entirely sure how to balance it how to balance uh the idea that this is something new for residents to um to ensure that at least they can they can provide the views and perspectives but at the same time to be usable so we're trying we might end up with two different versions actually with the care version and then something much much more easier to read as you suggest for for residents at least to have something that they can they can use either in the form of questionnaire or a few items that are um like you know like guidance or a booklet thanks marie okay i think we're probably going to have to wrap this up now emma as well approaching midday and just to let everybody know that the recording of this session plus these slides will be available and probably they started next week on the microwebsite and i can send an email to our attendees letting you know when the slides and the recording are available um any last words um from the from our panel if if not well thank you everyone for attending today thank you to our speakers we thought it was a great session and thanks for the audience for your participation and the question and answers and we look forward to seeing you all at future microwebinars thanks everyone



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