Detecting deterioration: Delivering RESTORE2™ training to care homes

By Harriet Matthews, deteriorating patient work stream lead, South West Academic Health Science Network  

Recognising when a care home resident’s health is deteriorating is important, particularly at a time of risk from COVID-19.

With our partners across Somerset, Devon, Cornwall and the Isles of Scilly, the South West Patient Safety Collaborative is supporting care homes, domiciliary care staff and carers to access training in the use of RESTORE2™ – a physical deterioration and escalation tool designed for use in care and nursing homes. Our tailored interactive training package is being delivered virtually by experienced trainers to care home staff, domiciliary care workers and carers across the South West.

Recently I sat down in conversation with nurses Jude Glide (Somerset Listening and Responding to Care Homes [LARCH] Collaborative) and Tricia Hymas (NHS Somerset Clinical Commissioning Group), to hear their experiences of delivering RESTORE2™ training to staff working in care homes across Somerset and how it is improving the delivery of care.

The challenge of detecting deteriorating residents  

At the outbreak of COVID-19 in March, the British Geriatrics Society (BGS) recommended care home staff use the RESTORE2™ tool to recognise deterioration in residents, measure vital signs and communicate concerns to NHS clinicians. In response our South West Patient Safety Collaborative set about collaborating with partners to equip staff in care homes with knowledge of RESTORE2™ and the skills to deploy it.

In Somerset, where a few care homes received RESTORE2™ training last year as part of a pilot project, the challenge is large. “Providing support in care homes is a massive project; there are around 7,000 carers in care homes in the county alone”, says Jude. “The good news is that between us we have a package of training which can be rolled out.”

Combined, Jude and Tricia have a wealth of knowledge and decades of experience in nursing and training. Tricia, with significant clinical experience in the NHS, the British Armed Forces and Public Health England during the national Ebola virus response, was no stranger to the challenges of delivering complex and urgent medical training. At the outbreak of COVID-19 Tricia joined Jude, who had already started delivering RESTORE2™ training with the LARCH team despite having booked to take a sabbatical.

“As nurses, Tricia and I are the right people to deliver this training”, says Jude. “We connect with our participants and they are keen to learn”.

RESTORE2™ as a tool to up-skill care staff

RESTORE2™ is designed to help care and nursing professionals to recognise when a resident may be deteriorating, obtain a set of physical observations, and act appropriately according to the resident’s care plan.

In care homes, training in RESTORE2™ is up-skilling staff, enabling them to provide the best care to residents that they can. In homes committed to quality improvement, RESTORE2™ can also be used as an evaluation tool, capturing any improvements in a resident’s condition.

“Some carers have never had formal training [in managing deterioration], so RESTORE2™ provides a gentle introduction to learning”, explains Jude. “It’s a structured way to capture soft signs [of deterioration], empowering carers to speak up and giving them confidence to escalate their concerns.”

Effective communication is critical when it comes to escalating concerns about a resident at risk of deterioration or sepsis. RESTORE2™ can be used to communicate between carers, clinical staff and administrators, enabling staff to provide a concise escalation history to health professionals to support decisions on care.

“They often know when their resident is ‘not quite right’ and RESTORE2™ provides a clear way to deliver their message, whether it’s via a receptionist, NHS 111, 999 or to a medical professional” says Jude.

Tricia agrees. “In my experience, care homes and primary care settings can be extremely busy, with competing priorities. RESTORE2™ has impact in itself but also leads to more effective communication which benefits staff and residents.”  

Online face-to-face training during COVID-19

At a time of social distancing, training health and care professionals in tools and processes usually taught in-person can prove challenging. However there can be benefits to hosting person-to-person training online, as seen in the case of RESTORE2™ training delivered via Microsoft Teams.

“Virtual training has its challenges, however it’s fun, interactive, fit-for-purpose and cost effective,” says Jude (pictured).

Both Jude and Tricia acknowledge a key difference in outcomes from interactive training online versus self-directed training online using video clips or podcasts. Online interactions during RESTORE2™ training sessions provide an opportunity for the trainee to build confidence, and for the trainer to ensure the outcomes of the training have been met.

Explains Tricia: “When online, we have the ability to gauge if a participant is in a position to use the information you have given; if they have the competences and confidence needed at the end of the training to go and use these skills in the care home.”

According to Tricia, the training to date has been incredibly well received and everyone who has participated has achieved the objectives of each training session. In the case of RESTORE2™ Mini, a ‘soft signs’-only version of the RESTORE2™ tool for use in settings where it isn’t possible to take clinical observations, training outcomes are being met in just one hour sessions.

The subsequent impact in care homes is immediate, explains Tricia. “One care home sent several of its staff [along for training]. When the second group joined the training, they told us ‘our colleagues have already used RESTORE2™ after their training’. They had real excitement about building the capabilities of their whole team.”

Adapting to the needs of care homes

Tricia and Jude look at each training session carefully, taking the time to find out about the staff participating and the care homes they work in so that they can effectively support them by adapting the training to the individuals. If the staff are managing residents with learning difficulties, for example, Tricia and Jude set scenarios during training that reflect the real-world challenges they are experiencing.

“Care home staff may have gained considerable skill sets over the years in different homes and settings”, explains Jude. “We value that experience and feed it into the training.”

“Participants remember the personal attention and care”, she adds. “This is how we are building rapport and trust with care home staff. The feedback we receive reflects this.”

So what next?

The delivery of RESTORE2™ training in care homes in Somerset has been a contained, three-month training programme introduced across the county specifically in response to the COVID-19 pandemic.

Feedback from participating care home staff has suggested value in giving NHS medical and reception staff access to the training, to ensure communication is as effective as possible between parts of the health and care system particularly important in the urgent care and management of vulnerable residents.

Jude and Tricia are taking this on board with plans to upskill participants from the current phase of RESTORE2™ training so that these individuals can provide ongoing training themselves, to other staff in their respective care home settings. This approach would continue to support care home staff, assist healthcare providers and ultimately help keep residents safe by sustaining the RESTORE2™ process.

Meanwhile at the SW AHSN, we are continuing to support all RESTORE2™ training teams across the South West by bringing them together in a bespoke collaborative where trainers and trainees have the opportunity to share best practice and resources. The SWAHSN will continue to work with our key partners across the region to develop sustainable local RESTORE2™ training projects integrating virtual and face-to-face training (post-COVID-19), as well as developing a ‘train the trainer’ model being led by Torbay and South Devon NHS Foundation Trust.

For more information about our work to support the management of deterioration patients and residents please visit our webpage.

The SW AHSN would like to thank Jude Glide, Tricia Hymas and their colleagues for their commitment and dedication to supporting the delivery of RESTORE2™ training to care homes during COVID-19, as part of the work of the South West Patient Safety Collaborative.  

Do you work for a care home or would like to know more about RESTORE2™ and the work of the South West Patient Safety Collaborative? Click here for more information on how you can take part in RESTORE2™ training and for related resources.