RESTORE2 Feature Article with Dr Sarah Andrews

RESTORE2 has been shown to reduce 999 calls and conveyances by 16% compared with care homes that have no deterioration tool.

Training in the use of RESTORE2 is playing a vital role in providing support to care homes during the COVID-19 outbreak and is now being rolled-out across the country.   

This feature explores the development of the project and the role played by Dr Sarah Andrews and a range of partners, including the South West Academic Health Science Network (SW AHSN).

In March 2020, the British Geriatrics Society (BGS) published a guide in response the coronavirus outbreak. ‘COVID-19: Managing the COVID-19 pandemic in care homes for older people’ recommended the use of the RESTORE2 tool to support care homes during the pandemic. 

In addition, guidance around ‘Admission and care of residents in a care home during COVID-19’ released in July by the Care Quality Commission, Department of Health and Social Care, NHS England and Public Health England included recommendation for the use of RESTORE2 to support resident care.

RESTORE2, originally developed by West Hampshire CCG, helps staff recognise the ‘soft signs’ of deterioration in residents, measure vital signs and communicate concerns to healthcare professionals.

At the beginning of the outbreak, Dr Sarah Andrews – a GP with the Rolle Medical Partnership in Exmouth – formed part of a team who identified an opportunity to deliver rapid virtual RESTORE2 training across South and East Devon.

Dr Andrews’ involvement in the project stemmed from a professional interest in care homes and how they can play a bigger role in a multi-disciplinary system. 

In her role as a GP Workforce Fellow with the Devon Training Hub, Dr Andrews joined a collaborative initiative which included Torbay Council, Torbay and South Devon Foundation Trust, local GPs and the SW AHSN to achieve this aim. 

Dr Andrews said: “Even before COVID-19, myself and a group of organisations were in discussion about how we could introduce RESTORE2 locally, and use it to link primary care and care homes.

“We did a lot of research to understand the potential the tool had to help care home staff recognise when residents were poorly and communicate their condition with GPs.

“When COVID-19 hit, it threw these plans into the air. We had to ask ourselves whether to continue with the project and if it was still important in the context of the pandemic.”

However, as the virus spread – and cases began to emerge in care homes – it quickly became apparent to the partnership that RESTORE2 was more important than ever. The BGS guide served to underline the role RESTORE2 could play.

“When COVID arrived and infections among residents began to rise, care home staff felt abandoned, because GPs couldn’t come into homes for fear of spreading the virus,” said Dr Andrews.

“They desperately needed more support in identifying poorly patients and signs of deterioration while minimising face-to-face contact with clinicians.

“RESTORE2 was the ideal tool to provide that support – by giving staff the knowledge and skills they need to make difficult decisions and communicate situations to GPs and, potentially, emergency services.”

The partnership worked with providers to develop a tailored, interactive training package that could be delivered ‘virtually’ to care home staff and domiciliary care workers across South and East Devon, as well as a toolkit which was shared locally and nationally. The programme was then rolled out to care homes. 

Training is offered at two levels – full and mini.

RESTORE2 mini helps staff recognise observable signs of deterioration in patients – for example, breathlessness, hot or cold to the touch, clammy hands, lack of co-ordination, confusion or anxiety, changes in eating habits, vomiting or diarrhoea.

RESTORE2 full involves recognising the signs included in the ‘mini’ programmes, as well as learning how to take and interpret vital observations including temperature, pulse, blood pressure, respiratory rate and blood oxygen levels.

Support also involved helping staff report concerns to health professionals using the ‘SBARD’ acronym – situation, background, assessment, recommendation and decision.

“After overcoming some early issues, we developed an efficient and effective way to deliver the training using the Zoom video platform,” said Dr Andrews.

“As well providing the practical skills staff need to pick up on changes in patient’s health, it gave them the confidence to make judgements and convey that information to health professionals so they understand and act on it.”

Dr Andrews also believes the benefits of the training programme extend beyond supporting care homes during the COVID crisis.

“It provides a vital link between care homes and primary care, and allows us to work together in a multi-disciplinary team – one that care homes have often felt isolated from.

“It makes sense for care home staff to be more involved in making decisions about the health of residents, who are some of the most poorly and vulnerable people in society. They get to know them closely and are in a better position than anyone to make judgements in their health. RESTORE2 allows us to make full use of this knowledge.

“RESTORE2 training also relieves pressure on primary care services. It means we (GPs) can manage the health of care home residents more effectively which, in turn, reduces our workload and enables us to dedicate more time to our other patients.

“What’s more, RESTORE2 has been shown to reduce 999 calls and conveyances by 16% compared with care homes that have no deterioration tool. By cutting down on unnecessary ambulance call outs, patients avoid the stress and anxiety that often entails.”

Since the virtual RESTORE2 training model was developed in the South West, it has been shared nationally. To complement this, Blue Stream Academy, the developer of the online training platform, has agreed to fund access to RESTORE2 mini training modules for care staff across the country. 

Dr Andrews said: “It’s really exciting that a model of virtual training delivery could be put together locally and spread wider to help other teams deliver this important training.”

If you would like to find out more or become involved the SW AHSN’s work around RESTORE2, please contact Harriet Matthews, Delivery Manager for this project.