On 1 July 2016 structured drinks rounds were introduced into four care homes (150 residents) in the Windsor, Ascot and Maidenhead area in partnership with East Berkshire Clinical Commissioning Group. The aim of this project is to reduce the number of urinary tract infections (UTIs) in care home residents which require antibiotics or admission to hospital.
The tests of changes are noted in the PDSA below:
Baseline data was collected for two months before the project officially started using safety crosses. A red sticker indicated if a resident had a UTI requiring admission to hospital, an orange sticker indicated a resident requiring antibiotics for a UTI and a green sticker was an incident-free day.
The training was aimed at all staff including nurses, care workers, activities coordinators, managers and nutrition advisors. It covered the anatomy and physiology of the urinary system, the importance of hydration and how to recognise dehydration, the effect of certain medications on the kidneys, signs and symptoms of a UTI and how to implement a structured drinks round.
Each care home chose the times that would best suit their routine and the aim was to achieve seven structured drinks rounds per day. This information was collected by the member of staff undertaking the drinks round by noting it in the allocated folder. At the end of each day the number of drinks rounds were tallied at the end of the page and the manager collated the information on a weekly basis.
Eighteen months into the project two care homes have consistently achieved 100% compliance with their seven daily structured drinks rounds and have demonstrated a reduction of the incidence of UTIs. The graphs below note the number of UTIs requiring antibiotics or admission to hospital. It is important to note that when examining the data one unwell resident can have multiple UTIs in the month due to other exacerbating conditions.
The following feedback was received from a focus group involving all four care homes:
- A positive experience being part of the project
- Some residents ask for their drink if we are late
- A resident who had a UTI every six weeks used the drinks diary (had capacity) and realised how little they were drinking. Increased fluids of own free will. Improvement noted in walking, social interaction and has been UTI-free for over eight months
- Noticed improved skin integrity and fewer falls
- Fewer GP visits
- Greater understanding within staffing groups of importance of hydration
- No major increase in cost or time commitment – just a different way of working.
This project is now being adopted within Oxfordshire, East Berkshire and discussions are in process with Chiltern CCG, Swindon CCG, CCGs and local authorities in the Bedford, Luton and Milton Keynes Sustainability Transformation Partnerships.
Sarita and Ida enjoying one of the structured drinks rounds in a residential home.
Below are examples of some of the trolleys designed by care homes to undertake their structured drinks rounds.