Hydration project report Written by Diane Allen Dehydration among our service users can be a serious issue if not addressed, especially when staff are not aware of the consequences of being dehydrated or the benefits of being hydrated. The Hydrant Drinking system, Winner of The Queens Award for Enterprise: Innovation 2013 is for use with our service users who are unable to drink independently or pick up a glass or jug. It is a system that is designed to solve the problem of reaching, lifting or holding drinks and thus promotes self-sufficiency and facilitates hydration for these individuals. There are two types of system: 1) - A sport s hydrant, which is made up of a bottle and lid with a sports spout. 2) - A larger hydrant, with bottle, lid and long plastic drinking tube. Aims and Objectives of this project: Promote independence, dignity and a persons well being. Reduce the use of medications especially antibiotics and laxatives. Reduce the amount of infections that a person may have. Reduce the amount of falls a persons may have Reduce the amount of hospital admissions. Method: The project was carried out over a two month period, 1 st June 2014-31 ST July 2014. There were eight homes chosen to take part in this project. A day was arranged to train a Hydration champion from each of these home who would cascade the training to the rest of the staff team. Each representative received training on the use of the Hydrant from Mark Moran who is the CEO of Hydrate for Health. Homes were given a service user assessment tool and a protocol for the use of hydrants in the homes which would be included within the service users care plan. The champions chose ten residents that they thought would benefit from using a hydrant and criteria was set out for gathering pre project data about these service users and also post project data. This data could then be analysed to see the benefits if any of the project. (Unfortunately by the of the trial period only 57 service users had been mapped, this was due to some service users been reassessed or passing away)
All staff was also given a hydrant to use whilst on duty. Formal feedback from staff has not been sought on this project but verbal feedback given to myself was that the staff using the hydrant felt more alert, had more energy whilst on duty. The criterion used for analysing the data against was: Use of antibiotics Use of laxatives Falls Pressure ulcers Hospital admissions Urine infections with a catheter in situ Urine infections without a catheter in situ. Chest infections Cellulitis Results: A total of 57 service users were mapped against the criteria. As you can see from the data below there was a real benefit to some of the service users using the hydrants. Overall there has been almost 30% reduction in the areas that were analysed. During the analysis it was found that some homes found the system more beneficial than the others: 3 of the homes found no benefits to. 3 of the homes saw a slight improvement. 2 of the homes saw a huge improvement. At a post project meeting of all the hydrate champions feedback was sought to determine why two of the homes had achieved real positive benefits and the others hadn t. The two homes had seen their overall data gathering reduce from: 35-10 33-9 These are quite astounding numbers and, if replicated across all of our homes, have the potential to deliver huge improvements to our users as well as substantial cost savings. A summary table looking at the event reductions in these two homes is shown below. See appendices 1 and 2 for the full detail from each location.
Care Homes Hydrant project: Amalgamated summary of reduction in 'events' from 2 care homes Event Pre Project Post project % change Falls 30 6-80 Antibiotics 17 4-76 UTI with Catheter 4 1-75 UTI without Catheter 4 1-75 Hospital admissions 6 2-67 Laxatives 2 1-50 Cellulitus 4 2-50 The rationale from the feedback given seems to be: Hydrate champions need to be proactive in driving the project. Staffs lack of knowledge about the benefits of hydration Senior managers to be more proactive in the project. It is very clear that where the project has been enthusiastically driven, and the staff has been fully engaged, then some amazing results have been achieved. There is no reason why the extraordinary results from the two homes detailed above could not be repeated in all homes. The key is that our teams want to make it happen Hydrate for Health need to be involved to deliver training to our teams and they are very happy to do this, and the provide back-up support as needed The majority of people used the Sports Hydrant version of the product and it is now in daily use being clipped to walking frames, beds, beds, chairs and so on the key to use being that it hangs, hooks or clips onto things so that it is always close to hand. It is the ease of access that makes the difference to the users.
Examples of where the system has proved successful: Mr DM who had cellulitis in his leg and was receiving daily visits from the district nurses to change the dressings has now been discharged. Mr MC has a catheter which would block 2/3 times a week, now doesn t see the district nurses unless his catheter needs changing. He is much brighter in himself and walks much more upright. This gentleman never goes anywhere without his hydrant. Mr DN who was waiting to be assessed for a nursing placement, his well being has improved to stage where this assessment is no longer needed. One lady that used the larger hydrant has limited movement in her arms but she was able to be more independent using this. The lady did have a problem with the drinking tube so this was replaced with a long drinking straw which proved successful. Pre data and Post data results: Hydration Project Analysis The summary of this chart is that there was a 25% reduction of incidents after the Hydration project was completed. 250 200 150 100 50 0 Anti- Biotics Laxative s Falls Pressure Ulcers Hospital Admissi ons UTI's W/Cath eter UTI's W/O Catheter Chest Infectio ns Cellulitu s Pre-Data 48 69 71 6 11 10 14 10 5 236 Post-Data 15 63 57 5 8 4 14 9 3 178 Total
Conclusion: The hydrant has proven to be beneficial in the well being of its users, some of our service users need to be encouraged to use it but I feel that not all staff were pro active in promoting this system. Despite this the overall reduction in events across ALL homes that took part is 30%, which is a significant number. However, it is worth noting that in the two homes where the projects were fully supported by all staff and driven by the project champions the reductions in events were 73% and 78% which is nothing short of phenomenal. This delivers great benefits for our service users but also can be seen to drive significant cost savings and efficiencies in what we do by reducing the time needed to take extra care of people when ill, by reducing the need for drugs, by reducing doctor s visits and so on. It is very clear from the pre data and post data that the main benefits have been: Reduction in the use of antibiotics Reduction in the number of falls Reduction in the amount of urine infections when a catheter is in situ. Reduction in hospital admissions Reduction in cases of cellulitis The rest of the criteria saw a slight improvement, but would this increase if staff were more aware of the benefits of using the system. Feedback from visiting professional was that they really liked the system, some taking away information on it. Recommendations: Roll the Hydrant project out across all 32 homes, ensuring that all staff understand the amazing results that have already been achieved Monitor the results by measuring the same events in each home and amalgamate the results across the group For each home to be provided with a starter pack there would be a cost implication of around 8 per Hydrant one litre system and 3.50 per 500ML Sports hydrant after the initial set up. All staff to be aware of the benefits of being hydrated and attend Healthy Hydration training. Work with Hydrate for Health to develop a programme for our community teams as there is huge evidence of the need for better hydration among those living at home in a care situation. The Hydrant is already keeping many people at home for longer by preventing dehydration related issues in a care setting and it will work well through our community teams.
Appendix 1 Pre project Hydration Data Collection - Care Home 1 Residents Name MC DM TB BB RW KB GN B.B JS GM Totals Antibiotics 3 0 0 0 0 2 0 0 0 0 5 Laxatives 0 0 1 0 0 0 0 0 0 1 2 Falls 0 1 0 0 4 6 3 0 0 1 15 Pressure ulcers 0 0 0 0 0 0 0 0 0 0 0 Hospital admissions 0 1 0 0 0 1 0 0 0 0 2 UTI with Catheter 3 0 0 0 0 0 0 0 0 0 3 UTI without Catheter 0 0 0 0 0 2 0 0 0 0 2 Chest Infections 0 0 0 0 0 0 0 0 0 0 0 Cellulitus 0 3 1 0 0 0 0 0 0 0 4 TOTALS 6 5 2 0 4 11 3 0 0 2 33 Post project Hydration Data Collection - Care Home 1 Residents Name MC DM TB BB RW KB GN B.B JS GM Totals Antibiotics 0 0 0 0 0 1 0 0 0 0 1 Laxatives 0 0 0 0 0 0 0 0 0 1 1 Falls 0 0 0 0 0 2 1 0 0 0 3 Pressure ulcers 0 0 0 0 0 0 0 0 0 0 0 Hospital admissions 0 0 0 0 0 1 0 0 0 0 1 UTI with Catheter 0 0 0 0 0 0 0 0 0 0 0 UTI without Catheter 0 0 0 0 0 1 0 0 0 0 1 Chest Infections 0 0 0 0 0 0 0 0 0 0 0 Cellulitus 0 1 1 0 0 0 0 0 0 0 2 TOTALS 0 1 1 0 0 5 1 0 0 1 9 Care home 1 headline figures: 1: 73% reduction in total 'events' 2: 80% reduction in falls 3: 80% reduction in use of antibiotics 4: 80% reduction in urinary infections 5: 50% reduction in cellulitis 5: 50% reduction in hospital admissions
Appendix 2 Pre project Hydration Data Collection - Care Home 2 Residents Name GS BA RB KM JB ER MS AL IA KD Totals Antibiotics 1 1 1 2 4 2 1 12 Laxatives 0 Falls 2 2 9 2 15 Pressure ulcers 0 Hospital admissions 1 1 2 4 UTI with Catheter 1 1 UTI without Catheter 1 1 2 Chest Infections 1 1 Cellulitus 0 TOTALS 5 2 4 0 9 3 8 3 0 1 35 Post project Hydration Data Collection - Care Home 2 Residents Name GS BA RB KM JB ER MS AL IA KD Total Antibiotics 2 1 3 Laxatives 0 Falls 1 2 3 Pressure ulcers 0 Hospital admissions 1 1 UTI with Catheter 1 1 UTI without Catheter 0 Chest Infections 1 1 2 Cellulitus 0 TOTALS 4 1 3 0 0 0 0 0 0 2 10 Care home 2 headline figures: 1: 78% reduction in total 'events' 2: 80% reduction in falls 3: 75% reduction in use of antibiotics 4: 66% reduction in urinary infections 5: 75% reduction in hospital admissions