Treat the person, not the diagnosis – how digital tech is helping improve residential care

Cheryl Baird, group director of quality at Orchard Care Homes, firmly believes that residents in a care home can lead happy and fulfilling lives. “Just because you walk into a care room doesn’t mean your life’s over,” she says. While many people see care homes as places where residents sit around waiting for a cup of tea, Orchard, she adds, is “determined that that is not going to be the experience of people living in our care homes.”

One of the ways in which Orchard is improving care for its residents is through intelligent use of technology. The company, which runs 23 care homes in England with 1,200 residents, has approached digitisation not just as a means to improve efficiency and eliminate paper-based processes, but to offer better quality of life and outcomes for its residents.

The organisation is now “fully digital,” with digital care records, electronic medication and administration recording (eMAR), digital audit and feedback and, most innovatively, Pain Check – artificial intelligence software that monitors patients’ pain levels. The software used by clinical staff (medication charts, care plans, pain assessment and audit) is all held on a single device to make it easier to use.

Reducing medication use

The provider’s major achievement has been to use data analytics to make changes that have radically improved residents’ experiences. Both eMAR and Person Centred Software, the electronic patient record, have made it easier to record and access information. But they also provide a rich source of data about patients, says Cheryl: “I can see who’s had their medication, who hasn’t had their medication, how much medication people have had and what type of medication they’re taking.”

Having that information provided an opportunity to review the medicines residents were taking. “We were really keen to reduce polypharmacy. Older people are just prescribed so many medications,” Cheryl says.

Cheryl gives the example of a patient who kept being prescribed pain relief medication, which was ineffective in controlling their pain. “We were able to show all the data from their medication charts, their care plans, their pain scores to say, ‘This isn’t working, let’s look at it again and really scale back.’ This person’s on one patch now, as opposed to a ton of medications every day, so they [GPs] are starting to use the information that we’re giving them.” The consequence is that in the space of a year, Orchard reduced required medications by 48%.

One of the particular challenges of dementia care, says Cheryl, is that residents are often prescribed antipsychotics because it’s assumed that aggressive or disturbing behaviour is the consequence of their dementia. In practice, that isn’t always the case: “We’ve spent a year researching and developing ways to reduce antipsychotic use and look at the person rather than the diagnosis.” Rather than give a patient antipsychotics in response to certain types of behaviour, the solution is to find out the cause of the behaviour and to support them. Antipsychotic use across the whole organisation has reduced by 6% in a year.

Some GPs, she says, have been resistant to change, but those who have seen the positive outcomes are coming round: “We are getting more GPs and multidisciplinary team members working with us and understanding what we’re trying to do. It can be a bit of a battle, but we’re plodding on, and some have really embraced it and asked for various bits of data every months before they come out.”

Reducing falls

Orchard can now see data about which patients have fallen, and when. “We are able to correlate between whether that is because they haven’t had enough to drink, or because they’ve been put on new medication and haven’t been monitored,” Cheryl notes. “From a residents’ outcome perspective, we’re able to use that data to really drill down and look at why things are happening and then proactively to learn from those and put measures in place. If somebody’s mobility is starting to decrease a little bit and they’re not drinking so much and not eating so much, we can see that quite quickly, and step in to prevent falls and pressure ulcers.”

This approach has led to a 16% reduction in the number of falls, a 17% decrease in weight loss and a 50% reduction in pressure ulcers over the course of a year.

One of the most exciting innovations has been the adoption of the AI-based Pain Check software, which uses a camera to observe facial movements that can show if a person is in pain. In the past, patients who behaved aggressively were often prescribed psychotropic medication to calm them down. Once Orchard began using Pain Check in a specialist dementia care home, staff realised that aggressive behaviour was often a response to pain. The solution was to prescribe them pain relief – and, within a “couple of months,” says Cheryl, alerts to the safeguarding team had dropped by 93%. Now, she says, those residents “are not distressed, they are not angry, and they are able to have their pain managed. If you manage their pain, they can interact, they can take part in engagement, and occupational activities. It’s had a huge impact on those people.”

Pain Check is also used if a resident falls over, says Cheryl: “Some older people are really stoic – they can fracture and not tell you.” The app enables staff to determine if the resident needs extra support or medical attention.

Making homes happier

Falls provide a major challenge for care homes, because they can lead to fractures, hospitalisation and sometimes death. Orchard’s care homes already use mats fitted with sensors that can alert staff if a patient has fallen, but it’s better to prevent the patient falling in the first place. This requires more investment in strength and balance training, says Cheryl, but technology can also help.

Currently the provider is trialling the Vitalerter – a device that, when placed on a resident’s bed, is able to identify the point at which they are waking up by monitoring their body temperature and heart rate. “If you’ve got somebody at very high risk of falls, the minute they get up, this allows us to get to them before they’ve woken,” says Cheryl.  Orchard is also working with the provider of its handheld devices to provide prompts to carry out certain checks when a resident has fallen. These include measuring blood pressure and carrying out a pain assessment at regular intervals until the signs show that the person has recovered from the fall.

Digitisation has made Orchard much more efficient, so that staff aren’t spending hours filling out paper forms and making photocopies to give to the regulator. The use of data analytics to slash medication use and reduce falls has saved money, not just for itself, but for GP practices and integrated care boards. Most importantly, Cheryl says, digitisation has enabled Orchard to improve the quality of life for residents: “What matters to people is being socially engaged and living in a fulfilled life – and we’re really far down the road of making sure that happens.”