“It has been a great joy to see a drop in UTIs, residents looking alert and not sleepy and constipation prevented. Lots and lots of benefits/positivity.”
Care Home Manager

KSS Hydrate logoOverview

KSS AHSN’s Hydrate in Care Homes project aimed to reduce admissions to hospital for falls, urinary tract infections (UTIs) and Fracture Neck of Femurs (#NOF) resulting from a fall and reduce incidences of falls and UTIs in care homes. This was achieved by improving hydration awareness and practices among care home staff. A key element of the project was the empowerment of care home staff who took on the role of “Hydration Champions”: 206 care home staff were trained to become hydrate champions.

KSS AHSN worked in partnership with 89 care homes impacting on 3,100 residents across five CCG localities – Coastal West Sussex, Thanet, Horsham & Mid Sussex, Crawley, and Guildford & Waverley.

An economic evaluation has been undertaken demonstrating that over the course of the five month implementation period, the project has made a reduction of £202,531 in hospital admission costs, with 564 potential bed days saved.  There have been significant reductions in admissions associated with #NOF in three localities; two localities showed reductions in hospital admissions associated with a fall.

The project has attracted interest from other CCGs. A tool kit is being developed to support them to implement Hydrate in Care Homes.

hydrate amended case study

Challenge/problem identified

Care Home residents are often among the most frail and vulnerable in society. They are at risk of dehydration due to a combination of age related changes, reliance on others to support them to drink and behavioural and cognitive factors such as the presence of dementia.

“Good hydration is a core element of care and plays a role in the prevention of avoidable harm associated with other known patient safety issues” Caroline Lecko, NHS England Patient Safety Lead 2013

In January 2015 a paper in the Journal of  Royal Society of Medicine by Wolff, Stuckler and McKee reported on the incidence of dehydration in acute medical admissions among patients aged 65 and above. The findings showed that patients admitted from care homes were five times more likely to be dehydrated (after adjustments for various factors) than those admitted from their own homes.

Actions taken

KSS Hydrate Bottle and Champion BadgeHydrate in Care Homes was developed from an initial project in North East Hampshire & Farnham CCG. KSS AHSN supported the project with funding, clinical expertise, project manager and improvement practitioner resources.

The project ran as a pilot for six months within 89 care homes (both residential and nursing) across five CCG localities. Improvement Practitioners supported the homes by delivering training sessions to the Hydrate Champions, assisting in the development of action plans and hydration policies They supported the homes in collecting both base line data and data during the duration of the pilot on number of falls and UTIs.

An additional aim of the project was to undertake evaluation of a dehydration risk assessment tool and care plan summary, Reliance on a Carer to drink, (ROC) developed by Naomi Campbell, RGN.

Impacts / outcomes

Key Outcomes

  • Collaboration of 5 CCGs Guildford & Waverley, Thanet, Coastal West Sussex and Horsham & Mid Sussex, and Crawley, 2 County Councils, (Kent and West Sussex, Sussex), Kent and Surrey Community Trust staff, and Kent Surrey Sussex AHSN
  • 89 care homes completed the project with 3100 residents involved.
  • 206 hydration champions trained
  • £202,531 reduction in admission costs
  • 564 potential bed days saved
  • Nursing homes greater admission reductions than residential homes
  • Reduction in #NOF admissions most significant outcome
  • 100% of hydration policies developed or updated
  • 100% of managers recommend participation in the project to others
  • 100% of champions enjoyed their role
  • 96% of managers felt the project had changed long term practice in their home
  • 72% of residents felt they were drinking more than in the previous 3-6 months (reflecting length of the project)
  • Homes that implemented the ROC dehydration risk assessment tool and care plan summary had significantly greater reductions in UTI admissions than those who did not
  • 100% would opt to continue to use the ROC tool and care plan summary after the end of the project.

KSS Hydrate 2 (002)

“Changes did not need to be expensive or create another job for someone in the home. Where the right changes were implemented with support from management, changes slipped seamlessly into everyday life in the home and began to filter into the existing culture.”
Improvement Practitioner

Plans for the future

  • We are producing a toolkit based on the resources developed for the project which will be available for commissioning groups, community teams and others to facilitate the development of other hydration initiatives primarily for care home residents. There has already been interest from a number of CCGs and county councils in Southern England
  • Recommendation for provision of refresher and top-up training which could be delivered as part of existing care home forum meetings
  • We are looking to publish in a number of Care Home Journals.

Which national clinical or policy priorities does this address?

  • Care and Quality
  • Funding and Efficiency
  • Health and Well Being

Start and end dates

April 2016 – October 2016

Contact us for help and advice

Frances Scott, Programme Manager, Kent, Surrey and Sussex AHSN
E: frances.scott@nhs.net

Rick Fell, Comms Lead, Kent, Surrey and Sussex AHSN
E: rickfell@nhs.net