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Br J Community Nurs. 2019 Feb 2;24(2):58-66. doi: 10.12968/bjcn.2019.24.2.58.

Managing deterioration in older adults in care homes: a quality improvement project to introduce an early warning tool.

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Specialist Nurse for Older People, North East London NHS Trust.
Associate Director of Nursing, North East London NHS Trust.
Reader in Older People's Healthcare, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London.


Many older adults living in care homes have complex health needs requiring comprehensive care. Early warning tools can help identify deterioration, but currently they are less often used in care homes. The aim of this quality improvement project was to introduce an early warning tool, the Significant 7, to facilitate identification and management of deterioration in care home residents. The plan, do, study, act (PDSA) method was used, and process mapping informed a tailored intervention. Introducing the tool had positive outcomes for residents and care staff. There was a reduction in the incidence of pressure ulcers and falls, and care staff were more confident in recognising resident deterioration. Next steps include scaling up the project to further examine how this early warning tool can improve resident, staff and organisational outcomes, in order to explore the potential use of the tool by community nurses with older people living at home.


Care homes; Deterioration; Early warning tool; Older adults; Quality improvement


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