An innovative approach to caring for Swansea Bay nursing home residents who have had a fall is now helping to keep them out of hospital.
The Older Persons Assessment Service, OPAS, at Morriston Hospital has been making waves since it was launched in 2018.
Main photo above: the OPAS nursing team. L-r: Catherine Beynon-Howells; Patricia Quinn; Debra Clee; Aklima Bari; Danielle Treseder; Alice Pritchberg; Baljinder Sanghera; Nia Daniel.
Most recently it made headlines with an initiative called Cwtch, which reverses the traditional response to old people falling in nursing homes.
The standard advice is not to move them after the fall, and not to give them any food or drink until the ambulance arrives.
That view has changed. Leaving them where they fell for a prolonged period can actually cause serious physical problems, and could lead to them needing hospital admission when the fall itself might not have.
Cwtch encourages most fallen patients to be helped back on their feet and given a cuppa and bed rest while awaiting an emergency response.
The OPAS team offers same-day direct assessment for nursing home patients who fall with suspected injuries, bypassing the ED.
This extended service went live earlier this year and has already seen a reduction in the number of residents taken to Morriston by ambulance.
The small but dedicated OPAS team is receiving more recognition at home by being finalists for a UK-wide RCN nursing award. It is also helping to set up similar services in Bangladesh and Sweden.
OPAS is a multidisciplinary service established in 2018, made up of healthcare professionals specialising in the care of elderly people.
During its opening hours it can see older people who may otherwise have faced a long, sometimes very distressing wait in A&E.
Originally located within the Emergency Department, OPAS now works out of a dedicated hub – a first for Wales – established alongside it.
The hub has six spaces for patients as well as a therapy area. Patients can have tests carried out and be seen by a senior clinician. In many cases this avoids the need for hospital admission.
The service sees on average 40 new patients a week. Originally, they would only be referred to OPAS after being seen in the main ED, which referred them on when appropriate.
Now it can see patients directly referred from the ambulance service and from ED triage. This has reduced waiting times for older patients and has helped the flow of patients through the ED.
But its remit has extended beyond the hospital and into nursing homes, firstly in the Swansea area and, as of August, Neath and Port Talbot.
OPAS emergency nurse practitioner Debra Clee developed Cwtch, a nursing home education programme that went live in Swansea earlier this year.
While there are circumstances when patients should not be moved, even then they can be given food, drink and painkillers.
However, many of them can be helped up, given a cup of tea and put to bed with some paracetamol.
This can be more comfortable while awaiting assessment by emergency or community services. Sometimes when there is no suspected injury they can be on their feet again very quickly.
If necessary, a GP can be called to see them or they can be referred to the virtual wards or other community services.
Cwtch is an acronym of the five main principles underpinning the education programme:
Can you move them?
Will it harm them (any new neck or back pain)?
Treat (wounds/pain relief).
Cup of tea (in most cases they can eat or drink).
Help (when to call).
“From the data, we are seeing no reduction in calls to the ambulance service for elderly fallers,” said Debra, who joined OPAS last December after 20 years as an A&E nurse.
“But we are seeing a reduction in the number being brought into the hospital.
“This indicates alternative pathways are being used to give patients the care they need in a timely fashion, in the community and at OPAS.
“Having patients referred directly from ED, the ambulance service, nursing homes and urgent primary care has reduced waiting times and has helped the flow of patients through the ED.
“Hopefully as confidence grows, calls to the ambulance service will reduce. All care homes have direct access to refer into OPAS if they have concerns of any injury or reoccurring falls.”
Cwtch has been paired with an initiative in partnership with the Welsh ambulance service and the Acute GP Unit (AGPU) at Morriston.
This involves taking patients from advanced clinical practitioner paramedics who are actively monitoring ambulance referrals and signposting patients to alternate pathways via AGPU.
This collaborative approach has shown the average reduction of 20 patients a month taken to ED by ambulance.
In addition, OPAS sees an average of eight patients a month directly, bypassing the ambulance service entirely, following the success of Cwtch.
Meanwhile, having been such a success in Swansea, Cwtch is now being extended into Neath and Port Talbot nursing homes.
Debra added: “We are also looking at the possibility of rolling out to residential homes, trialling first responders attending to assess injuries.”
She admitted to being overwhelmed by the reaction to Cwtch around the UK after it was introduced, initially in Swansea, earlier this year.
Not only did it gather extensive media coverage but it has also featured in four national journals.
Even before that, just five weeks after it launched, Cwtch picked up Best Presentation Award from the British Geriatric Society for Wales.
The presentation was made by Dr Alexandra Burgess, a senior research fellow undertaking an MD while working in the team.
Dr Burgess made a platform presentation on the work of OPAS at the European Geriatric Society Conference in London last month.
And the plaudits continue. Last year OPAS service was a finalist in the Advanced Practice category of the RCN Nursing Awards. Now it has made the finals again, this time for the 2022 Team of the Year.
The winners will be announced at a glittering awards ceremony in London’s Park Plaza Westminster Bridge Hotel this month.
OPAS advanced nurse practitioner Catherine Beynon-Howells said “It’s a small team here but they work incredibly hard and I think they deserve this recognition.
“Having the hub means patients have a better experience. It’s better for them all-round.
“The feedback has been very good. Patients like the environment and like being seen by the whole team. They get a thorough, holistic assessment.
“We are very proud to have been shortlisted for the Team of the Year Award. It’s fantastic. There were more than 500 entries so to be one of the five finalists in our category is really great.”
Consultant geriatrician Liz Davies (right) said OPAS had always enjoyed good relationships with its community and secondary care partners, which was vital to the success of the service.
“The Acute GP Unit moving to Morriston last year allowed closer links between our services and has been key to the success of this initial work but will be sure to yield further innovations in the future,” said Dr Davies, who was instrumental in establishing OPAS.
“It is remarkable for the OPAS team to have been recognised by the national RCN Awards on two consecutive years. I am always very proud of the team and happy to be part of all that we do.”
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