Summary of attainment The following table summarises the number of standards and criteria audited and the ratings they were awarded. Attainment Rating Continuous Improvement (CI) Fully Attained (FA) Partially Attained Negligible Risk (PA Negligible) Partially Attained Low Risk (PA Low) Partially Attained Moderate Risk (PA Moderate) Partially Attained High Risk (PA High) Partially Attained Critical Risk (PA Critical) Standards 2 42 0 1 0 0 0 Criteria 2 90 0 1 0 0 0 Attainment Rating Unattained Negligible Risk (UA Negligible) Unattained Low Risk (UA Low) Unattained Moderate Risk (UA Moderate) Unattained High Risk (UA High) Unattained Critical Risk (UA Critical) Standards 0 0 0 0 0 Criteria 0 0 0 0 0
polypharmacy project commenced in February 2016 with the aim of reducing falls and improving resident safety and quality of life. supervision), being able to walk further, independent with meals due to increased strength in hands. The ‘Move & Groove’ quality initiative has been successful in improving muscle strength and balance. 2) The registered nurses identified residents who were falls risk and on polypharmacy. A meeting was held with general practitioners (GPs) to discuss reviewing medications and reducing polypharmacy. The house GP responded positively and reviewed the 16 residents under their care who were on more than five medications. All 16 residents’ medications were reduced with positive outcomes as evidenced on the individual resident database. Falls were reduced for residents and residents became more alert and actively engaged in activities. One resident at hospital level on 11 medications reduced to six medications, now mobilising independently and to rest home level. The reduction of polypharmacy has been successful in reducing falls risk and improving the quality of life for residents. Data evidences a reduction of falls from 25 falls February 2016 to eight falls July 2016. New admissions with high falls risk saw an increase in falls to 17 in August 2016. The falls had reduced to nine in September 2016. The service has been successful in reducing falls through the ‘Move & Groove’ club and the polypharmacy project. Criterion 3.5.7 Results of surveillance, conclusions, and specific recommendations to assist in achieving infection reduction and prevention outcomes are acted upon, evaluated, and reported to relevant personnel and management in a timely manner. CI The service commenced a quality project in March 2015 to reduce chest infections and urinary tract infections (UTIs) to improve resident health and remain below the Arvida group average. The data for chest infections and UTIs for the period April 2015 to March 2016 evidences reduction of infections below the Arvida 1) The infection control coordinator identified trends and analysed monthly statistics for chest infections. Residents were leaving windows open during the winter for fresh air. The comfortable sleeping temperature is identified at 18 degrees Celsius. Staff were informed through meetings of the need to check windows were closed and the heating set at 18 degrees Celsius. An increase in chest infections in 2015 were identified due to staff being unwell on duty and a staff sickness policy was enforced. Staff were encouraged to receive the flu vaccine and on-site sessions were arranged at various times to suit staff rather than staff attending the GP surgery. This was