The population of older people is rapidly growing and many are not living in good health; this escalating problem has significant economic and resource implications but more importantly impacts on individual quality of life in later years. In recognition of this 'perfect storm' the importance of embedding prevention strategies and health promotion interventions specific to older people is widely recognised. One approach to tackling this, Making Every Contact Count (MECC), empowers staff to initiate opportunistic conversations with people who report 'risky' health behaviours, supporting the first positive steps towards health behaviour change and self-management.
This quality improvement project was initiated following a record keeping audit which identified that healthy lifestyle conversations were recorded in only 19% of clinical records. It aimed to increase the number of documented healthy lifestyle conversations that clinicians have with Integrated Community Team patients.
To understand the low audit result 31 staff were surveyed and asked if they were having healthy lifestyle conversations with their patients and if not why. For those that were, having these conversations, the survey also explored use of the electronic record.
The survey showed that 45% of staff were not having healthy lifestyle conversations with patients with three main reasons: lack of knowledge, lack of confidence and perceived barriers.
From this information a project plan was developed which included:
- Co-design of training materials with patients
- Delivery of MECC Plus (adapted for the services older population) training to staff
- Staff involvement in the design of new record keeping tools
- 'MECC Plus' as a standard agenda item at team meetings
24 staff attended 'MECC Plus' training and also contributed into the design/content of a new electronic tool to capture healthy lifestyle conversations. Evaluation of this intervention is as follows:
• Attendees all reported finding the MECC training relevant and confidence that it was applicable to practice.
• 83% of staff had positively altered their practice when surveyed 2 months post training.
• Case studies demonstrate some significant changes in practice.
• The new electronic template, 1 month post launch, is not being used.
Cost and savings
No direct costs though time was invested in; engaging with staff and patient, releasing staff for training, electronic record adaptations and investing in culture change.
'MECC Plus' training, adapted for a multidisciplinary community team, increased the staff reported number of healthy lifestyle conversations with older people. Training alongside regular discussion at team meetings initiated a culture shift; embedding an ethos of health promotion and self-management.
Further work is required to address issues with the electronic record so that the reported increase in healthy lifestyle conversations can be captured at annual audit. Staff feedback indicates healthy lifestyle documentation needs to be within the assessment, rather than as a separate template.
For practice: Provision of 'MECC Plus' training, specifically tailored to older people, alongside supportive resources should be considered in other trusts and wider settings.
For management: All staff working in community settings with predominantly older people should be 'MECC Plus' trained.
For education: Health promotion interventions specific to older people should be included in undergraduate training. Research is needed to establish the impact that 'MECC Plus' may have on health outcomes for older people.
Top three learning points
The work was unfunded but supported by
Health Education England and Kings College London as part of the Older Persons Fellowship
This work was presented at Physiotherapy UK 2018.
For further information about this work contact Charlotte Tucker.