Implementation of RESTORE2 in Care Homes in England: A Mixed-Methods Evaluation

Context: Older adults are more susceptible to acute deterioration. Delayed recognition or response is linked to poor health outcomes and adverse events. Identification and management of deterioration is more difficult in this population due to increasingly complex healthcare needs and limited/no healthcare knowledge of some staff. Enhancing ability of care home staff to recognise and communicate concerns could reduce avoidable harm for residents at risk of or experiencing physical deterioration. Objective: To evaluate the implementation of RESTORE2, a physical deterioration and escalation tool, in care homes. Methods: A mixed-methods approach, comprising individual semi-structured interviews and online survey, was used. A total of 35 care home staff from 34 care homes took part in this evaluation. Findings: Implementation of the full RESTORE2 tool was low. Several challenges that impeded successful implementation including complexity, uncertainty over carers’ role in carrying out clinical observations, inadequate training and buy-in from health-service providers, need to be addressed. Nevertheless, some benefits including improved staff knowledge/confidence to identify deterioration, escalate and communicate concerns, as well as potential to reduce unnecessary healthcare utilisation particularly 999 calls and hospital admissions were reported. Limitations: This study was limited by the small sample size of the quantitative phase. The Covid-19 pandemic affected recruitment and engagement with care homes. Implications: RESTORE2 has a long way to go to become a common language in social care. Collaboration between health professionals and care staff is important for RESTORE2 to become embedded into practice. Further quantitative and qualitative research is required to strengthen the evidence base.