CQC: Care homes and NHS fail to communicate on infection

Dangerous infections are not being adequately controlled because care homes and hospitals are failing to communicate when patients pass between care settings, a Care Quality Commission study has revealed.

Yesterday’s report, Working Together to Prevent and Control Infections, found there were particular problems when patients were discharged to a care home from hospital.

However, it also found that many care homes had not implemented 2006 guidance on infection prevention and control.

New requirements to share information

The report comes ahead of the implementation of requirements under the Health and Social Care Act 2008 for care homes and hospitals to have plans in place to communicate information on infections.

Of more than 1,000 care homes that responded to a survey for the report, 17% said they received no information when patients were discharged into their care from hospital, while 28% raised concerns about the quality of information shared, including that it was illegible.

And while 42% of care homes used written care plans to convey information to hospitals when patients were transferred, just 28% of homes received information in this way from hospitals on discharge, with 61% receiving information verbally.

This was despite standard NHS contracts specifying that hospitals should provide information on infections as part of a written discharge summary, though they are only required to pass this on to GPs, not care homes.

Overwork and confidentiality confusion

The report highlighted overworked hospital staff and confusion about what can be shared under data protection or confidentiality law as the primary causes of hospitals’ failure to communicate information.

The report said current Department of Health guidance states that information cannot be shared by clinicians with a third party without the patient’s informed consent.

However it warned that this may be difficult to obtain in some circumstances, and that attempts to protect individuals’ rights could put themselves and others at risk of infection.

Infection prevention in care homes

The report found infection prevention in care homes was inadequate with many failing to follow two guidance documents published by the DH in 2006: Essential Steps, which provides practical advice on infection control, and Infection control guidance for care homes.

The report found 28% of homes were not implementing Essential Steps and 12% were not aware of it at all, while 17% had not read Infection control guidance for care homes and 8% were not aware of it.

In August, the DH launched a consultation on revising the infection control guidance for care homes, as part of a wider consultation on a new code of practice for health and social care providers on infection prevention and control, under the Health and Social Care Act 2008.

The draft code lays out how providers should comply with registration requirements on infection management which will come into force for NHS providers in April 2010 and adult care providers in October 2010. Under these, care homes and hospitals will have to:-

  • Have a policy on information sharing when admitting, transferring, discharging and moving service users within and between health and social care settings. 
  • Provide sufficient and suitable information on infection whenever a person moves from one setting to another.
  • Ensure agencies, such as ambulance trusts, are involved in joint plans where necessary.

Among its recommendations, the CQC said it would develop clear policy on how the code of practice and regulatory requirements will be applied to care homes, and work with the DH to produce definitive guidance on information sharing between the NHS and care homes.

Warning to providers

However, CQC chief executive Cynthia Bower warned that it would impose regulatory requirements on organisations that failed to comply:  “Care homes and hospitals should make sure they have good arrangements for joint working to ensure they are providing high quality, safe care. If we find that providers of care are not coming up to standard in this area we will take action.”

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