Impact case study database

Hydration is a fundamental care need. If neglected, it can lead to numerous adverse health outcomes including urinary tract infections (UTI) and Escherichia coli (E. coli) bloodstream infections, especially in the elderly. These infections have become more prevalent in recent years and are associated with a high morbidity and mortality; reducing their incidence has become an NHS priority.

The I-Hydrate resources have given public health teams, NHS trusts and social care providers a series of simple solutions to help address these issues amongst elderly people. The resources have been used to improve hydration practices and increase staff knowledge and awareness, leading to greater fluid intake by patients, care home residents and service users. Additionally, a commercial provider of digital health products is incorporating the I-Hydrate resources into an app for social care staff. In some instances, as noted below, organisations have paused wider implementation under the pressures of the COVID-19 pandemic but have said they intend to re-start when the situation changes.

In May 2019, I-Hydrate was featured in the Universities UK’s MadeAtUni campaign, the Lifesavers – 100+ ways universities are saving lives and keeping us healthy. [S1]

The I-Hydrate resource pack has four sections: hydration and the care home environment; improving practice and the Plan-Do-Study-Act cycle; strategies to improve hydration; training your staff. There are also five videos to support use of these resources. [see R5]

The University’s data analytics showed that between September 2018 and December 2020 there were 567 unique downloads of the resource pack and over 11,500 unique page views. The “introduction to hydration” video was played over 550 times, and the hydration care and audit sheet appendices were each downloaded almost 500 times. [S2]

Feedback survey forms were sent by the research team to users who downloaded the pack and left contact details. A total of 14 forms were returned by December 2020, and feedback on the pack included the comments from two users as below:

As the nutritionist I have created and delivered hydration training to all our staff. I have also updated and introduced a 35-page hydration policy which is bespoke to our setting and from this there is monitoring and evaluation tasks for me to complete to monitor our hydration procedures and make changes where required. I also have a designated board which is currently on the topic of hydration. Generally, more awareness for both staff and residents.

This was a great resource for care homes, was easy to follow and resources could be implemented easily by managers at homes. I particularly liked the resources that focused staff on personal reflection about hydration to then put it into context of how this impacts on residents.

A full set of the responses received are included with the sources of evidence for this impact case. [S3]

The I-Hydrate’ project video was one of the six resources to improve hydration in care homes featured on the NHS England webpage on “Reducing Gram-negative bloodstream infections – hydration”. [S4]

In 2019, Public Health Wales (PHW) commissioned a national training programme from the I-Hydrate project team after learning about the research at the annual Healthcare Infection Society conference. The training programme was targeted at care home staff and community teams across Wales and aimed to improve resident hydration using the tools and methods in the I-Hydrate resource pack, thereby reducing urinary tract and E. coli bloodstream infections.

A “train the trainer” programme was delivered by Wilson and Loveday for PHW in February and March 2020 with a total of 112 residential and care home staff attending. PHW have reported that:

The programme was highly evaluated on both days training, and improvement plans including use of I-Hydrate and other methodologies were in the process of being developed by a number of the care homes and improvement teams; however, the COVID-19 pandemic has created considerable challenges in the social care sector and we have been unable to move this forward at the pace we had anticipated.

The I-Hydrate project is also featured on the PHW UTI webpage as the listed resource pack for Hydration. [S5]

The I-Hydrate research and resource pack has been used to underpin initiatives to improve hydration and prevent UTI in both acute healthcare and long-term care settings.

In Hertfordshire in 2019, the I-Hydrate team supported a 90-day quality initiative improvement project co-ordinated by the Clinical Commissioning Group (CCG) to reduce UTI across seven acute and community organisations. Project leads from each of the seven organisations worked with an I-Hydrate researcher to identify how they could use the I-Hydrate tools to improve the hydration of their patients or clients.

In the East and North Hertfordshire NHS Trust, the improvement project focused on two elderly care wards where it highlighted the poor fluid intake among patients. Initiatives introduced included protected drinks time, assessment of patient’s needs to support drinking and increased focus on staff supporting patients to drink. These initiatives 1) increased the overall amount of fluids drunk, and the number of patients drinking at least 1500ml a day; 2) led to changed staff practices to provide more support for drinking; and 3) increased staff awareness of the problem.

In West Hertfordshire Hospitals NHS Trust the improvement project was focused on wards for patients waiting for transfer of care. The outcomes reported were that 1) the amount of fluid consumed increased by an average of 400ml per patient each shift; 2) staff awareness of the importance of hydration improved; and 3) overall patient satisfaction increased.

Infection Prevention and Control lead staff for both organisations have reported that although roll-out of these strategies was interrupted by the pandemic, they plan to proceed once activity returns to normal. [S6]

Similar strategies were implemented in a care unit in the mental health trust and two care homes. An independent living service for people with dementia used the drinks menu to extend choice and changed their mugs so that they were larger and easier to hold. These changes led to a 35% increase in the amount of fluid drunk by the service users. [S7]

The Infection Prevention and Control (IPC) Team for Kirklees and Wakefield Councils used the I-Hydrate resource pack as the principal tool in a Hydration Champions initiative that began in 2019 and engaged all their care home and domiciliary care providers. Following a launch, Hydration Champions were given a hard copy of the I-Hydrate resource pack to take back to their place of work. The resources were used to identify problems with how residents were hydrated, and design solutions which were implemented over a 6-month period using quality improvement methods. Solutions adopted included increased choice of drinks, regular blind tasting sessions to find new favourites and larger drinking vessels. One care home reported a reduction in residents treated by their GP for a UTI in the summer months from 12 in 2018 to 2 in 2019. The lead IPC staff for the initiative reported that the learning from the Hydration Champion project has resulted in changes in practice in the participating areas, which has been shared across Kirklees and Wakefield. [S8]

While many residential care settings have limited access to technology, the use of app-based tools is increasing. I-Hydrate is being developed for that market by Elaros 24/7 Ltd, a Sheffield-based company with a portfolio of digital health products focused on the needs of older people. Working with the UWL research team, Elaros have digitised the I-Hydrate tools to integrate them into one of their existing hydration monitoring applications. The company CEO has written to say:

We identified these resources would enhance the value of our digital solution to fluid monitoring in care homes (Hydr8) as it would provide care staff with information about the problems associated with dehydration and simple strategies to overcome poor fluid intakes in residents identified by the monitoring system. We have therefore developed the I-Hydrate resources into a digital solution which will make them more accessible to staff in care homes than the document format.

The CEO further reported that although the timeframe of the development programme had been affected by the COVID-19 pandemic, they were confident that the digital solution will be a valuable product that can be sold across the care home sector and used to support better hydration for care home residents, improving their quality of life and standard of care. [S9]