Conveyance Monitoring Form

Backgroundinformation and instructions for use

Background information

As part of the work between Sutton and Merton Community Services and Care Homes to improve joint working, we have developed this monitoring form to capture a snapshot of what is going on for the resident prior to conveyance, who prompted the call (clinical, family or home led decision) and what outcome was achieved. The measure of improved joint working is a reduction in ambulance conveyances from care homes and so we need to have an independent measure of this to compare with London Ambulance Service (LAS) data to ensure it is correctly capturing information.

There were several reasons for this:

  1. Within the London Ambulance Service data there are several codes which do not accurately reflect the cause of the call (Health Care Professional Admission Protocol, Unknown and Sick person) and so this information capture will allow us to get underneath this data.
  2. CQC and the CCG value this information as an indicator of good practice.
  3. Many of the current conveyances are necessary and so we need a way to demonstrate this to commissioners.
  4. The form provides a section for practice and joint working reflection to identify any learning going forward.

Instructions for use

The form should be used on any occasion 999 has been used.

Following the incident - at a staff debrief or meeting, the form can be used to capture information such as:

  • Was there any clinical decision involved in the conveyance?
  • Why was the person conveyed or not?
  • Were they admitted and for how long?

On the 1st of the month, please send scanned copies of the form to so that the information can be collated and analysed.

Thank you!

CARE HOME - CONVEYANCE MONITORING FORM

Home Name: / CMF No:
Date of Call: / Time of Call:
  1. Reason for 999 call: ______
  • How was this managed in the home, before and during the call:
  • Was there any Clinical or SMCS (Community Nursing, CPAT, EOLT) input to care and/or decision making:
  1. Was the person conveyed to A&E:
  • If yes, please give reason for conveyance:

Was the resident admitted: YES/NO

If no, why not______

If yes, how long did they stay in hospital: ______

  • If not conveyed, please give reason:

What follow up was done:

  • Opportunities for Improvement

Working with Community and Prevention of Admission Services:

After review of this transfer/non-transfer has your team identified any opportunities for improvement:

Was there anything that may have prevented this transfer to hospital?

Completed by: Signature: Date: