E2 Rapid Fire: The Challenges of Providing the Best Care for Seniors - C. Estabrooks

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E2 Rapid Fire: The Challenges of Providing the Best Care for Seniors - C. Estabrooks

  1. 1. Safer Care for Older Persons(in residential) Environments--Lessons learned from a 12-month quality improvement project
  2. 2. Funding Health Santé Canada CanadaSafer Care for Older Persons (in residential) Environments
  3. 3. Outline • Overview of SCOPE • Methods • Results • Impact of interventionSafer Care for Older Persons (in residential) Environments
  4. 4. Objectives1. To improve the safety and quality of care to frail elderly residents living in nursing homes2. To improve the quality of work life for frontline caregivers in nursing homes Safer Care for Older Persons (in residential) Environments
  5. 5. Who participated? • 7 Nursing Homes, 2 large in Alberta (Calgary and Edmonton) , 5 small in the Okanagan • 10 units/10 teams in these 7 NHsSafer Care for Older Persons (in residential) Environments
  6. 6. Quality Improvement Team 2-3 HCAs, 1-2 registered professionals HCA RN Team Leader HCA Senior Sponsor HCA RPTLegend: HCA: Healthcare Aide; RN, registered nurse, and RPT, registered physiotherapist, represent the registered professional.Safer Care for Older Persons (in residential) Environments
  7. 7. Design Two year proof-of-principle pilot with parallel research and QI intervention arms 12- MONTH L EARNING C OLLABORATIVE QI Timeline 0 Months 6 Months 12 Months 18 Months 24 Months Research Project Timeline• Team Hiring Dissemination• Ethics Approval• Recruitment TIME 1 SURVEY TIME 2 SURVEY Safer Care for Older Persons (in residential) Environments
  8. 8. SCOPE Learning Collaborative Model Adapted from the IHI Breakthrough Series Collaborative Model Hiring of SCOPE Team Selection of Areas of Focus Tools/Resource Development by Clinical & QI Experts AP 1 AP 2 AP3 LS1 LS 2 LS3 LC Recruitment: 7 sites AB & BC COACHING & CHANGE MANAGEMENT SUPPORTS Emails Site Visits Phone Calls Conference Calls Assessments Senior Leader Reports Team ReportsQuality Improvement Tools: Experts, Tools, Learning Sessions (LS), Action Periods (AP), Plan-Do-Study-Act (PDSA) Cycles, Coaching & Change Management Support Safer Care for Older Persons (in residential) Environments
  9. 9. Selection of Focus Areas 3-step collaborative approach STEP 1: STEP 2: STEP 3: Input from Input from QI Team gerontology stakeholder Discussion, experts groups with SupportPreliminary Modified 1 Care List of The Top 5 List of AreaCare Areas Care Areas Care Areas Chosen by each team Safer Care for Older Persons (in residential) Environments
  10. 10. Three Focus Areas • Pain • Behaviour • SkinSafer Care for Older Persons (in residential) Environments
  11. 11. Model for Improvement by the Associates in Process ImprovementQI teams received training in QI techniques and changestrategies using the Model for Improvement. The modelconsists of a set of 3 questions and the PDSA Cycle. What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result In improvement? Safer Care for Older Persons (in residential) Environments
  12. 12. Coaching & Change Management Support to QI Teams COACHING & CHANGE MANAGEMENT SUPPORT SCOPE STAFF, QI QI EXPERTS TEAM Weekly QI Team Coaching AND CLINICAL E-mails EXPERTS Online Access to team data Monthly Feedback Reports Change PackagesSafer Care for Older Persons (in residential) Environments
  13. 13. QI Techniques Tested by HCA’s Care Area Sample QI Technique PilotedSkin Care Turning schedules for at-risk residentsPain Management Education on screening toolsBehaviour Isolating residents with behaviouralManagement issues at meals Safer Care for Older Persons (in residential) Environments
  14. 14. Site A: Completion of Resident TurningSafer Care for Older Persons (in residential) Environments
  15. 15. Results – Process Data Leadership Engagement• Teams placed greater value on manager support than administrator support• Successful teams had strong leadership engagement and support Safer Care for Older Persons (in residential) Environments
  16. 16. Results – Process Data Team Communication Team success was higher with more frequent team huddles and regular participation in telephone callsSafer Care for Older Persons (in residential) Environments
  17. 17. Results – Process Data Barriers• Time constraints• Flu outbreaks• Manager or staff turnover, staff working different shifts• Structural/regional issues• Lack of buy-in Safer Care for Older Persons (in residential) Environments

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