e2 rapid fire: the challenges of providing the best care for seniors - c. estabrooks

Safer Care for Older Persons

(in residential) Environments--Lessons learned from a 12-month quality improvement project

Safer Care for Older Persons (in residential) Environments

Funding

Health Santé

Canada Canada

Safer Care for Older Persons (in residential) Environments

Outline

• Overview of SCOPE

• Methods

• Results

• Impact of intervention

Safer Care for Older Persons (in residential) Environments

Objectives

1. To improve the safety and quality of care to frail elderly residents living in nursing homes

2. To improve the quality of work life for frontline caregivers in nursing homes

Safer Care for Older Persons (in residential) Environments

Who participated?

• 7 Nursing Homes, 2 large in Alberta (Calgary and Edmonton) , 5 small in the Okanagan

• 10 units/10 teams in these 7 NHs

Safer Care for Older Persons (in residential) Environments

Quality Improvement Team2-3 HCAs, 1-2 registered professionals

Senior Sponsor

Team Leader

HCA

HCA

HCA

RN

RPT

Legend: HCA: Healthcare Aide; RN, registered nurse, and RPT, registered physiotherapist, represent the registered professional.

Safer Care for Older Persons (in residential) Environments

Design

Two year proof-of-principle pilot with

parallel research and QI intervention arms

0 Months 6 Months 12 Months 18 Months 24 Months

QI Timeline

Research Project Timeline

• Team Hiring • Ethics Approval• Recruitment

Dissemination

12-MONTH LEARNING COLLABORATIVE

TIME 2 SURVEYTIME 1 SURVEY

Safer Care for Older Persons (in residential) Environments

SCOPE Learning Collaborative Model

COACHING & CHANGE MANAGEMENT SUPPORTSE m a i l s S i t e V i s i t s P h o n e C a l l s C o n f e r e n c e C a l l s A s s e s s m e n t s S e n i o r L e a d e r R e p o r t s T e a m R e p o r t s

Adapted from the IHI Breakthrough Series Collaborative Model

Hiring of SCOPE Team

Recruitment:7 sites AB & BC

AP 1 AP 2 AP3

Selection of Areas of Focus

Tools/Resource Development by Clinical & QI Experts

LS 2LS1 LS3 LC

Quality 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

Selection of Focus Areas3-step collaborative approach

Preliminary List of

Care Areas

The Top 5 Care Areas

1 Care Area

Chosen by each team

Modified List of

Care Areas

STEP 1: Input from

gerontology experts

STEP 2: Input from stakeholder

groups

STEP 3: QI Team

Discussion, with Support

Safer Care for Older Persons (in residential) Environments

Three Focus Areas

• Pain

• Behaviour

• Skin

Safer Care for Older Persons (in residential) Environments

Model for Improvementby the Associates in Process Improvement

QI teams received training in QI techniques and change strategies using the Model for Improvement. The model consists of a set of 3 questions and the PDSA Cycle.

What changes can we make that will result

In improvement?

How will we know that a change is an

improvement?

What are we trying to accomplish?

Safer Care for Older Persons (in residential) Environments

Coaching & Change Management Support to QI Teams

Weekly QI Team Coaching

SCOPE STAFF, QI EXPERTS

AND CLINICAL

EXPERTS

Monthly Feedback Reports

E-mails

Online Access to team data

QI TEAM

Change Packages

COACHING & CHANGE MANAGEMENT SUPPORT

Safer Care for Older Persons (in residential) Environments

QI Techniques Tested by HCA’s

Care Area Sample QI Technique Piloted

Skin Care Turning schedules for at-risk residents

Pain Management Education on screening tools

Behaviour Management

Isolating residents with behavioural issues at meals

Safer Care for Older Persons (in residential) Environments

Site A: Completion of Resident Turning

Safer Care for Older Persons (in residential) Environments

Results – Process Data

• Teams placed greater value on manager support than administrator support

• Successful teams had strong leadership engagement and support

Leadership Engagement

Safer Care for Older Persons (in residential) Environments

Results – Process Data

Team success was higher with more frequent team huddles and regular participation in telephone calls

Team Communication

Safer Care for Older Persons (in residential) Environments

Results – Process Data

Barriers

• Time constraints

• Flu outbreaks

• Manager or staff turnover, staff working different shifts

• Structural/regional issues

• Lack of buy-in