November 2008 IN THIS ISSUE

2 Highlights of the Provincial Survey

2 The New Motto of Long-Term Care is: Learning to Share

3 The Summer Institute 2008 Learning Experience

3 Improving Continence Care (IC3) Update

4 Champions at Vision Nursing Home are truly champions Long-Term Care Best commitment to the long-term care homes and our ongoing support for staff who strive to provide 4 Elder People Deserve the Best

Practices Initiative: New excellent resident care and outcomes remain 5 Oral Care in the East

unchanged. The Long-Term Care Best Practices 5 Quality Worklife, Quality Health Team! New Beginning! Initiative team invites you to join us in embarking on Care Collaborative

By Josephine Santos, RN, MN a journey to best practice implementation. 6 Announcements Project Manager, LTC Best Practices Initiative March 31, 2008 marked the end of a 3-year pilot of the Long-Term Care Best Practices Initiative funded by the Ministry of Health Meet the and Long-Term Care’s Nursing Secretariat. Coordinators! As of April 1, 2008, the Registered Nurses’ Association of (RNAO) has assumed the management of the initiative under the Long-Term Care Best Practice funding of the Ministry of Health and Long- Coordinators (L-R): Natalie Warner, Term Care’s Performance Improvement and Heather Woodbeck, Janet Evans, Beverly Compliance (PIC) Branch. Ann Faubert, Gina De Souza, Rahim Charania and Maryanne D’Arpino Since then, the initiative has gone through some changes. Some of the Long-Term Care Best Practice Coordinators (LTC BPCs) from Getting Started and Establishing Partnerships the pilot phase have moved on in their  conducting a brief survey to gain a careers. Their contributions and their efforts By Josephine Santos, RN, MN provincial perspective on the uptake of in raising awareness about the initiative in the Project Manager, LTC Best Practices Initiative best practices in the LTC sector; long-term care sector have paved the way for  establishing regional networking forums the new Best Practice Coordinators. The Provincial Advisory committee was established to provide strategic advice to the such as Communities of Practice to In this phase of the initiative, some of the initiative at a provincial level. Membership on the support uptake of BPGs; changes that have taken place include the committee includes representatives from the  providing ongoing consultation with RAI- hiring of the following staff: a project following stakeholder groups: Registered Nurses’ MDS (Resident Assessment Instrument - manager to oversee the initiative; an Association of Ontario (RNAO), Registered Minimum Data Set) and non-RAI-MDS administrative assistant to provide support Practical Nurses’ Association of Ontario (RPNAO), LTC homes in order to develop a common for the initiative; and new LTC BPCs to assist Ontario Association of Non-Profit Homes and approach to implementation; LTC homes in implementing best practices Services for Seniors (OANHSS), Ontario Long-Term  linking and integrating the initiative with and enhancing the quality of care of Care Association (OLTCA), Ministry of Health and RAI-MDS and with other performance residents. Currently, all regions have a LTC Long-Term Care (Performance Improvement and improvement initiatives; BPC who is based at a LTC host home. In each Compliance Branch and Nursing Secretariat),  liaising with the RNAO Champions region a LTC host home has entered a Regional Geriatric Program of Ontario (RGP), program to deliver LTC specific contract with RNAO to host a LTC BPC. A list Seniors Health Research Transfer Network champions workshop including booster of LTC regional breakdown, LTC BPCs and host (SHRTN), Ontario Health Quality Council (OHQC), sessions on sustainability and homes is provided on page 6. and Ontario Seniors’ Secretariat. mentorship; and,  participating in evaluation/research While there have been some changes to Some of the key activities of the initiative for 2008 opportunities focusing on impact of best structure of the team, our unwavering to 2009 include: practices on resident care outcomes.

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Highlights of the The New Motto of Long-Term Care is: Provincial Survey Learning to Share

By Josephine Santos, RN, MN By Maryanne D'Arpino RN, BScN Depression (3D’s); and, Pressure Ulcers. Project Manager, LTC Best Long-Term Care Best Practice Coordinator, Practices Initiative Region Our CoP initiatives have contributed to the successful uptake of BPGs within our own Between the months of August and Congratulations to the Toronto Communities homes and in the greater long-term care September 2008, a provincial of Practice (CoP) on celebrating their first community. Within the CoP, positive results survey was conducted to anniversary! For the Registered Nurses, have been achieved by working collaboratively determine the current uptake of Registered Practical Nurses, Directors of on guideline implementation and sharing best practice guidelines (BPG) in Care, Assistant Directors of Care, Clinical strategies, processes, resources and evaluation the long-term care sector. The Educators, Nurse Consultants, Nurse tools. Examples of resources used and results of the survey will be used to Managers, Best Practice Champions and the developed by the Toronto CoP can be found at: assist the LTC Best Practice Long-Term Care Best Practice Coordinator http://rgp.toronto.on.ca/node/133). We were Coordinators in developing who belong to the group, sharing pleased to discover that the excitement of strategies to support the LTC information and ideas around the table has evidence-based practice had spread beyond homes in BPG implementation. become a common culture. our CoP, when three homes who are members of the CoP shared their stories of best practice Of the 619 LTC homes in Ontario, Our CoP is one of the largest and we are implementation at a recent RNAO Champions 236 participated in the survey with proud of the group’s diversity, richness and Workshop. Our efforts have also been a response rate of 38%. About collective experience and expertise in long- recognized outside of our sector. In 73.3% of the respondents indicated term care (LTC). Our goal is to improve September, one home in the Toronto CoP that they have implemented or are resident care through the implementation of received a prestigious award “Award of currently implementing a BPG. The evidence-based best practices in LTC homes. Excellence”, at the 2008 Public Sector Quality top 10 commonly implemented Our fundamental guiding principles - raising Fair. The home was being honored for the BPGs are: Falls, Continence, awareness, engagement, capacity uptake of the BPG on 3Ds (Dementia, Delirium, Pressure Ulcers (Assessment and development, BPG implementation, Depression). Management and Risk Assessment integration, and evaluation - are based on and Prevention); Pain; the Ontario Circle of Care Model. We have If you and your home share our vision for Constipation; Infection Control; been working on the implementation of improving resident care through evidence- Delirium, Dementia and various BPG topics which include: Falls based best practices, we invite you to join the Depression; Oral Care, Client Prevention; Pain; Dementia, Delirium, Toronto Communities of Practice. Centred Care; and Foot Ulcers.

Pain, falls prevention and management, client centred care, pressure ulcers and continence care are the top resident concerns identified by the LTC homes across the province. To address these provincial concerns, the LTC BPCs will compile a compendium of existing best practice resources for regulated and unregulated LTC home staff. They will also provide consultation including education sessions on guideline implementation.

The Toronto Communities of Practice with Josephine Santos, Project Manager (third from right, front row) and Citlali Singh, Project Assistant (far left, front row).

| www.RNAO.ca/bestpractices | p2 The Summer Institute 2008 Learning Experience leading the group to a Zen-like outdoor location where we had some moments of By Gina De Souza, RN, BScN implementation projects in their practice final reflection and made personal and Long-Term Care Best Practice settings to share challenges and public commitments to implementing best Coordinator, Central South Region innovations. The week did not end with practices. the usual ‘check in’ to see what we had During her opening remarks to Summer learned; instead participants The Summer Institute was an exceptional Institute participants, Irmajean Bajnok, demonstrated their acquired knowledge professional development opportunity Director of RNAO International Affairs and using talents not often seen in the health- where I was able to meet other Best Practice Guidelines (IABPG) care setting. Such diversity! This led one professionals from the Long-Term Care Programs, stated that the Summer participant to claim she felt “20 years sector. The building of this network will be Institute is a place to bring clinical ‘hot’ younger” as a result of being re-energized invaluable as we continue to work together topics. She explained that during the by her participation in the foundational to increase the uptake of evidence based week participants gain the foundational focus stream’s curriculum. nursing recommendations in long-term concepts of best practice implementation care homes across Ontario and focus on needed to develop an action plan. This sharing was followed by Heather achieving excellence in resident care. Sounds like a large and overwhelming McConnell, Associate Director, order until you are riveted by her

exceptional and engaging presentation skills. ‘Will the implementation process ever seem less daunting?’ and ‘Where do we begin?’ are the questions on most of the participants’ minds.

We learned about some of the tools used Interactive in BPG implementation and put them to learning activity at the use. Our guest presenters shared their BPG Summer case studies in a comfortable setting Institute which invited dialogue and fostered mentoring. I have since used tools such as the stakeholder analysis to determine which group members support an implementation project and which ones have the influence to move the project forward.

The positive energy in each of the Improving Continence Care (IC3) Update sessions was contagious as we connected the dots between research, evidence By Heather Woodbeck, RN, HBScN, MHSA 42% of their residents. Their RAI/MDS based nursing and quality client Long-Term Care Best Practice statistics show some added benefits – a outcomes. A trade fair type session gave Coordinator, North West Region and Co- decrease in constipation, laxative use and us a chance to connect one-on-one with lead, IC3 urinary tract infections. representatives from organizations that The long-term care homes in the The eleven LTC homes involved in the IC3 had implemented best practices. Improving Continence Care (IC3) project have all been able to make positive Returning Coordinators Josephine Santos Community of Practice from Ottawa, changes using the Rapid Cycle Method of and Heather Woodbeck staffed a booth Kingston, Thunder Bay and Fort Frances Improvement. This approach involves for the Long-Term Care Best Practices are making concrete progress. By setting a clear aim and measuring tools, Initiative and shared their experience and restructuring how their continence then using successive Plan/Do/Study/Act resources that had been developed in the products are used, the team from one (PDSA) cycles to take baby steps toward the pilot phase of the project. home has been able to save enough improvement goal. The interactive nature of the week money to hire an additional personal The IC3 project is funded by the Seniors enabled us to build new professional support worker. Another home’s team Health Research Transfer Network. relationships and provided an opportunity has implemented prompted voiding in a for those who have lead BPG big way. They are now regularly toileting

| www.RNAO.ca/bestpractices | p3 Champions at Vision Nursing Home are truly champions! Dana and Cheryl attended the Healthy Work Environments Summer Institute and By Beverly Ann Faubert, RN, BScN The action plan for implementation gained new insight on capacity building. Long-Term Care Best Practice Coordinator, included: creation of information packages They plan to increase staff buy-in by South West Region about fall risks for families, information enlisting registered and non-registered boards throughout the home and a monthly Dana Horton and Cheryl Beauvais are two staff to participate in the Champion newsletter informing everyone about BPG Best Practice Guideline (BPG) Champions at workshop in November, thus increasing updates. the number of best practice champions in Vision Nursing Home, a 110 bed nursing home in Sarnia. However, they have When they analyzed the recommendation the home. successfully implemented 12 of the 37 of prescribing vitamin D and calcium, they In summary, they credit their success to BPGs and are currently working on identified cost to families and lack of “supportive management who ensures a implementing the BPGs for pain and falls physician support as barriers. The BPG dedicated day each month for BPG and the healthy work environment Champions overcame these barriers by implementation, the RNAO BPG guidelines. consulting with the home’s dietitian and Coordinator’s mentorship and provision of pharmacist who provided research and a They enlisted the support of the LTC Best resources and their ability of keep cost analysis of alternative forms of calcium. Practice Coordinator as they revised their education interesting and fun.” falls policy. She provided resources from across the province and informed them of Champions Dana websites, LTC partners, information sharing Horton and Cheryl and resources that would simplify their Beauvais proudly work. presented the BPGs they are currently For example, a community of practice in implementing at Windsor implemented the Falls BPG and Vision Nursing readily shared their work allowing for a gap Home. analysis of what best practice initiatives were missing in their policies.

while providing the tools needed to Now Available! Elder People Deserve advance elder health and elder care It is with great excitement that the Registered the Best within their communities. Nurses’ Association of Ontario shares the Long- By Rahim Charania RN, BScN, CHCA The RNAO Best Practice Coordinators had Term Care Best Practices Initiative with you! Visit Long-Term Care Best Practice Coordinator, the opportunity to share evidence-based our website at www.RNAO.ca/bestpractices Central West Region research with nurses, seniors, advocates, to download a copy provincial policy makers, nurse of our brochure The key to excellence in elder care is researchers, and long-term care directors today! continued dedication to promoting healthy and administrators. aging, evidence-based practice and public policy changes which impact on the This event showcased innovations, broader social determinants of health. successes and strategies that support nurses and stakeholders in their quest to From September 24 to 26, 2008, the provide quality health care for elder Registered Nurses’ Association of Ontario persons. We look forward to encouraging (RNAO), in collaboration with the innovations, applying technology and Alzheimer’s Society and the Regional improving efficiencies through new and Geriatric Program of Ontario, hosted the improved models of care as we anticipate 7th International Elder Care Conference. the 8th International Elder Care During this dynamic international forum, Conference that’s taking place on October delegates explored needs related to 6-8, 2009. infrastructure, systems and processes and shared ideas for challenging the status quo

| www.RNAO.ca/bestpractices | p4 Oral Care in the East Quality Worklife, Quality Health Care Collaborative By Janet Evans, RN, BScN By Natalie Warner, RN, MN, BFA guideline simultaneously. Their choice of Long-Term Care Best Long-Term Care Best Practice Coordinator, this guideline reflects staff interest in Practice Coordinator, Central East Region reviewing a topic covered in that guideline - East Region the use of restraints. The recommendations Funded by the MOHLTC, 17 participants included in the healthy work environment Bonnechere Manor in from long term care homes around Ontario guidelines are directed at individual’s Renfrew was the site attended the RNAO’s Healthy Work organization and the system. By applying for an oral care blitz Environments (HWE) Summer Institute in these recommendations to the on October 1, 2008. Oral care best August to learn more about implementing development of practice involving falls practices were chosen for implementation workplace best practices in their homes. prevention and restraint strategies, the by the Manor after nursing staff attended a These participants have formed the first group is exploring how they currently work Champions workshop. I was greeted by the healthy work environment Community of together and refining the ways collaborative best practice champion of the facility. She Practice which holds monthly practice recommendations can be had done the initial groundwork regarding teleconferences to support one another implemented to improve the work existing tools and policies currently existing and share ideas. at the Manor. I had the opportunity to environment. review this material, and provide relevant While most of the examples of workplace feedback to support their endeavors. implementation at the Institute came from the acute care sector, one participating There were six “train the trainer” sessions organization is flipping that standard by held throughout the day. A number of staff working first within their long term care from different disciplines attended. The goal sector and then moving their HWE of the day was collaborative, by promoting experience into their ambulatory/ the importance of oral care in the long-term emergency care and community services. care setting across all disciplines. That organization is Haliburton Highlands The presentation began with a review of Health Services (HHHS) who held a meeting what oral care consists of and identification that included front line staff, the week of common terminology. Attendees were after the Institute to begin implementing engaged during the presentations through the Collaborative Practice Among Nursing A fundamental way to better health care is interactive questioning, myth identification, Teams guideline in their two long-term through healthier workplaces. It is and practical examples that attendees care homes. Undaunted by pioneering a unacceptable to work in, receive care in, identified. healthy work environment guideline in govern, manage or fund unhealthy health Evidence-based recommendations were long-term care, the group has decided to care workplaces. identified, and applications of these work on the Falls Prevention clinical practices were tied to the nursing process. The presentation concluded with a discussion of various commonly seen oral care issues like denture care and dry mouth.

The day finished with a discussion about future oral care plans. The plans include changing toothbrushes every 3 months when the RAI-MDS quarterlies are completed, assessment of each resident’s oral health through the integration of a paper assessment tool (found at http://www.rgpc.ca/best/subjects/oral.cfm), and the creation of a reference manual for each unit.

The participants from the Long-Term Care sector during the Healthy Work Environments Summer Institute in August 2008.

| www.RNAO.ca/bestpractices | p5 Announcements Welcome to the Team! Who are the LTC Best Practice Coordinators? Below is the contact list of the LTC Best Practice Coordinators and their Host Homes.

LTC Best Practice LTC Region Host Home Coordinator CENTRAL EAST REGION Natalie Warner, RN, MN, BFA Covers: York, Durham, Mobile: (705) 768-8434 Hillsdale Estates Northhumberland, Kawartha Phone: (905) 579-1777 ext. 235 590 Oshawa Blvd. N.

Lakes, Peterborough, Haliburton, Fax: (905) 579-3911 Oshawa, ON L1G 5T9

and Simcoe Email: [email protected] Gina De Souza, RN, BScN CENTRAL SOUTH Mobile: (289) 407-9658 John Noble Home Covers: Hamilton, Brant, Phone: (519) 756-2920 Ext 233 97 Mt Pleasant St

Haldimand, Niagara, Norfolk Fax: (519) 756-7942 Brantford, ON N3T 1T5 E-mail: [email protected] RNAO is delighted to Rahim Charania, RN, BScN, CHCA CENTRAL WEST introduce Heather Mobile: (519) 520-7283 Specialty Care Road Covers: Waterloo, Wellington- Thompson as the new Best Direct: (905) 817-7074 4350 Mississauga Road Dufferin, Halton & Peel including Practice Coordinator for Fax: (905) 812-1173 Mississauga, ON L5M 7C8 Mississauga & E-mail: [email protected] Long-Term Care in the North EAST REGION East Region! Janet Evans, RN, BScN Covers: Renfrew, Ottawa, Mobile: (613) 864-0238 Miramichi Lodge Eastern Counties, Kingston, Direct: (613) 735-4693 ext. 213 725 Pembroke St. West Frontenac, Lennox & Addington, Fax: (613) 735-8061 Pembroke, ON K8A 8S6 Lanark, Leeds & Grenville, RNAO Office Email : [email protected]

Hastings Prince Edward 158 Pearl Street, Toronto, ON M5H 1L3 NORTH-EASTERN REGION Heather Thompson, RN

Covers: Algoma, Cochrane, Mobile: (705) 206-3344 Algoma Manor Manitoulin, Nippising, Muskoka, Direct: (705) 842-2840 ext. 232 135 Dawson Street Josephine Santos, RN, MN

Sudbury, Timiskaming, and Parry Fax: (705) 842-2650 Thessalon, ON P0R 1L0 Project Manager Sound Email: [email protected] Direct: 416-408-5587 Heather Woodbeck, RN, HBScN, Toll-free: 1-800-268-7199 ext. 231 MHSA St. Joseph's Care Group Fax: 416 -907-7962 NORTH-WESTERN REGION Phone: (807)-768-4432 St. Joseph's Heritage Covers: Thunder Bay, Kenora, Email: [email protected] Fax: (807)-768-7793 63 Carrie Street and Rainy River Cell: (807) 621-1127 Thunder Bay ON P7A 4J2 Citlali Singh Email: [email protected] Project Assistant Beverly Ann Faubert, RN, BScN Direct: 416-408-5590 SOUTH WEST REGION Mobile: (519) 401-8485 Vision Nursing Home Covers: Grey-Bruce, Huron, Toll-free: 1-800-268-7199 ext. 266 Phone: (519) 336-6551 ext. 207 229 Wellington Street Perth, Middlesex, Oxford, Elgin, Fax: 416-907-7962 Fax: (519) 336-5878 Sarnia, ON N7T 1G9 Lambton, Kent, Essex Email: [email protected] Email: [email protected] Maryanne D’Arpino, RN, BScN TORONTO REGION General Hospital Phone: (416) 756-0066 ext. 8074 Covers: North York, York, East Seniors' Health Centre Mobile: (416) 807-0367 York, Scarborough, , 2 Buchan Court Fax: (416) 495-9738 and Toronto Toronto, Ontario M2J 5A3 Email: md'[email protected] LTC Best Practices Initiative Newsletter Mark Your Calendars! Editors: Natalie Warner & Jill-Marie Burke, Media Relations Coordinator June 14-19, 2009 October 6-8, 2009 th 7th Annual Nursing Best Practice 8 International Elder Care Conference: Older People Newsletter Designed by: Citlali Singh

Deserve the Best: The Journey of Transformational & Guidelines Summer Institute Please send comments/inquiries to Citlali Sustained Change August 9-14, 2009 Singh (contact info as above). Creating Healthy Work Environments December 2-4, 2009 th Summer Institute 5 International Conference on Evidenced-Based Made possible through funding by the Practice: Sharing Global Visions & Local Solutions. Government of Ontario.

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