How to use this slide deck

This presentation is intended to assist with staff engagement and implementation. Speaker notes have been developed for many of the slides.

You can contact the Ontario Stroke System Regional Community and LTC Coordinator for your area to discuss any questions or additional needs you may have.

How to use this slide deck

This slide deck provides an overview of the Integration of Stroke Best Practice into LTC Resident Care Planning Project.

It may be adapted in order to meet the needs of your facility. Please ensure the integrity of the content is maintained.

The Integration of Stroke Best Practice into Long Term Care Resident Care

Planning

April 2013

The Project: Objective

ObjectiveIntegrate the Tips and Tools for Everyday Living resource into LTC care plan libraries. As a result, the RAI-MDS assessment findings would then link with relevant care plan(s) for stroke survivors.

Stroke in Long Term Care

22% of residents in LTC age 65 or older have had a stroke (Heart and Stroke Foundation of Ontario, 2000).

Stroke is the third most common diagnosis in long-term care (Price Waterhouse Cooper 2001).

Ontario Stroke System

Ontario Stroke System

Consists of 11 regional stroke networksAddresses the full continuum of careGoal:

• to coordinate equitable access and improve outcomes for stroke survivors and their families through integration of best practices.

Connecting with Long Term Care

The Regional Community and Long Term Care Coordinators/Specialists of the Ontario Stroke System (OSS) work closely with LTC stakeholders to increase awareness and facilitate the uptake of stroke care best practices.

Tips and Tools for Everyday Living is a best practice resource available to assist health care providers in LTC to care for resident’s with stroke.

Knowledge Translation within LTC

The dissemination of stroke care best practices to LTC homes can be challenging for many reasons including:• increased complexity of residents• turnover of staff and management• competing priorities e.g. implementation of

the RAI- MDS, other clinical demands• time and resource constraints. • variation in the sector (software, practices,

staffing)

Knowledge Translation: Enablers

There are many enablers in long term care which support knowledge translation:

• Engaged, committed staff• Collaboration and resourcefulness• Interest in and support for best practices• Quality agenda• Restorative care philosophy• Focus on the resident

RAI-MDS: The Opportunity

The RAI- MDS provides a framework for care providers to complete a comprehensive screening assessment of resident care needs in a number of areas, including psychosocial status, communication, activity levels, cognition and physical condition.

ADDING IT UP

RAI MDS+ Tips and Tools for Everyday Living TM

= Best Practice Stroke Care Plans

The Project: The Task

• Working groups included representatives from LTC and Ontario Stroke System

• 12 Stroke Care Plans based on the Tips and Tools resource were developed

• Reviewed by Compliance Director, Retirement Home Regulatory Authority, Ministry of Health and Long Term Care

Developing the Stroke Care Plans

Tips and Tools Modules• Communication• Pain• Cognition• Perception• Depression • Behaviour• Mobility, positioning, transfers• Bowel and bladder control• Hydration, meal assistance &

special diets• Activities of daily living• Skin care & hygiene• Leisure• Interprofessional team • Caregiver stress

Stroke Care Plans• Cognition• Depression/Mood• Mobility/Transfers• Hydration, Meal Assistance• Activities of Daily Living

(ADL)• Leisure• Skin Care/Hygiene• Bowel and Bladder• Behaviour• Communication• Pain• Perception

Stroke Care Plans: Guidelines

Uses clear, simple and action-oriented language

FIVE STANDARD CARE PLAN COMPONENTSFocus

•Uses PESS (problem, etiology, signs,symptoms).

Goal•SMART format written from the resident’s perspective (i.e. what resident will do, look like, etc.).•Reflects the RAI-MDS Outcome Scales.

Stroke Care Plans: Guidelines

InterventionsA restorative, interdisciplinary approach. The number of interventions range from 5 to 10 per goal.

AccountabilitySpecific team members must be identified for each intervention.

Stroke Care Plans: Guidelines

TimelinesTimelines should not automatically coincide with reassessments (i.e.q3months). Timelines are to be related to resident’s goal or goal assessment.

Example – Perception Care Plan

FOCUS GOAL(S) TIMELINES INTERVENTIONS ACCOUNTABILITY Apraxia Impaired perception related to stroke as evidenced by the resident being confused over proper sequence of steps for eating, grooming, etc. Impaired perception related to stroke as evidenced by the resident having difficulty using common objects even though he/she is aware of what the object is (e.g. combs hair with a fork)

Resident will require decreased cueing when dressing Resident will require decreased cueing for grooming Resident will require decreased cueing for eating

Use short and simple instructions while performing tasks Plan steps of the task with the resident Assist in starting the next step Break the task into simple steps and reminders for the proper sequencing of task Instruct resident to practice activities Provide hand-over-hand guidance

Instruct family on interventions to increase resident’s task performance. Report to the RN/ RPN any improvements or deterioration in awareness level.

HCA/PSW/Restorative Care/ Therapy Assistants

Stroke Care Plans: Anticipated Benefits

• Enhanced quality of care• Supports restorative care approach • Supporting compliance with:

• Best practice and research-based standards of accreditation organizations (e.g. Accreditation Canada and Commission on Accreditation of Rehabilitation Facilities [CARF])

• The July 2010 LTC Act (including an integrated care planning approach); and

• MOHLTC Inspector expectations

Pilot Project (2012): Background

The pilot sites were a mix of urban and rural facilities.

Four LTC Facilities participated:• Carefree Lodge (Willowdale)• Fairhaven (Peterborough)• Pine Meadow (Northbrook)• Seven Oaks (Scarborough)

Time frame ≈ 6 months

Pilot Project: Evaluation•95.8% of respondents indicated that the stroke care plans enhanced their ability to care for stroke residents to varying degrees.•Care plans on transfers and mobility, perception, cognition, pain and communication were found to be particularly useful.•Pilot homes reported an increase awareness and uptake of best practice stroke care.

Pilot Project: Feedback

“The opportunity to ensure that our care planning contained best practices and an evidence base was the foundation for us to move forward in this project.”

“This resource (Tips and Tools for Everyday Living) has been an extremely beneficial tool which assisted staff to understand brain physiology, risk factors, stroke impact on life and how the care team can affect resident outcomes.”

Pilot Project: Feedback

“Tips and Tools for Everyday Living provided an evidence based approach for team members to assist the stroke survivor to achieve the optimal wellness level and their full potential. Our staff repeatedly expressed the value of this resource.”

Pilot Project: Dissemination

• All Ontario Long Term Care facilities• Ontario Long Term Care Association• Ontario Association Non-Profit Homes &

Services for Seniors• Long Term Care Expert Panel• Ministry of Health & Long-Term Care• Registered Nurses Association of Ontario

Best Practice Champions

Pilot Project: Dissemination

• Stroke Collaborative 2011& 2012• Canadian Stroke Congress 2012• Ontario Gerontology Association

Conference 2013• Ontario Long Term Care Association

Conference 2013

Implementation Resources

•Regional OSS representatives would welcome the opportunity to discuss how s/he might be able to support you in the implementation process. •Implementation Toolkit

Available at:• (www.ontariostrokenetwork.ca)

Implementation Toolkit

Contents:• Project Overview• Stroke Care Plans• Implementation Tips• Frequently Asked Questions• PowerPoint Presentation

Project ContributorsLTC Home Representatives Andrea DeNeire RAI MDS Coordinator Terrace Lodge, Aylmer, ON Phillippa Welch LTC Consultant Woods Park, Barrie, ON Natalie Cameron Registered Nurse St. Joseph’s Villa, Dundas, ON Sylvia Masters RAI Coordinator Leisureworld, Brampton, ON Erin Cunningham Administrator Muskoka Landing, Huntsville, ON Alice Jyu Patient Care Manager Veterans Centre, Toronto, ON Ceclia Yeung APN Veterans Centre, Toronto, ON Razane Diab Acting DON Cedarvale Terrace, Toronto, ON

LTC Home Representatives Denyse Duke Director of Care, LTC Residence St. Louis, Ottawa, ON Manon Simard RAI Coordinator Residence St. Louis, Ottawa, ON Darlene Lawlor RAO MDS Coordinator Perth Community Care Centre. Perth, ON Jackie Maxwell DOC Village Green, Selby, ON Pam Brown Corporate RAI-MDS Coordinator Extendicare (Canada) Inc. Eastern Operations Wendy Campbell Assistant Administrator Stayner Nursing Home Marsha Nicolson City of Toronto Resident Care Director, LTC Homes and Services Theresa Savard-Maki RAI Coordinator Bethammi Nursing Home, Thunder Bay, ON

MOHLTC Sandra Schmidt Project Lead Implementation and Support Long Term Care Common Assessment Project (LTCH CAP) Soo Ching Kikuta LTCHCAO Program Manager OSN Community & LTC Coordinators/Specialists Paula Gilmore Vicky Smith Donna Cheung Sharon Trottman Alda Tee Jessica Comay Gwen Brown Pauline Bodnar Sue Verrilli Jocelyne McKellar Mark Morris

CONTACTS

Contact information for your Regional Community and LTC Coordinator can be found at the OSN website.

http://ontariostrokenetwork.ca/landing_map.php?rf=2&id=153&sec=2

Incorporating Stroke Care Plans into the Care Planning

library at this facility

Discussion

Thank you