Registed Nurses' Association of Ontario

Evidence Booster: Tilbury Manor Nursing Home

Tilbury Manor Nursing Home Implements Best Practice Guidelines to Improve Resident Care and Create a Healthy Work Environment

Background

As public reporting of quality indicators become a greater focus in the long-term care sector, long-term care home (LTCH) leaders and staff have sought new ways to improve resident outcomes.
One of Tilbury Manor is a 75-resident LTCH in the Erie St. Clair Local Health Integration Network, Ontario, Canada.

Sara Le, the Director of Care at Tilbury Manor, began her role with aspirations of enhancing resident quality of life, family experience and staff work-life balance and experience. She was supported by RNAO’s long-term care best practice co-ordinator, Beverly Faubert.

“We initially started by reaching out to our LTC BPC for ideas on how to use best practices to improve pain management and documentation,” says Le.

This initial request led to a discussion about strategies to improve nursing services. To identify the areas of resident care that required improvement, we completed a gap analysis that compared best practice recommendations with current practices and determined which BPG recommendations the home had met, partially met, and had not met.”

The interprofessional team used gap analysis tools to review current practices in relation to the best practice guideline (BPG) recommendations and create action plans to improve outcomes. Existing policies, resident care practices and documentation were reviewed to determine the extent to which screening, assessment and re-assessment tools aligned with best practices.

Since November 2014, Tilbury Manor has implemented practice changes based on the recommendations within 12 RNAO BPGs. This has resulted in a number of measurable improvements to the quality of care that is provided to their residents.

Practice Change

Program teams, led by nurses, were established to promote practice changes and improve resident outcomes. Each leader was responsible for training and education, implementing practice changes, and evaluating their effectiveness. Results of chart audits, nursing care reviews, and RAI-MDS scores were monitored and regularly reported to the DOC to promote continuity and ensure sustainability of practice changes. Within one reporting cycle (fiscal quarter), the RAI-MDS indicators showed improvements.

"We initially started by reaching out to our LTC BPC for ideas on how to use best practices to improve pain management and documentation. This initial request led to a discussion about strategies to improve nursing services. To identify the areas of resident care that required improvement, we completed a gap analysis that compared best practice recommendations with current practices and determined which BPG recommendations the home had met, partially met, and had not met" - Sara Le


Tilbury Manor Staff (left to right): Kerri Taylor RPN, Megan Drummond RPN, Deborah Robert RN, Colette Berg RN, Cheryl Labonte-McFeggan RN, Sara Le RN Director of Resident Care (DOC), and Jovanna Klassen RPN

Healthy Work Environment Implementation Strategies

A number of measures were also taken to improve the work environment. The LTC BPC provided coaching and support to enhance the leadership skills of nurses, who were facilitators throughout these changes. Healthy work environment (HWE) topics were selected for strategic planning sessions based on the home's needs.  These topics involved nurses identifying challenges that prevented them from implementing HWE best practices and approaches to improve the confidence of point-of-care leaders.

Several recommendations were implemented from the following HWE BPGs:

    • Collaborative Practice Among Nursing Teams (2006)
    • Developing and Sustaining Interprofessional Health Care (2013)
    • Developing and Sustaining Nursing Leadership (2012)
    • Managing and Mitigating Conflict in Health-care Teams (2012)
    • Professionalism in Nursing (2007)

Impact: This analysis demonstrates improvements in staff work-life balance and staff experience following the implementation of five RNAO healthy work environment best practice guidelines.