Registed Nurses' Association of Ontario

Evidence Booster: William A. ‘Bill’ George Extended Care Facility’s Champions empowered to create change

The "Bill George" is a 20-bed long-term care (LTC) home located in Sioux Lookout, which is one of the most northern LTC home in Ontario. Many residents are of indigenous background and are non-English speaking. The home's goal is to respect and recognize cultural and language diversity through the integration of traditional and modern medical practices.
In 2016, the Bill George began a three-year partnership with RNAO as a LTC Best Practice Spotlight Organization® (LTC-BPSO®) pre-designate and committed to implement five best practice guidelines (BPG) across the entire home focusing on falls, continence, oral health, pressure injuries and pain.

Practice Change
To support BPG implementation activities, senior leadership decided to train the majority of staff as Best Practice Champions, starting with registered staff.
Use of Champions

  • Champions became the Implementation Leads for each BPG which provided leadership opportunities for front-line staff
  • Leads were given dedicated paid time for required implementation activities. Depending on staffing needs, Leads could use up to two 8-hour shifts per month designated as "pick-up" shifts to work on BPSO-related activities
  • Leads were required to demonstrate the aspects of their BPG action plan they worked on during these shifts
  • Time to discuss BPG implementation was added to the existing daily huddles/meetings in which 3 questions were asked:
    • What is the team spirit?
    • Do you have everything you need to fulfill your role as a Champion?
    • Are you concerned about any safety issues?
  • Huddles helped staff to understand the implementation activities and resulted in a decentralized process for communication and collaboration between staff and management. This ensured that implementation was continually being discussed
  • A BPSO bulletin board was created to highlight the current status of projects and measurement data.

Falls

  • Improved communication and collaboration with the physiotherapy team
  • Implemented the Scotts Falls Assessment Tool
  • Post fall – started a 24-hour post fall assessment and regular falls huddles utilizing an interdisciplinary team approach to address resident needs

Continence

  • All residents are screened for their potential for prompted voiding using a voiding record
  • All residents who qualify for prompted voiding are placed on the program and an individualized care plan is created
  • Staff are committed to dignity and respect around toileting

Oral Health

  • Implemented a new assessment tool on admission
  • Implemented new daily documentation of oral care (when, who, how)
  • The benefits experienced  by improving oral care for residents included no respiratory outbreak, better appetites and better affect