Evidence boosters

An Intervention Strategy for Improving Outcomes

Professional Education - An Intervention Strategy for Improving Outcomes

Download (130k)


Mackenzie Health Long-Term Care (LTC) Facility is a 168 bed non-profit Central Local Health Integration Network (LHIN) home in Richmond Hill, Ontario. It is affiliated with the Mackenzie Health Hospital and managed by Universal Care, Inc. Mackenzie Health LTC has benefited from strong, supportive leadership, resulting in innovative practices, with 18 per cent of residents receiving hemodialysis services on site. They were one of the first LTC homes in Ontario to adopt the use of medical cannabis for chronic pain management, palliative care and responsive behaviour.

In February 2015, Clara Nisan began her role as a full-time Nurse Practitioner (NP) and Director of Clinical Services, with the aim of being in alliance with the mission statement, "To be the best of the best in health care and senior living!"  Her approach was preventative, to ensure assessments and treatments for residents were done at the LTC home, and to avoid unnecessary transfers/admissions to the hospital.

Registered Staff Education

With an aim to improve quality of resident care, including quality indicators, Nisan planned to provide annual, mandatory, paid professional skills days for all registered nurses. The goal was to ensure all nurses had access to continuous education on best practices to improve critical thinking, knowledge, judgment and skills.

Practice Change

Two days of Professional Skills training were provided annually for registered staff. Internal and external experts supported the training, including the RNAO LTC Best Practice Coordinator.


  1. Increased staff knowledge and coaching from the NP resulted in a 45 per cent decrease in transfers to the emergency department (ED) in 2015. This trend continued with an annual average decrease of 31 per cent in transfers to the ED.
  2. When registered staff were given the knowledge and tools to assess and evaluate resident outcomes, the impact was a 40 per cent decrease in residents with pain and a decrease of 48 per cent in antipsychotic use without a diagnosis.