Case studies

Cardioinfantil Foundation of Cardiology Institute (FCI-IC) is a 340-bed hospital in Bogotá, Colombia. Recognizing that the use of best practice guidelines (BPG) for nursing care was uncommon in Colombia, they joined RNAO’s Best Practice Spotlight Organization® (BPSO®) program with the goal of achieving excellence in care.

FCI-IC had 10 years of evaluation data that revealed problems in specific clinical areas such as fall prevention and wound care. They conducted a baseline diagnostic evaluation to identify the highest priority problems to tackle and to select the most appropriate guidelines and best practice recommendations. As part of this, they surveyed their key partners in the change to learn more about their use of assessment tools, the status of electronic medical records, routine clinical practices such as the use of bed rails, and prevalence data.

This assessment process led to them selecting three RNAO BPGs as knowledge tools: Prevention of Falls and Fall Injuries in the Older Adult, Risk Assessment and Prevention of Pressure Ulcers, and Assessment and Management of Foot Ulcers for People with Diabetes.

Tilbury Manor, a 75-resident long-term care home in Tilbury chose to focus on provincially-mandated “required programs” (fall prevention, skin and wound care, continence care, bowel management and pain management) when seeking to improve resident care.

They conducted a gap analysis to compare their current practices with the best practices outlined in related RNAO best practice guidelines. Their analysis included an assessment of clinical practices, policies and documentation systems. The results of the gap analysis helped them create specific action plans.

Tilbury Manor then formed project teams led by nurses and supported by a team of champions. These teams proceeded to educate staff, implement new clinical practices, conduct care reviews and conduct audits.

Multiple positive outcomes were reported as a result of implementing these best practices including reductions in reports of pain, less use of restraints, and less falls, pressure ulcers and urinary tract infections.

Sioux Lookout Meno Ya Win Health Centre (SLMHC) is a pre-designate Best Practice Spotlight Organization® (BPSO®) in Sioux Lookout, a town in Northwestern Ontario. SLMHC is a hub for inpatient and outpatient hospital services, providing services to including Sioux Lookout and 28 northern communities. The service area is remote, isolated and encompasses 385,000 square kilometres, with a population that is 85 per cent First Nations.

As part of its pre-designation process, the SLMHC change team implemented the Person- and Family- Centred Care (PFCC) best practice guideline (BPG). During implementation, the SLMHC change team worked to adapt the PFCC BPG to the local context of their organization in order to best serve the needs of the population in the surrounding areas as well as in other remote communities.

The SLMCH local context posed unique challenges. Among these:

• Standard guidance on privacy did not always apply to members of the First Nations communities served. Some members wished to have their health information shared with their chief and community.
• Some people must travel as far as 400 or 500 kilometers to return home after discharge from SLMHC. Thus, it was essential to arrange appropriate care transitions and make sure people being discharged would not lose personal belongings.

The SLMHC change team adapted the PFCC BPG to the local context by:

SLMHC Patient Oriented Discharge Summary. Shared with permission.   

• placing names on the doors of the hospital rooms of some individuals, so their community members could stop by and visit.
• creating a Patient Oriented Discharge Summary (PODS) that included the following options to indicate the person’s preferences regarding sharing their health information:

• I agree to my health information being shared with________
• I do not agree with my health information being disclosed to people in my community (for example, band or council) 
• creating a detailed staff checklist within the PODS to ensure safe care transitions (by, for example, faxing the completed form to an external Indigenous Transition Navigator, or listing personal items collected from the room).

• working with an Indigenous Transitions Facilitator, whose roles include conducting follow-up phone calls with the person, patient rounding, and coordinating safe transitions.

After successfully creating a tailored PODS that meets the need of the population they serve, SLMHC has been able to better support person- and family-centred care principles within the organization.

Shared with permission by Sioux Lookout Meno Ya Win Health Centre