RNAO is proud to celebrate four homes that successfully achieved their BPSO designation in June 2020 during RNAO's Virtual Annual General Meeting.
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Fiddick's Nursing Home Ltd.
Author: Mandy Judah, RN, Director of Resident Care, Fiddicks Nursing Home, Ltd.
About us: Fiddick’s Nursing Home (FNH) is located in the rural community of Petrolia, Ontario. FNH is independently owned and operated by the Fiddick family who proudly offer a very traditional and personal experience for everyone, and a focus on quality of life is incorporated into practice. The staff is committed to going above and beyond for the residents by having home-cooked meals and desserts and ensuring the environment is home-like. FNH endeavors to meet legislated standards of practice and to raise the quality of services by working with the RNAO and Accreditation Canada to provide excellent care for all.
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BPGs implemented:
• Oral health: Nursing assessment and intervention;
• Prevention of falls and fall injuries in the older adult;
• Promoting safety: Alternative approaches to the use of restraints
Impact: With the successful completion of the BPSO pre-designation period, residents, families and staff continue to benefit from enhancements to the provision of care at FNH. The implementation of the RNAO guidelines has resulted in reduction of restraint use, improved oral hygiene practices and prevention of falls and fall related injuries.
Sustainability and spread: FNH’s significant success of sustaining a restraint free environment for the enhanced safety of residents has been recognized by the Ontario Association of Residents' Councils who marketed our alternatives to restraints resources widely across the province. Through this spread of our implementation strategies, FNH’s work has reached other long-term care homes and other sectors across the continuum of care.
Holland Christian Homes – Faith Manor
Author: Kaitlan Laviolette, MN, NP-PHC, Holland Christian Homes
About us: Faith Manor is a long-term care facility located in Brampton, Ontario, and is part of Holland Christian Homes – an organization serving a primarily Dutch population of seniors. Faith Manor is home to 120 residents and will soon be expanding to a new building with capacity for 160 residents.
BPGs implemented:
• Assessment and management of pain
• Preventing and addressing abuse and neglect of older adults
• Preventing falls and reducing injury from falls
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Impact: Over the past 3 years, best practice guideline implementation has contributed to significant quality improvement efforts, which have had a positive impact on resident safety and satisfaction.
Through the implementation of Preventing and Addressing Abuse and Neglect of Older Adults, we saw an improvement in overall resident satisfaction of 5%. We also saw a reduction in the number of concerns reported, which drastically decreased between 2017 – 2019, from 152 concerns in 2017 to 44 in 2019.
Through the implementation of Preventing Falls and Reducing Injury from Falls, Fourth Edition, we continue to see an improvement in the total number of resident falls and a reduction in serious injuries due to a fall. One of the biggest impacts from this guideline has been the introduction of Purposeful Hourly Rounding, which is used as a fall’s prevention strategy, but also to address pain management, positioning and personal needs on a consistent and frequent basis.
To give some context, the following outlines the total number of falls on an annual basis: 2017: 551 falls, 2018: 416 falls, 2019: 236 falls, between 2017 to 2019 this reflects a 57% reduction in total number of falls. Overall, we have seen a decline in injuries related to falls as well, including a drastic reduction in the number of fractures resulting from a fall, with a 10-month span without any fractures between 2018-2019.
Sustainability and Spread: Over the next year, we plan on spreading the Assessment and Management of Pain BPG from our sister home to Faith Manor. We also plan to implement the Person-and Family-Centred Care best practice guideline across the entire home.
Markhaven Home for Seniors
Author: Dorothy Hoffman, RN BPSO Liaison, Markhaven Home for Seniors
About us: Markhaven Home for Seniors has served the Township of Markham and the surrounding area for more than 50 years. This non-profit organization, with 96 residents, began with a vision to provide a home where seniors would be nurtured in a Christian environment. The staff and management of Markhaven are very proud to be the first designate Long-term Care Best Practice Spotlight Organization in Central East Ontario.
BPGs implemented:
• Preventing falls and reducing injury from falls
• Person-and- family centred care
• Promoting continence using prompted voiding
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Impact: Our journey to become a Best Practice Spotlight Organization has been a series of incredible accomplishments including the publication of an article about our practice changes related to providing person-and- family-centred care. Our falls rates have decreased and many residents are experiencing improved continence. We have many Best Practice Champions with the skills to implement best practices as we strive to continually improve resident care and outcomes.
Sustainability and Spread: Markhaven is in the process of setting up a Snoezelen room for residents in each home area, so they can enjoy an aquarium, peaceful music and a spa like environment. Our falls brochure is being updated and is included in each admission package. We will continue with safety rounds, tracking falls and monitoring preventative measures to keep our falls rates as low as possible.
Nipigon District Memorial Hospital
Author: Madison Boudreau, Nurse Manager, Nipigon District Memorial Hospital
About us: Nipigon is at the mouth of the Nipigon River on Lake Superior and the junction of Ontario Highways 17 and 11. The Nipigon District Memorial Hospital (NDMH) is an accredited 37-bed facility providing both long term (LTC) and acute care to the surrounding communities and reserves. We do everything, from the occasional unplanned birth to triaging accident victims to providing palliative care for our LTC residents. Approximately 50 clinical nursing staff along with other health professionals work in the hospital.
BPGs implemented:
• Assessment and management of pain
• Oral health: Nursing assessment and intervention
• Person-and family-centred care (PFCC)
• Prevention of constipation in the older adult population
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Impact: The PFCC BPG has had the most impact. Our Person, Resident and Family Advisory Council (PRFAC) was established a few months before we started our BPSO pre-designate period. We soon realized that rolling out the PFCC BPG was aligned with the work of this Council. The BPSO Person and Family Centered Committee was amalgamated with the Hospital PRFCC Committee which includes members of the public.
Many PFCC initiatives were completed. The leadership team started rounding on acute care to get feedback from patients. As well, installing white boards helped to improve communication with patients, families and the care team. Regular Resident and Family Council meetings ensured consideration of residents and families’ opinions and preferences. A family member spearheaded our LTC Garden Club. Our NOD (Name, Occupation and Do) program ensures that patients and residents know who is providing their care. By March 2019, regular auditing on the whiteboards, NOD and patient rounding in acute care showed that improvements are being sustained.
Sustainability and spread: We established purposeful rounding to target LTC residents who frequently fall. Resident safeguards include call bells being in reach and beds in lowest position. Bi-weekly LTC team conferences help to improve communication. All new staff receive education during orientation to ensure understanding of our PFCC philosophy.
Our close connections with our patients, residents and families proved invaluable during the COVID-19 pandemic. Residents and families gave input into our visiting policies, as we work to keep our patients and residents at the centre of everything we do.
