Better use of resources, education and teamwork point to success
By Kristian Partington
Imagine you live in a long-term care home, surrounded by people and things that have become familiar, despite the fact that for some time now the effects of dementia have altered your perception of time and memory. You may be unable to express yourself as you once did, and perhaps certain sounds, smells or images can inspire uncomfortable or even fearful memories and yet, the people who care for and support you have this unique ability to make you feel calm.
Now imagine two paramedics come into your room. You don’t know who they are or why they’re there. They urge you to lie upon a gurney before taking you outside into the cold air and they place you in the back of an ambulance. They then race to a crowded emergency room dominated by loud voices, the sound of machinery and lights so bright you can barely concentrate on the voice of the nurse who jabs your arm and inserts a needle attached to a tube attached to a metal pole with bags hanging upon it.
You are nothing, if not terrified.
Nobody likes a visit to the emergency room but for older adults living with complex health challenges like dementia, it can be a truly harrowing experience. This is one of the main reasons why team members at the Village of Sandalwood Park made a concerted effort to reduce the number of avoidable emergency room transfers among its residents.
Director of nursing care Megan Newbury explains how the village learned it had a high percentage of avoidable ER transfers when compared to neighbouring long-term care homes in the Central West LHIN. When these statistics were shared among the team, the village’s quality improvement plan was designed to make a change and in the spring of 2015, the village embarked on a mission to address the issue.
To do so, they shifted their approach in four key areas: they began utilizing the available nurse practitioner more effectively; they focused on additional education for registered team members in the village, much of which was specifically related to the respiratory conditions that accounted for many of the transfers; they increased the number of days independent lab technicians came to the village to carry out physicians’ requests for things like blood work; and they worked to strengthen the relationship between the active registered nurse on duty and the team members in each neighbourhood.
The team conservatively hoped to see positive change within two years but in less than a year, the village managed to reduce the percentage of emergency room visits deemed “avoidable” by the LHIN from a high of 30.66 per cent to a mere 5.9 per cent, and they couldn’t be more proud.
“It was surprising to us to see the comparison between all the long-term care homes and us,” Megan admits when considering that first high number. “That was a shock,” and everybody was eager to improve once they saw those statistics. She credits much of the success with both the implementation of the four-point plan and the willingness among team members in each neighbourhood to work together and challenge each other to do better. Residents’ life quality, on the whole, has improved as there are simply fewer transfers beyond the comfort of their home, and the relationships among team members in nursing seem to have grown stronger as well. The next step will be to create opportunities for other team members to play a major role in helping avoid unnecessary transfers to hospital.
“Even though we’ve hit this goal, we’re going to continue to work on it this year but the focus is actually going to go to the front lines,” Megan says, noting that in many respects, personal support workers are best positioned to be the earliest point of contact if a residents’ health takes a turn.
The Neighbourhood Team Development program has helped all team members feel more comfortable working together to put residents’ needs first, Megan points out. With more education for direct caregivers she believes greater improvements can be made and each resident who avoids an uncomfortable visit to the hospital will feel the success of all these efforts.