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1 Personal Care Home A monthly summary of activities and announcements relating to personal care in Winnipeg Volume 2, Number 9 Season s Greetings from Réal Cloutier With the holiday season fast approaching, I want to take this opportunity to thank all of the staff for their hard work during this past year. Your commitment and dedication to our residents and patients - ensuring they are cared for with dignity and compassion - is admirable. I wish you and your families the best over the holiday season and in the New Year. Réal Cloutier, WRHA Regional Vice President, Long Term Care Deer Lodge Centre wins award at Patient Safety Conference November 4 th 2005 For the last 6 years the Winnipeg Regional Health Authority has held a one-day conference on Patient Safety. In planning this year s conference Advancing Quality in the Name of Patient Safety, the conference committee put out a call in the Winnipeg region for submissions describing local success stories with respect to patient safety. Facilities had to describe a near miss or a critical clinical occurrence that resulted in facilities implementing a change in policy and clinical practice to prevent occurrences of patient injury. From all the submissions received, the organizing committee would choose three to present at the conference. The Deer Lodge Centre, Lifts and Transfers Review submission was chosen as one of the 3 success stories to present. The other two facilities chosen to present were Children s Hospital and St. Boniface Hospital. Although, the initial request for submissions indicated that one winner would be chosen from the three for the best example of a local success story, the committee chose to award the Advancing Quality in the Name of Patient Safety - Leading us to Excellence Award to all three Continued on page 2 You may submit articles for Personal Care Home View by to Leanne Drad at ldrad@wrha.mb.ca 1 November, 2005 RAI Implementation: Data Quality Management Convalescent Home of Winnipeg manages the challenge! Convalescent Home of Winnipeg has been very hard at work! Each and every one of their Residents have had an MDS assessment completed, most have had three quarterly assessments and soon the annual assessments will be due. The data that has been entered with every MDS assessment completed to date will prove to be helpful in making sound, evidenced based decisions in regards to resident care. In support of reliable decisions, Convalescent Home staff have realized that the data must be reliable and of high quality. The RAI data is only as good as the assessor s skills in managing the process. Quality data also is reliant upon administrative process such as assessment schedule management and assignment of responsibilities. Convalescent Home of Winnipeg is in the process of fine-tuning their internal practices to manage the data quality and the process of the of the RAI. The Trainers Karen Bauer and Karen Kearney with the support of their Resident Services Director Rhonda Crane and all of the trained RAI assessors are using creative techniques for seeking out assessment reliability and functional process. Recently in a coordinated effort to determine data quality levels, the Regional RAI Coordinator completed a randomly selected paralleled assessment. Using the assessment observation tool, the progress notes and other supporting documentation and information sources, the assessment process was mirrored as closely as possible. In respect to the Resident a hands on assessment was not completed, which did limit some of the information sources in items such as the Range of Motion test and the Balance test found in section G. The summary included a review of; the assessment and observation process, the MDS timing, the interdisciplinary contribution and the use of available supportive documentation. The outcome of the paralleled assessment provided the site Trainers with insight and direction for further assessment education and RAI process development. A second part of the visit by the RAI Coordinator was Continued on page 2

2 Patient Safety Continued facilities. All the presentations were great examples of ensuring patient safety in their respective programs. Although, I was lucky enough to attend the conference and present the Deer Lodge submission, this is an award that belongs to the members of the Lifts and Transfers Review committee, current and former and to Deer Lodge as a facility. Without the support of the Senior Management, Managers of Resident/Patient Care, Allied Health Department managers, other departments such a Property Services, Security, Housekeeping, DLC s media specialist, the administrative support staff and the volunteers who were our patients for the competency lab, the various components of the Deer Lodge Lifts and Transfers Program could not have been as successful. Without this success, we wouldn t have anything to brag about. I would like to personally acknowledge the following for their contributions to the success of this program. The current committee members are: Sherisse Abraham, Physiotherapist; Luana Whitbread, Educator; Laurie Wallin, LPN; Jan Gunness, MORC; Katherine Campbell, RN; Shaun Haas, Safety Officer (ad Hoc) Former committee members are: Heather Nowatski, Physiotherapist; Diane Gantzel, OHN; Taras Stecy, Safety Officer; Michele Klassen, RN; Donna Cummings, OHN; Jocelyn Danylchuk, HCA CNS - Clinical Corner Best Practice Statement: Cerumen (Ear Wax) Management Recently, a best-practice question was raised as to the appropriateness of ear irrigation/syringing for removal of ear cerumen in older adults. To address this question, a Best Practice Statement has been developed to guide practice around this issue. Please see pages 7 and 8 to this issue of PCH View; feel free to contact me with any questions. Deanne O Rourke Clinical Nurse Specialist, Personal Care Home Program Thank you! A big Thank You! from the PCH Speech-Language Pathology Service for all those who attended (even in snow storm conditions) our Train the Trainer Refresher In-Services. If you missed the sessions, be sure to contact our office so we can ensure you are the list for next year! Kelly Tye Vallis, M.S., SLP Speech-Language Pathologist PCH Program- Deer Lodge Centre 2 RAI Implementation Continued to review the RAI sequencing and timeliness. Attention was given to the sites assessment due report and schedules. As well, a thorough, random review of Resident MDS files was conducted. Through this process the site Trainers could identify timing successes and challenges. The Convalescent Home Trainers plan to develop work processes that will support both the timely completion of the RAI and the interdisciplinary approach that are important for successful assessment. Not only did this visit benefit the site, it also supported the Regions efforts to understand the successes and challenges face by sites to ensure data quality. Education approaches and suggestions for management of the RAI process are both outcomes of the Convalescent Home review. Much credit should be given to those site Coordinators, Trainers and Assessors that have begun to see the need for development of process to support the RAI. Having the MDS, RAPs and Care Plans completed is just a small part of the RAI implementation. Ensuring quality data and then using this data for decision support is the goal that care providers should be seeking. Sites who wish to have their data reviewed in a similar fashion may book times with the Regional RAI Coordinator. ROUTINE PRACTICES UPDATE What are Routine Practices?? Routine Practices are based on important information there is no easy way to determine who is carrying an infectious disease. It is important that we treat all people as though they may be infectious, each and every time we come into contact with blood, all body fluids, broken skin, and/or mucous membranes (such as in the mouth or nose). Routine Practices include Hand Hygiene and barriers such as gloves, gowns, masks, and eye and/or face protection. Other important parts include resident accommodation, resident care equipment, environmental controls, specimen collection, visitor guidelines, education for workers, residents and visitors, and post mortem care. Germs can be spread from one resident to another through sharing equipment and during direct care activities. Routine Practices are the most important way to prevent the spread of infections in all healthcare settings. Submitted by Marianne Woods, Regional Educator, PCH Program & Betty Taylor, Regional Manager Infection Prevention & Control

3 Fall Education Session All about YOU Coming together is a beginning; keeping together is progress; working together is success The Long Term Care Association of Manitoba hosted a seminar on Monday, October 3, 2005 at the Clarion Hotel, Winnipeg where over 100 front-line staff including RNs, HCAs, dietary and housekeeping staff were in attendance. Catherine Cronin, Vice President, Leadership & Organizational Development and Beverly Sterling, Vice President, Labour & Employee Relations from the Bowes HR Group facilitated the morning interactive session. The session identified the importance of team collaboration in today s health care settings and individual commitment to working together to produce the best possible environment for Long Term Care residents, their families and all employees. THE WORKSHOP TOOK PARTICIPANTS THROUGH THE BEST AND WORST WORKPLACE CHALLENGES Deanne André a certified Focusing Trainer from Power of Presence facilitated the afternoon interactive session. Participants were introduced to the practice of Focusing and Bio-Spirituality and some of the potential benefits for health care providers. FOCUSING A POWERFUL TOOL FOR PERSONAL TRANSFORMATION! Participants had an opportunity to view the film Fish during registration and the lunch break. Fish Philosophy has four simple but powerful principles that can be used in everyday life; be there, play, make their day and choose your attitude. To begin to change anything, we have to change the way we speak about it, the way we feel about it and definitely the way we act about it day in and day out. For more information on Fish Philosophy visit: 3

4 PET CORNER: Pet Paradise at Golden Door Geriatric Centre Pets enhance people s lives. Spending time with animals supports social interaction and calms agitated Residents. Pets provide distraction from pain. They counter loneliness and depression, and lower blood pressure. At Golden Door Geriatric Centre we have recognized these benefits for a long time. Our cat Nick and rabbit Thumper have been important members of our Resident population for over five years. In March 2005 we decided to expand our pet program. A Pet Team was developed. Staff members were invited to join, based on their own desire to be involved with this program of care for our Residents. The team members have remained committed and have been invaluable in organizing care for the animals and involving Residents. Recently, two Residents have joined our Pet Team. Our first new pet Finn is a 3 year old mixed breed, medium-sized dog we obtained from an animal rescue in the city. He had been a farm dog with an interest in chasing chickens. He came to us on a two-week trial basis, and then the Residents voted. At Resident Council the response was overwhelming. No one wanted the dog to leave. He is just the right height to be patted from a wheelchair. He is extremely gentle, quiet and calm. His duties include being constantly patted by Residents, eating the numerous dog treats brought in by family members and kept by Residents in their rooms, singing Karaoke with the We want your stories! Do you have news stories, resident profiles or successes in the services you deliver? There are many great things happening in Personal Care Homes in Winnipeg, and we want to share stories from PCH s with others through the PCH View. If you have questions about submitting articles, please contact Leanne Drad at or ldrad@wrha.mb.ca. Getting acquainted with our lovebird. 4 Residents and exercising the staff on their breaks. He has proven to be the perfect pet. Residents love to watch the brightly colored larger fish that swim in our five large aquariums. We have posted laminated information sheets about the fish by the aquariums. Residents and their families talk about the fish identify them and learn about and their natural environments. We have also just acquired 2 peach faced loved birds that were hand raised. The Residents are already enjoying the experience of holding the birds and having them eat from their hands. Pet visitation with animals that may be less suitable to living in a personal care home is also an approach we have been successful with. A big hit with Residents was the miniature horse visiting this summer with his owner. Bringing the horse indoors meant many more Residents could benefit from his visit. The sight of this horse, and offering handfuls of hay, stimulated conversation and reminiscence among the Residents that lasted for many days. The parrot club of Manitoba brought in several tropical birds for a visit. The Residents took turns holding the birds and the expressions on their faces were worth a thousand words. Our plans for more unusual pet visitation include pot belly pigs. We are currently planning to rescue a cat who would be content sitting on Resident s laps. We would love to hear about your successes with Resident pets and pet visitation. We are always open to new experiences. Darlene Solvason, Director of Care Golden Door Geriatric Centre darlene.solvason@goldendoor.ca Continued on page 5

5 Enjoying the Parrot Club visit Nick the cat doing what he does best Finn, our pride and joy Not sure who s enjoying this more Thumper our Dwarf Bunny Finn enjoying one of his many treats of the day. 5 A gold ghourami from our aquarium

6 MIDDLECHURCH HOME OF WINNIPEG, INC. Staff Pictures are Worth a Thousand Words! Staff Recognition Grocery Scramble Staff Recognition Crazy Hat Days Halloween Staff Recognition Grocery Scramble Winner Halloween Winner $50 6 Halloween Winner $50

7 Personal Care Home Program Best Practice Statement Cerumen Management Best Practice Questions: Is ear syringing/irrigation a recommended practice to remove a build-up of cerumen (ear wax) in the ears of older adults? What is the optimal method for removal of cerumen? Summary of Relevant Literature: There have been very few studies done in this area and most of those that do exist are not of good quality. The following is a summary of current research. Indications for removal of cerumen: 1.Asymptomatic cerumen accumulation serves a protective function to the ear and should not be removed. 2.Cerumen removal should only be considered when visualization/assessment of the ear canal and tympanic membrane is required and/or in the presence of otological complaints, for example; Hearing loss, Poorly functioning hearing aid, Ear pain, Ear fullness, Vertigo, Tinnitus 3.Prior to cerumen removal, the ear should be examined by a trained clinician using an otoscope. If the tympanic membrane is visible, cerumen removal is not required. Ear irrigation for the removal of ear cerumen: 1.Ear irrigation may be effective for removing soft cerumen, but there is no research data to support this. 2.Ear irrigation has a number of documented complications; Trauma and/or bleeding to the ear canal, Perforation of the tympanic membrane, Hearing loss, Otitis externa, Tinnitis, Vertigo, and Pain 3.Ear irrigation should not be performed if any of the following contraindications are present: Current, previous or suspected perforation of the tympanic membrane, Presence of tinnitus or vertigo with ear irrigation, Swelling or bleeding of the ear canal, Previous ear or mastoid surgery, Unable to cooperate, Presence of ear tubes, Foreign body in ear, Recurrent external or middle ear infections, Deafness in one ear and impacted cerumen in the other (risk of causing bilateral deafness), and 7 Resident anxiety about the procedure. Referral to a specialist (i.e., audiologist or ENT specialist) may be considered in the above situations. Ear drops for the removal of ear wax: 1.Ear drops (either oil- or water-based) assist in the removal of ear cerumen without the use of ear irrigation. 2.There is no evidence to suggest one type of ear drop is superior to another. 3.There is no definite evidence to support the use of ear drops prior to ear irrigation is helpful in removing ear cerumen. Prevention of excessive cerumen accumulation: 1.Ears should be examined by a trained clinician on a yearly basis or with changes in hearing or other otological complaints. 2.In cases where ongoing excessive cerumen accumulation is a concern, a preventative approach should be undertaken (i.e., 1-2 drops of mineral or olive oil in an otherwise normal ear(s) prior to bedtime, once per week). Best Practice Recommendations: The following recommendations are based on the literature and expert opinion in this clinical area: Recommendation #1: Ear irrigation is associated with a number of risks and its use should be limited. Recommendation #2: The following procedure for cerumen removal is recommended: 1.Instillation of ear drops: Have resident lie with the affected ear upwards. Pull the pinna upwards and backwards. Instill 2-3 drops of mineral or olive oil into the ear canal. Gently massage just in front of the ear. Have resident remain in this position for 5-10 minutes. Do not plug the ear with cotton, as this will absorb the oil. Repeat in other ear if necessary. Repeat this once daily (preferably at hs) for 14 days. When bathing/showering resident, allow warm water to flow into the ear canals to assist in flushing out the cerumen. *Note: The oil will cause the wax to swell while it loosens, which may cause a temporary worsening in hearing. Continued on page 8

8 Best Practice Continued 2.If the above procedures are not effective in removal of the cerumen and no contraindications are present, then ear irrigation may be indicated/considered. 3.If irrigation is undertaken and not effective in removal of the cerumen, referral to a specialist (i.e., audiologist or ENT specialist) may be required to provide advice or to remove the cerumen using other methods. 4.After the cerumen has been removed using any of the above methods, the resident and ear canal/tympanic membrane should be closely monitored for signs and symptoms of infection for a few days following the procedure. Recommendation #3: Ear irrigation should be only performed by a trained/ qualified clinician. If a nurse is to perform ear irrigation, there must be a process for training and a transfer of function agreement and policies in place at the PCH to support the practice. Educational Resources: Educational and reference materials regarding ear care procedures/policies are available via the PCH Program. Please contact Marianne Woods at for further information. References: Bird, S. (2003). The potential pitfalls of ear syringing. Australian Family Physician, 32(3), Browning, G. (2004). Ear wax. Clinical Evidence, 14, Burton, M.J. (2005). Ear drops for the removal of ear wax (Cochrane Review). The Cochrane Library, 2. Dinces, E. A. (2005). Cerumen. UpToDate, topictext.asp?file=genr_med/26969&type Grossan, M. (2000). Safe, effective techniques for cerumen removal. Geriatrics, 55(1), Prodigy Knowledge (2004). Prodigy guidance: Earwax. Rodgers, R. W. (2004). Hearing loss and wax occlusion in older people. Practice Nursing, 15(6), South Western Staffordshire NHS. (2005). Ear irrigation guidelines. DN10.pdf Compiled by: Deanne O Rourke, R.N., M.N., GNC(C) Clinical Nurse Specialist, Personal Care Home Program Transfers to Emergency Data Collection The Emergency Care Task Force Report identified a number of deliverables for the WRHA PCH Program, including the development of criteria for transfer of a resident to an Emergency Department. In order to achieve these deliverables, it was essential to have accurate data regarding the number of transfers to Emergency Departments and the reason for the transfer. As the data required was not available from other sources, each PCH collected and reported data on transfers to Emergency for a six- month period from April 1, 2005 to September 30, We are now in the process of collating a summary of the data and expect to have some outcomes for the PCH Program in the near future. Thank you to all Personal Care Homes for faithfully submitting your data each month!! Submitted by Marianne Woods, Regional Educator, PCH Program Transfer Referral Form Effective communication is the key to quality resident/ patient care. Safety issues occur when vital information is not shared between receiving and sending facilities during transfers. To assist with effective communication, the Regional Health Authorities of Manitoba felt that a common documentation tool to accompany the resident/patient on transfer was required. This new Transfer Referral Form was developed with input from both rural and urban health care providers, and is intended for use with all resident/ patient transfers across Manitoba. If you have any questions about this new form, please contact Marianne Woods at Submitted by Marianne Woods, Regional Educator, PCH Program 8

9 Focus on the Video Collection Picks from the J.W. Crane Memorial Library These three videos are newly arrived at the Crane Library. See me. Distributed by Concept Media, c2001. (10 min.). Suggested by a poem of an unknown author, this film urges the viewer to see the individuality - the talents, the rich family history, and the ageless person - residing inside the lined faces and time-worn bodies of the elderly. For adult caregivers, students of lifespan human development, and anyone in the helping professions. Call no.: WT 31 S451s 2001 AV Accepting the challenge : providing the best care for people with dementia. Presented by the Alzheimer s Association, Eastern North Carolina Chapter. [Raleigh, N.C.], Eastern North Carolina Chapter of the Alzheimer s Association ; [Baltimore, Md.] and distributed by Health Professions Press, c2003. Through interactive classroom lecture, demonstration and on-site interactions with Alzheimer patients, this DVD helps professional caregivers to provide the best care for people with dementia. Call no.: WM 220 A28a 2003 AV House calls. Montreal : National Film Board of Canada, 2004 (55 min.) Mark Nowaczynski, a physician and photographer who, as part of his practice, started documenting the lives of many of his elderly clients with evocative black and white photographs. In addition to being one of the few doctors who perform house calls, Dr. Mark uses the photos as calling cards as he tries to stimulate change by raising awareness about the lack of in-home medical care for this growing segment of the population. His passion for photography is matched only by his commitment to improve the lives of his patients. Call no.: WT 100 H842h 2004 AV The Crane Library has a collection of over 800 videos, games and other audiovisual titles. To find out what other videos are available you can download our video catalogue in PDF at health/deerlodge/videocat.shtml. You can also search the Crane catalogue for specific video titles in the J.W. Crane Library, deerlodge or call Laurie at To see what is available at other Winnipeg hospital libraries, search BISON, The UM Library Catalogue Videos may be borrowed for a period of 7 days. To arrange to borrow a video, call the J. W. Crane Memorial Library at And don t forget: If you re interested in this or any other healthcare related topic, the J. W. Crane Memorial Library at Deer Lodge Centre is now offering free literature search services and article delivery service for all Winnipeg personal care home staff. Library staff will perform literature searches on your topic of interest, and provide a list of references and abstracts to journal articles, books and websites. You may then identify and request any articles, books or videos on this listing from the Library. To request a literature search, , fax or phone Laurie Blanchard, Outreach Librarian at lblanchard@deerlodge.mb.ca, FX: (204) or by phone at (204)

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