Misericordia Place Hosts Resident Art Show

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1 HomeView Personal Care A m o n t h l y s u m m a r y o f a c t i v i t i e s a n d a n n o u n c e m e n t s r e l a t i n g t o p e r s o n a l c a r e i n W i n n i p e g September, 2008 Volume 5, Number 7 Misericordia Place Hosts Resident Art Show By Ellen Locke, Misericordia s Recreation Services Manager Resident Marie Mackle and her sister Evelyn Lamont pose with some of the artwork on display. The members of the popular Art Circle Group are in the midst of their first Art Show, showcasing the talents of our Misericordia Place residents. The Display Gallery is located in the main hallway on the first floor and celebrates the past and present artistic talents of the residents. The Recreation Department, with the help and support of Teresa Campbell from Spiritual Care, invited families, friends and staff to join us in celebrating the gallery opening with a Sparkling Juice and Cheese Event featuring the music of Dorothy Penner. Tours of the gallery were offered to residents and families. The Art Circle Group was created by Recreation Facilitator Linda Martinenko to fulfill a request by the residents at a Resident Advisory Council Meeting. The group started out with six members meeting to draw and socialize. The group has since grown to residents. We invite everyone to come and see the Art on Display through the month of July at Misericordia Place, 44 Furby Street. Ethics News: Call to Register! WRHA Level Two: Ethics Resource Workshop Are you interested in learning more about: the role of conflict resolution in ethical situations? a systematic approach to ethics in clinical decision-making? where to find additional ethics resources in Winnipeg and on the web? WRHA Ethics Services is now accepting registrations for the 5th Annual Level Two: Ethics Resource Workshop. This three-day event will be held October 29-31, See attached Call to Register. Note: Not sure if you meet the pre-requisite for this workshop? Contact WRHA Ethics Services at or ethics@wrha.mb.ca

2 Deer Lodge Centre Implements New Recreational Assessment and Care Plan Tool By Rosie Sikora, Manager Recreation and Volunteer Services, Deer Lodge Centre An external review conducted of the recreation program at Deer Lodge Centre last year recommended the use of a new assessment tool called the Measurable Assessment in Recreation for Resident-Centered Care (MARRCC). The tool was implemented at the Centre in February 2008 with a plan to replace all previous assessments and care plans by year end. As summer draws to an end this project is approximately 75% completed with high satisfaction reported by staff as well as external reviewers. MARRCC is a computer software program, but can be used in paper form as well. It is comprised of a Recreational Initial Assessment, Care Plan Library, Recreation Quarterly Progress Notes and the Recreation Annual/Change of Care/ Re-Admit Assessment. The initial assessment includes a general information section where all pertinent information is recorded. These include medications that could affect leisure functioning, dietary concerns, safety issues and prior life roles and routines. The assessment then guides the recreational professional to determine a resident s abilities in the cognitive, social, physical and emotional domains. The recreation professional will determine a resident s abilities within each domain by answering true or false to a number of indicators. Once this section is completed a score Deer Lodge Centre resident, Bob Farr, with Recreation Facilitator, Eddy Veltri based upon the answers will determine the residents abilities in each of the four domains as high, moderate or low. This scoring process rated very high on reliability and validity in a study conducted on 66 residents from 11 skilled nursing facilities across North America. The last section of the assessment is the Past and Present Leisure Interest Activity List Quick Reference. This section is comprised of a list of leisure activities. It also provides an area for the recreational professional to record current or past interest as well as opportunities for leisure education. The section includes past leisure participation patterns, present attitudes and awareness and the emotional response to placement in long-term care, all factors in providing therapeutic programming. Once the assessment is completed MARRCC will assist the recreational professional in care planning. The care plan library includes a number of sample care plans for each ability within all domains and sample interventions. Each statement is specific, measureable and clearly related to the problem. The recreation professional may choose the care plan appropriate for the resident, or modify or create a new care plan statement to best suit individual needs. Quarterly progress notes assist the recreational professional in Recreation Assessment continued on page 3

3 Recreation Assessment continued evaluating the effectiveness and appropriateness of the resident s individualized care plan. It ensures that the resident s progress towards the achievement of the care plan goals are reviewed and helps to determine the need to revise the residents goals and interventions. The Annual/Change of Care/Re-admit Assessment is formatted similarly to the initial assessment. It is designed to assist the recreational professional to evaluate the effectiveness and appropriateness of the resident s individualized care plan and monitor change in the resident s functioning level. It helps to determine the need to revise the residents goals and interventions View and enables the recreation professional to track and monitor change in resident s individual needs and adjust the recreation program designed to meet those needs. The Annual/COC/Re-admit Assessment is completed upon the resident s readmission to the facility, once per year prior to the resident s MDS and within 14 days of a major change in health or ability. While the paper copy of the assessment is useable, the software offers handy features such as completing the score calculations accurately and instantly and keeping recreation professionals informed on the due dates of progress notes and annual reviews. A lovely feature to the program is the ability to group residents by domain functioning level, participation pattern, activity preference and additional information, allowing the recreation professional to program plan to specific target audiences. To list just a few examples, at the click of a button, lists can be generated of those interested in a specific activity; have a birthday in a specific month; are veterans or who have a history of wandering/ elopement, etc. For more information on MARRCC visit www. siennasmarkllc.com Take me out to the ballgame By Ellen Locke, Manager of Recreation Services On June 26, 2008 the Misericordia Health Centre Recreation Department took 20 of its Interim Care residents to a very exciting Goldeyes Game. The Thursday evening game was against the Kansas City Rail Cats with the Goldeyes winning seven to three. The residents were treated to a Goldeyes homerun, as well as some very exhilarating plays. Most of the residents who attended had played on a baseball or softball team in their youth. All were definitely Goldeyes fans! For some, it was their first visit to the Canwest Park. We were lucky to have a beautiful summer evening to cheer on our winning Goldeyes. Best of all, each resident received a Goldeyes bandana for coming to the game.

4 Falls Prevention Initiative in PCH Spreading Patient Safety Learning The number of critical incidents (CIs) reported to the WRHA Patient Safety (PS ) team has increased over the last four years in 2008 we project that almost 500 CIs will be reported and reviewed. New legislation (November 2006) made the reporting and review of CIs mandatory. Evidence Act changes facilitated the engagement of healthcare providers in robust discussions of CIs. This produced more effective recommendations focusing on systemic factors that combine to produce the conditions for a given CI. The PS Team wanted to promote system-wide sharing of the learning arising from the review of CIs without breaching the provisions of the Evidence Act. A Critical Incident Learning Summary (CILS) is developed based on a given CI review committee s final report. The CILS is a carefully deidentified abstracted summary of a CI. It consists of a short description of what happened, followed by the main findings of the review and the recommendations which have some learning potential for others. With strong support from the WRHA Board, 12 CILS were distributed in March and by summer 35 CILS had been circulated. Groupings of CILS will continue to be sent to all facilities and clinical units within WRHA with the request that they be circulated widely to direct care providers. Along with health disciplines faculties, licensing bodies and all other RHAs within Manitoba and an increasing number of national organizations the list of those receiving the CILS continues to grow. Additionally, a CILS is provided to the patient and/or family members when the results of the investigation are being shared with them. An assessment of this process is now underway. Anecdotal reactions to date seem to validate the usefulness of sharing the learning form CIs. Staff are happy to learn that action has been taken when CIs are reported. The CILS are used to stimulate discussions on clinical units and have been used as teaching examples in health disciplines faculties. The CILS will soon be available on the WRHA intra- and inter-nets. ***If you have questions about the process or would like to receive examples please contact the PS team at: ci@wrha.mb.ca submitted by Dr Rob Robson

5 CNS Corner Luana Whitbread and Judy Robertson, Clinical Nurse Specialists, Personal Care Home Program Increasingly Personal Care Homes have expressed interest in being able to initiate subcutaneous infusion lines as an alternative method for intermittent medication administration. Although the oral route is the preferred route there will be circumstances where the oral route is no longer feasible. If pain management is the only issue for the resident who is already taking opioids it may be possible to switch to a Fentanyl patch. Otherwise the subcutaneous route offers an effective, safe and comfortable alternative for symptom management. As well, it doesn t significantly increase the nurse s workload since the subcutaneous cannula can be left in situ for up to one week. Common indications for the use of the subcutaneous route for medication administration: Circumstances hat preclude or compromise oral administration: Dysphagia due to neuromuscular weakness or mechanical obstruction Decreased level of consciousness Intestinal obstruction Nausea and vomiting Symptom control crisis requiring rapid and reliable medication administration and absorption. Poor or variable compliance because of: Dementia Agitated delirium, with paranoia and non-compliance Personality issues (Beel & Harlos, 2001; Letizia, Shenk & Jones, 2000; Mitten, 2001). What you need to know about risks: A retrospective study evaluating intermittent subcutaneous infusions in 191 hospice patients found that complications such as redness, tenderness or inflammation at the catheter site, leaking needles, and catheter malfunction were each reported less than 1% of the time (Letizia, Shenk & Jones, 2000). With the over-the-needle cannula (IV catheter) a needle is only required for insertion. Following insertion, the needle is discarded and all that remains in place is a plastic cannula. This will reduce the risk of needlestick injuries (Dawkins, Britton, Johnson, Higgins & Dean, 2000) and also reduces the frequency of site changes as compared to a metal butterfly needle (Dawkins et al., 2000; Macmillan, Bruera, Kuehn, Selmser & Macmillan, 1994). Methods to consider: When you have decided that subcutaneous infusion lines are something that your PCH would like to implement there are two methods to consider. Option A: A completely needleless system using over the needle cannulas (BD Saf-T- Intima), interlink injection cap, and interlink injection cannulas Option B: A partially needleless system using over the needle cannulas (BD Saf-T- Intima) Option B is the simplest as only one extra item is needed over and above the usual supplies that you would stock at your facility. In this case the medication would be injected into the injection cap using a safety engineered needle and syringe instead of using a syringe and plastic cannula as in option 1. The supplies can be purchased at Stevens. The BD Saf-T-Intima sells at a contract price of $78.40 for a box of 25; order number If your are interested in learning more about Subcutaneous lines as an option for medication administration please call Judy Robertson, CNS or Luana Whitbread, CNS References: 1. Palliative Info website: 2. WRHA Pain Assessment and Management Clinical Practice guideline 3. WRHA Palliative Care subprogram Procedure for Over the Needle Cannula Insertion, Removal, Medication Administration, and Fluid Administration for the Individual in the Home

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7 WRHA Nutrition and Food Services Diet Compendium Implementation Did you know 5 to 85% of LTC residents are malnourished, under-nutrition affects residents day-to-day functioning, increases the risk of death and disease and many nutrition related problems in the LTC setting can be ameliorated? Nutrition and Food Services has completed an evidence-based review of current literature in order to guide the provision of meals. This is part of an ongoing commitment to ensure that nutritional interventions provided are based on sound science, recent evidence and expert review. The second revision of the Diet Compendium, which was distributed to Personal Care Homes and Hospitals this spring, describes all of the standard and therapeutic diets used within the region and includes a new category, Long Term Care. The goals of the Long Term Care Clinical Nutrition Expert Review Group were to consider the unique nutrition needs of the senior population, to ensure the usual standard diets for this population are appropriate and to identify gaps where present. While not all diets listed in the compendium will be used in each personal care home, where a diet is needed, this tool allows consistent care across the continuum of services within the WRHA, promotes quality service and reduces risk that occurs with confusion about what a diet consists of and which foods fit within each diet. The Diet Compendium is a cornerstone to best address the nutrition issues in the personal care home setting. Many individuals contributed to the development of the Clinical Nutrition Executive Summary. The Long Term Care Clinical Nutrition Executive Summary, approved by the Nutrition Advisory Subcommittee (a subcommittee of the WRHA Pharmacotherapy Coordinating Committee), the PCH Medical Director Advisory Committee and the PCH Pharmacy Advisory Committee, was reviewed by many WRHA dietitians as well as staff from a wide range of settings and disciplines including medicine, nursing, pharmacy, occupational therapy, speech-language pathology, university professors and industry professionals. The feedback was valuable to improve the end result and is much appreciated. Interested in what this evidence based review includes? Contact your facility dietitian or Jean Helps, Clinical Nutrition Manager, Long Term Care (jhelps@wrha.mb.ca).

8 News from the J. W. Crane Library University of Manitoba Health Sciences Libraries Association Education-in-a-Box: We are pleased to announce that a new addition to the Education-in-a-Box series is now available. The Education-in-a-Box series is collaboration between the J. W. Crane Memorial Library at the WRHA Personal Care Home Program. Each box focuses on a topic of interest to staff in personal care homes and includes one or two current videos, printed material, and a list of associated websites and other material, such as books and additional videos available from the J. W. Crane Memorial Library. Additional materials can be ordered from the Library. Topics to date are: Falls, Sexuality, Wandering and Person-Centred Care. A box on Oral Care is in development. Caring for Residents with Multiple Sclerosis contains resources supplied by the MS Society of Manitoba to assist personal care home staff in caring for the unique needs of residents with Multiple Sclerosis. To reserve the Caring for Residents with Multiple Sclerosis box, contact the J. W. Crane Memorial Library at or dlclibrary@umanitoba.ca Current Perspectives Series: Don t forget to check out the J. W. Crane Memorial Library Current Perspectives series. This series of bibliographies focuses on specific issues of interest to long term care workers including Falls, Communication and Dementia, End of Life in LTC, Continence, Family Relationships, Transitioning to Long-Term Care, Depression, Sexuality and more. Each bibliography contains recent journal articles, practice guidelines, books and audiovisuals at the J. W. Crane Memorial Library, and relevant websites. They are an excellent starting point for information on a subject, if you are working on continuing competency, or writing a paper for a course. You can print out copies of the series online at umanitoba.ca/libraries/units/health/links/aging.html, or if you don t have access to the Internet, contact the Library to have one mailed to you. Library Fines: Effective Sept 2, 2008, the J.W. Crane Memorial Library will be implementing the University of Manitoba s policy for overdue library materials. A fine of $.50/day/item will be assessed on overdue materials. The fine will be effective following a 7-day grace period and will accumulate until the material is returned to a maximum of $20.00 per item. When an account accumulates $ of fines that account is blocked. This means that borrowing privileges, including access to online journals and databases, will be suspended until the fine is paid. For more information please contact the Library.