Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/31/2017 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a Quality Improvement Plan. While much effort and care has gone into preparing this document, this document should not be relied on as legal advice and organizations should consult with their legal, governance and other relevant advisors as appropriate in preparing their quality improvement plans. Furthermore, organizations are free to design their own public quality improvement plans using alternative formats and contents, provided that they submit a version of their quality improvement plan to Health Quality Ontario (if required) in the format described herein. 1
Overview The Corporation of the City of London Dearness Home, is a Municipal home owned and operated by the City of London, managed by Extendicare who has developed a Quality Framework which is comprised of key components. These key components are illustrated by the supporting structure of a house. This framework provides guidance and direction to assist our home to achieve our mission, vision, standards of care and commitment to our residents. The Framework is built on strategically aligned and interdependent blocks of foundational elements which, combined, enables all of us to achieve our overall mission "Compassionate People enriching the lives of others. Always." The framework is intended to focus our thinking and activities towards advancing Dearness Homes' guiding business principles: quality of resident care, safety and a quality of life experience that is meaningful to each resident. Dearness Homes Mission Dearness is about Compassionate people enriching the lives of others. Always. Dearness Homes Vision Dearness Home aspires to become recognized for our leadership in the provision of comprehensive long-term care and community services. We will continue to provide a warm and caring setting for the community we serve. We will work diligently as we anticipate the rapidly changing future of healthcare to work to develop innovative and dynamic ways of responding to the needs of our residents, clients and members of the London community. Performance monitoring will include but not be limited to the following: - Monitoring key quality indicators - Internal audits - External audits - Program evaluations To successfully advance quality, all staff will be involved in data collection, data analysis, satisfaction surveys and resource utilization analysis. Dearness Home measures and monitors our quality initiatives through the use of data accuracy and quality indicator score cards. Overview Dearness Home, managed by Extendicare Assist has a Quality Framework that outlines the way in which our home is supported to achieve success in all aspects of quality, in addition to the focus on quality of life, safety, compliance and resident satisfaction. Extendicare s assisted homes in Ontario are responsible for driving their quality improvement plan and are working closely with specific consultant leads who support homes in their own area of expertise. The focus of consultant support will be falls, restraints, pressure ulcers, continence, antipsychotics, resident experience and Emergency Department visits. Our strategic direction and the initiatives that support it also closely align with CARF standards and meet the requirements of our Long Term Care Service Accountability Agreement. Dearness Home will continue to focus on the reportable indicators identified below that are impacting residents well-being and quality of life, striving towards the Health Quality Ontario benchmarks. 2
Falls Restraints Worsening pressure ulcers Antipsychotic drug use ED visits Resident Satisfaction Our Resident Satisfaction survey did not capture the information as needed this past year so our goal is to incorporate the Inter RAI Qol question into our survey to accurately capture this information. QI Achievements From the Past Year Last year the Dearness Home was incredibly proud to accomplish a 3 year excellence award with CARF Accreditation. Months of preparation for this accomplishment included amazing team work and input from all aspects of our stakeholders from our Resident Council, Family Council, staff, management, volunteers, caregivers, community partners and the list goes on. There are many contributing factors as to why this accomplishment created much excitement for our Home. Accreditations allows us to compare our services with national standards of excellence for quality and safety, it guides our ongoing quality improvement processes and has helped (and will continue to help)our residents, care partners and staff to become more informed and involved with important quality and safety processes in our home. Our Resident Council took a valued lead in ensuring diversity is valued in our Home with committee work and inclusion on admissions. Our Surveyors gave us outstanding feedback from all who were interviewed during the survey and this was supported by the fantastic outcomes of our Resident/Family Satisfaction survey showing a 100% score in how we valued Diversity in our Home as well as the overall rating of 93% for Dearness as an excellent place to live. Accreditation has been and continues to be a source of great pride and accomplishment for all who live, work, support and volunteer at Dearness Home. Population Health The Southwest LIHN has identified a strong demand for mental health resources over the last year as per the South West Local Health Integration Network Annual Report. As a result the LIHN experienced an increase in ALC days for seniors with responsive behaviours in conjunction with an increase in high acuity mental health patients overall, placing a significant strain on the Emergency rooms and hospitals in general. Dearness addresses these concerns by supporting our in-house BSO team and ensuring all residents in need have a timely referral and response. Dearness also offers access to an in-house psychiatrist. The psychiatrist works closely with our BSO team and our Full-time Social Worker to address the mental health concerns of our residents. The psychiatrist, social worker, and BSO team collaborate with our team of in-house physicians to prevent hospital transfers for mental health reasons when appropriate. Dearness also works closely with the Regional Psycho- Geriatric outreach team. The team focuses on elderly individuals who are challenged with mental health problems such as depression, psychotic disorders and dementia. The team consists of a Geriatric Psychiatrist and a Clinical Nurse Specialist with expertise in mental health issues. Services provided by the team include clinical 3
consultation, education, and community development. The Regional Psycho-Geriatirc team uses Cognitive Behavioural Therapy as their therapeutic approach to care. Dearness also offers 2 secure units for residents requiring a secure environment with more environmental controls, such as those individuals suffering with significant responsive behaviours, dementia, mental health and addiction issues, and/or other disorders. Dearness has also committed to training the majority of all direct care staff (goal of 80%) in Gentle Persuasive Approach. Dearness has 5 GPA certified coaches who guide the participating staff members to understand responsive behaviours in order to be able to respond effectively and appropriately. There is a focus on respectful self-protective and gentle redirection technique for use in situations of risk. Dearness also maintains 2 Snoezelen rooms. Snoezelen rooms have proven to be effective in calming aggressive behaviour, reducing agitation and anxiety, and improving mood overall in elderly suffering from dementia and other mental health and development issues. One of our rooms is located in a general area for all residents with need to access, the second room was added last year to one of our secured units to mitigate stimulation to and from the other room in the general area. Equity As per the South West Local Health Integration Network Annual Report 2015-2016, our LIHN is home to 5 First Nations communities and a significant off reserve indigenous population. In order to better serve this particular population, Dearness has adopted the Indigenous Cultural Safety Training for all of the management team. This is an on-going process which will serve to increase knowledge, and self awareness, while enhancing the skills of those who work with and/or interact with Indigenous peoples. Also, outcomes of the 2016 resident satisfaction survey reiterate 100% score of excellence under the question "Diversity is Valued at Dearness Home". Dearness home has a Spiritual Care committee that meet quarterly to review reports regarding religious affiliation and need. As per these reports 80% of Dearness home has self disclosed as Christian. As such, the majority of our spiritual care programs are geared towards this group. Dearness does however ensure individuals identifying non-christian spiritual care needs have access to community supports. Our recreation team will contact the appropriate spiritual care provider and have them come to the home to meet the needs of the residents. An on-call list of these providers is kept at all nursing stations for easy referral and access. Dearness home also has a multi-faith guide in our palliative care binder on each of our 9 units. For a 45 different faith groups the guide identifies holy day observations, health and dietary considerations, end of life care, and beliefs and practices. At Dearness each floor has a list of staff who speak languages other than English and what area they work. These staff can be called upon when needed to communicate with residents and families. Dearness also has an interpretation services resource binder at each nursing station which includes Pictographic Communication Resources, Language Translation Resources, Resource Access to CNIB and Canadian Hearing Society. 4
The corporation of the city of London has an AODA committee and funding for upgrades that fall under that category. This past year we received funding for accessibility upgrades including height adjustable tables and improvements to our accessible doors. Integration and Continuity of Care The success of this QIP requires collaboration with multiple partners which CCAC, the LHIN, BSO, OARC, OANHSS, research partners, and vendors such as Medical Mart and Rexall Pharmacies. In addition, our partnerships extend to our Medical Advisor and Attending Physicians and as a teaching facility for the University of Western Ontario for physicians. Dearness will be working closely with Rexall as our new pharmacy provider in converting to PCC Orders Management from the previous legacy edition. This conversion will streamline workflows, reduce errors and costs while improving quality of care. Access to the Right Level of Care - Addressing ALC Issues Dearness home has an active and engaged Behavioural Supports Ontario team, two secured units with expertly trained staff, and a full-time social worker. Combined, these supports assist in decreasing the amount of time persons with symptoms of dementia, other mental health concerns, or responsive behaviours wait in acute care for extended periods of time to be admitted or return to long term care. Dearness also supports a robust team of physicians, which provides in house care to our residents 5 days per week, with access to an on-call physicians 24hours per day, 7 days per week. As a teaching facility of resident physicians, we also have regular access to several resident physicians above our standard compliment of in house doctors. As a new initiative by our Medical Director, in house physicians are being encouraged to complete suturing at Dearness when appropriate to prevent a transfer to hospital and possible admission. This coming year, we will be focusing on IV management as an essential part of our education for Registered Staff. With the addition of this skill, our residents may be released from their hospital phase of treatment earlier. Residents may also be more likely to receive initial IV treatment in Dearness, preventing a possible transfer to hospital. Engagement of Clinicians, Leadership & Staff Dearness Home as an Extendicare Assist Home is part of a large organization in which there are many opportunities to engage with staff and leadership in sharing quality improvement goals and commitments. This is achieved through bench marking, using experiences of other homes to share best practices, annual quality and strategic planning conferences and participation in the Ontario Association of Non- Profit Homes for Services for Seniors and annual quality forums. Resident, Patient, Client Engagement Dearness Homes mission is Compassionate People Enriching the Lives of Others Always and we accomplish this by engaging our residents and families. We promote transparency with residents and families by requesting their participation in various activities such as quality improvement projects, satisfaction surveys, various committees, and resident and family councils. We actively share Ministry inspection reports, quarterly indicator results, Accreditation survey results and concerns and successes in the home. On an individual basis we involve residents and/or families by discussing their unique needs, preferences and concerns and then building their plan of case based on these discussions. 5
Staff Safety & Workplace Violence In depth education on Bill 168, Workplace Violence and Harassment, has been integrated into our annual Mandatory education which must be attended by all staff and management of Dearness Home. On their first day of orientation at Dearness, all new staff are educated on Bill 168, Workplace Violence and Harassment. All members of the management team and staff are participating in the the City of London's I Step Forward program, which is a sensitivity training program aimed at ending harassment, violence in the workplace. All Dearness staff are also being trained in Gentle Persuasive Approach which teaches de-escalation techniques/approaches to decrease risk of workplace violence. Through the city of London Dearness home also has access to Corporate Security and Emergency Management who: 1. Assist in the assessments of risks of workplace violence. 2. Assist with the development of corporate-wide and department/division specific workplace violence prevention measures, procedures and related training. 3. Notify Human Resources of incidents of workplace violence and domestic violence in the workplace 4. Respond to reports of incidents of workplace violence and domestic violence in the workplace, including the development of safety plans where appropriate. 5. Assist in the response to incidents of workplace violence, including those likely to expose a worker to physical injury in the workplace relating to domestic violence 6. Track, analyze and provide recommendations on incidents of workplace violence. Through the city of London, Dearness also has access to Human Resources who: 1. Assist in the response to incidents of workplace violence and domestic violence in the workplace. 2. Coordinate and provide support services for those who have experienced workplace violence or domestic violence in the workplace. 3. Assist with the development of corporate-wide and department/division specific workplace violence prevention measures, procedures and related training. 4. Assist in the assessments of risks of workplace violence. 5. Assist in the development of employee safety plans. 6. Review and update this policy as often as necessary, but at least annually. 7. Advise the appropriate joint health and safety committee of the results of all workplace violence risk assessments and provide copies if the assessments are in writing. 8. Provide support to employees, including referrals to available services and programs on workplace and domestic violence. Through the city of London, Dearness also has access to the Workplace Violence Prevention Response Team who: 1 Where appropriate, provide advice and/or direction with respect to dealing with concerns and incidents of workplace violence and domestic violence in the workplace. 2 Determine appropriate corrective and/or disciplinary action to be taken in response to incidents of workplace violence and domestic violence in the workplace Sign-off It is recommended that the following individuals review and sign-off on your organization s Quality Improvement Plan (where applicable): 6
I have reviewed and approved our organization s Quality Improvement Plan Board Chair / Licensee or delegate Administrator /Executive Director Quality Committee Chair or delegate CEO/Executive Director/Admin. Lead (signature) Other leadership as appropriate (signature) 7