How to use this slide deck

This presentation is intended to assist with

staff engagement and implementation.

Speaker notes have been developed for

many of the slides.

You can contact the Ontario Stroke System

Regional Community and LTC Coordinator

for your area to discuss any questions or

additional needs you may have.

How to use this slide deck

This slide deck provides an overview of the

Integration of Stroke Best Practice into LTC

Resident Care Planning Project.

It may be adapted in order to meet the needs

of your facility. Please ensure the integrity of

the content is maintained.

The Integration of Stroke Best Practice

into Long Term Care Resident Care

Planning

April 2013

The Project: Objective

Objective

Integrate the Tips and Tools for Everyday

Living resource into LTC care plan libraries.

As a result, the RAI-MDS assessment

findings would then link with relevant care

plan(s) for stroke survivors.

Stroke in Long Term Care

22% of residents in LTC age 65 or older have had a stroke (Heart and Stroke Foundation of Ontario, 2000).

Stroke is the third most common diagnosis in long-term care (Price Waterhouse Cooper 2001).

Ontario Stroke System

Ontario Stroke System

Consists of 11 regional stroke networks

Addresses the full continuum of care

Goal:

• to coordinate equitable access and

improve outcomes for stroke survivors

and their families through integration of

best practices.

Connecting with Long Term

Care

The Regional Community and Long Term Care Coordinators/Specialists of the Ontario Stroke System (OSS) work closely with LTC stakeholders to increase awareness and facilitate the uptake of stroke care best practices.

Tips and Tools for Everyday Living is a best practice resource available to assist health care providers in LTC to care for resident’s with stroke.

Knowledge Translation within

LTC

The dissemination of stroke care best practices to LTC homes can be challenging for many reasons including:

• increased complexity of residents

• turnover of staff and management

• competing priorities e.g. implementation of the RAI- MDS, other clinical demands

• time and resource constraints.

• variation in the sector (software, practices, staffing)

Knowledge Translation:

Enablers

There are many enablers in long term care which

support knowledge translation:

• Engaged, committed staff

• Collaboration and resourcefulness

• Interest in and support for best practices

• Quality agenda

• Restorative care philosophy

• Focus on the resident

RAI-MDS: The Opportunity

The RAI- MDS provides a framework for care

providers to complete a comprehensive

screening assessment of resident care

needs in a number of areas, including

psychosocial status, communication, activity

levels, cognition and physical condition.

ADDING IT UP

RAI MDS

+ Tips and Tools for Everyday Living TM

= Best Practice Stroke Care Plans

The Project: The Task

• Working groups included representatives

from LTC and Ontario Stroke System

• 12 Stroke Care Plans based on the Tips

and Tools resource were developed

• Reviewed by Compliance Director,

Retirement Home Regulatory Authority,

Ministry of Health and Long Term Care

Developing the Stroke Care

Plans Tips and Tools Modules

• Communication

• Pain

• Cognition

• Perception

• Depression

• Behaviour

• Mobility, positioning, transfers

• Bowel and bladder control

• Hydration, meal assistance & special diets

• Activities of daily living

• Skin care & hygiene

• Leisure

• Interprofessional team

• Caregiver stress

Stroke Care Plans

• Cognition

• Depression/Mood

• Mobility/Transfers

• Hydration, Meal Assistance

• Activities of Daily Living (ADL)

• Leisure

• Skin Care/Hygiene

• Bowel and Bladder

• Behaviour

• Communication

• Pain

• Perception

Stroke Care Plans:

Guidelines

Uses clear, simple and action-oriented language

FIVE STANDARD CARE PLAN COMPONENTS

Focus

•Uses PESS (problem, etiology, signs, symptoms).

Goal

•SMART format written from the resident’s perspective (i.e. what resident will do, look like, etc.).

•Reflects the RAI-MDS Outcome Scales.

Stroke Care Plans:

Guidelines

Interventions

A restorative, interdisciplinary approach. The number of interventions range from 5 to 10 per goal.

Accountability

Specific team members must be identified for each intervention.

Stroke Care Plans:

Guidelines

Timelines

Timelines should not automatically coincide with reassessments (i.e.q3months). Timelines are to be related to resident’s goal or goal assessment.

Example – Perception Care

Plan

FOCUS GOAL(S) TIMELINES INTERVENTIONS ACCOUNTABILITY Apraxia Impaired perception related to stroke as evidenced by the resident being confused over proper sequence of steps for eating, grooming, etc. Impaired perception related to stroke as evidenced by the resident having difficulty using common objects even though he/she is aware of what the object is (e.g. combs hair with a fork)

Resident will require decreased cueing when dressing Resident will require decreased cueing for grooming Resident will require decreased cueing for eating

Use short and simple instructions while performing tasks Plan steps of the task with the resident Assist in starting the next step Break the task into simple steps and reminders for the proper sequencing of task Instruct resident to practice activities Provide hand-over-hand guidance

Instruct family on interventions to increase resident’s task performance. Report to the RN/ RPN any improvements or deterioration in awareness level.

HCA/PSW/Restorative Care/ Therapy Assistants

Stroke Care Plans: Anticipated

Benefits

• Enhanced quality of care

• Supports restorative care approach

• Supporting compliance with:

• Best practice and research-based standards of accreditation organizations (e.g. Accreditation Canada and Commission on Accreditation of Rehabilitation Facilities [CARF])

• The July 2010 LTC Act (including an integrated care planning approach); and

• MOHLTC Inspector expectations

Pilot Project (2012):

Background

The pilot sites were a mix of urban and rural

facilities.

Four LTC Facilities participated:

• Carefree Lodge (Willowdale)

• Fairhaven (Peterborough)

• Pine Meadow (Northbrook)

• Seven Oaks (Scarborough)

Time frame ≈ 6 months

Pilot Project: Evaluation

•95.8% of respondents indicated

that the stroke care plans enhanced

their ability to care for stroke

residents to varying degrees.

•Care plans on transfers and

mobility, perception, cognition, pain

and communication were found to

be particularly useful.

•Pilot homes reported an increase

awareness and uptake of best

practice stroke care.

Pilot Project: Feedback

“The opportunity to ensure that our care planning contained best practices and an evidence base was the foundation for us to move forward in this project.”

“This resource (Tips and Tools for Everyday Living) has been an extremely beneficial tool which assisted staff to understand brain physiology, risk factors, stroke impact on life and how the care team can affect resident outcomes.”

Pilot Project: Feedback

“Tips and Tools for Everyday Living provided an

evidence based approach for team members to

assist the stroke survivor to achieve the optimal

wellness level and their full potential. Our staff

repeatedly expressed the value of this resource.”

Pilot Project: Dissemination

• All Ontario Long Term Care facilities

• Ontario Long Term Care Association

• Ontario Association Non-Profit Homes & Services for Seniors

• Long Term Care Expert Panel

• Ministry of Health & Long-Term Care

• Registered Nurses Association of Ontario Best Practice Champions

Pilot Project: Dissemination

• Stroke Collaborative 2011& 2012

• Canadian Stroke Congress 2012

• Ontario Gerontology Association

Conference 2013

• Ontario Long Term Care Association

Conference 2013

Implementation Resources

•Regional OSS representatives would welcome

the opportunity to discuss how s/he might be

able to support you in the implementation

process.

•Implementation Toolkit

Available at:

• (www.ontariostrokenetwork.ca)

Implementation Toolkit

Contents:

• Project Overview

• Stroke Care Plans

• Implementation Tips

• Frequently Asked Questions

• PowerPoint Presentation

Project Contributors

LTC Home Representatives Andrea DeNeire

RAI MDS Coordinator Terrace Lodge, Aylmer, ON

Phillippa Welch LTC Consultant Woods Park , Barrie, ON

Natalie Cameron Registered Nurse

St. Joseph’s Villa, Dundas, ON Sylvia Masters

RAI Coordinator Leisureworld, Brampton, ON

Erin Cunningham Administrator Muskoka Landing, Huntsville, ON

Alice Jyu Patient Care Manager

Veterans Centre, Toronto, ON Ceclia Yeung APN

Veterans Centre, Toronto, ON Razane Diab

Acting DON Cedarvale Terrace, Toronto, ON

LTC Home Representatives

Denyse Duke

Director of Care, LTC Residence St. Louis, Ottawa, ON

Manon Simard RAI Coordinator Residence St. Louis, Ottawa, ON

Darlene Lawlor RAO MDS Coordinator

Perth Community Care Centre. Perth, ON Jackie Maxwell

DOC Village Green, Selby, ON

Pam Brown Corporate RAI-MDS Coordinator Extendicare (Canada) Inc.

Eastern Operations

Wendy Campbell

Assistant Administrator Stayner Nursing Home

Marsha Nicolson City of Toronto Resident Care Director, LTC Homes and Services Theresa Savard-Maki RAI Coordinator

Bethammi Nursing Home, Thunder Bay, ON

MOHLTC Sandra Schmidt Project Lead

Implementation and Support Long Term Care Common Assessment Project (LTCH CAP)

Soo Ching Kikuta LTCHCAO Program Manager

OSN Community & LTC Coordinators/Specialists Paula Gilmore Vicky Smith

Donna Cheung Sharon Trottman Alda Tee

Jessica Comay Gwen Brown Pauline Bodnar

Sue Verrilli Jocelyne McKellar Mark Morris

CONTACTS

Contact information for your Regional Community and LTC Coordinator can be found at the OSN website.

http://ontariostrokenetwork.ca/landing_map.php?rf=2&id=153&sec=2

Incorporating Stroke Care

Plans into the Care Planning

library at this facility

Discussion

Thank you