Quality improvement narrative for Davis Centre

In 2024, our LTC division is introducing advanced diagnostic equipment to all five centers to enhance resident clinical care, improve efficiency and contribute to better health outcomes for our residents.

These devices include ePOC machine and Hemoglobin meter. Our home already uses Afinion CRP meter, Urinalysis machine, bladder scanner and ECG machine. These equipment support early detection of specific medical conditions such as pneumonia, acute changes due to CHF, and UTI etc., providing our clinical team a tool to intervene promptly and treat the condition and potentially avoiding an unnecessary hospital transfer or external medical facilities for diagnostic tests. These devices also help identify and monitor specific chronic conditions when there is an acute change in residents’ health condition and would allow the practitioner to adjust treatment as needed. Overall, the use of these devices will also enhance collaboration among healthcare providers to achieve best possible care to our resident on a more timely manner. Davis Centre also utilizes the Prevention of Error-based Transfer project which focuses on preventing unnecessary hospital transfers.

Davis Centre was also able to secure One-Time Funding from Ontario Health Central Region for bariatric equipment and wound care training in February/March 2024. This will ensure timely access to care by admitting residents with complex care needs and avoid hospital transfers.

Peel's Long-Term Care (LTC) homes are prioritizing the use of data to address health inequities in their programs and services for residents. This work will initially be piloted in one home and efforts will extend to the remaining four, aiming to enhance the quality, scope, completeness and use of health equity data collection. To apply a health equity lens to Continuous Quality Improvement (CQI) work, activities include a comprehensive literature review to identify best practices, a current state assessment of data collection processes, and summarizing findings to highlight gaps and develop recommendations for improvement and future decision making.

In parallel, Peel Region is committed to advancing truth and reconciliation with Indigenous peoples. Staff underwent mandatory Indigenous Cultural Awareness training, achieving 100% completion by November 15, 2023. New employees are required to complete the relevant training modules within their first month of recruitment. Ongoing promotion of Indigenous cultural awareness is facilitated through the Employee Ambassador program, encouraging participation in Truth and Reconciliation Events and raising awareness about available Indigenous resources. Land acknowledgments are integrated into meetings and training sessions, and inclusive leadership training has become a core competency for People Leaders. Davis Centre has been working towards establishing an equitable environment by imparting knowledge to the staff and celebrating the cultural diversity and indigenous culture each year.

In the process of identifying and piloting health equity metrics within LTC homes, there's an opportunity to recognize and support Indigenous people, contributing to a better understanding of the Indigenous culture.

We use ongoing opportunities to engage residents and their families to support improvements that reflect the collective voice and experiences of those living in the home.

Resident and Family Experience Surveys:
The Resident and Family/Caregiver Experience Surveys provide crucial insights into their experiences. We annually review and discuss survey findings via formal and informal channels with stakeholders. These results inform priority areas for quality improvement efforts. Homes diligently act on survey feedback to enhance program and service delivery.

Family Council and Resident Council: We welcome feedback and collaboration with residents and families through council meetings. Regular monthly resident council meetings and quarterly family council meetings are held by Davis Centre to garner feedback for further improvement. These venues also provide peer-to-peer support and the opportunity to share information, discuss potential program improvements, and to stay informed.

CQI Committee Meetings: Davis Centre has a CQI committee in place that utilizes an interdisciplinary approach to evaluate sources of data and discuss, plan, and prioritize quality improvement initiatives. Inclusion of representatives from both residents and families in CQI committee meetings has provided rich discussion and a diverse, lived-experience perspective that was previously missing from the work. They have made valued contributions that have encouraged the group to pause and re-evaluate previous assumptions about what might be the priorities for residents and families. They have also supported the development and review of this year’s Quality Improvement Plan submission. There have been number of positive outcomes from their participation. This fosters a new approach to quality planning that is co-created and co-led with families and residents rather than professionally driven. Davis Centre has worked and strived towards creating a resident-oriented and family-driven environment and workplace.

Care Conferences: Care conferences provide an opportunity to engage residents and their families to share their feedback on care and services. These conferences happen on admission, quarterly, and with significant changes in condition.

Employee wellbeing and a positive workplace culture are central to delivering high-quality care to residents and clients. Staff shortages, challenging workloads, and cumulative exposure to stressful events during the pandemic have highlighted the importance of enhancing measures to support psychological health and wellbeing of the employees. Activities aimed to support employee wellbeing at Peel include:

How Are You Doing Survey (HAYD): The HAYD survey is an important tool that gathers point in time employee feedback on their well-being to identify gaps, opportunities, and themes to enhance psychological health and safety in our workplace. Customized engagement tactics for boosting response rates for LTC staff included utilizing Employee Ambassadors, placing dedicated HAYD iPads on each floor, integrating promotion into employees' job routines, and creating targeted posters. Support from culture & wellness advisors and business coordinators was crucial, alongside new corporate strategies such as prize draws and QR codes linking to the survey.

Health Services Culture and Wellbeing Advisory Group: Formed in the early 2022, this advisory group identified the following immediate priorities: leadership development, raising awareness and engagement with wellbeing initiatives, and promoting diversity, equity and inclusion tools and resources. In addition, there are plans for select employees to undergo a provincial training program that aims to support the National Standard of Canada for Psychological Health and Safety in the Workplace.

Supporting the mental health of the workforce: All homes were successful in their application to Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI) Workplace Mental Health Program. This training and support program aims to develop a culture that promotes and protects the mental health of all team members and improves workforce productivity.

Enhancing workforce analyses: There are challenges related to recruitment and retention across the LTC sector and health system. To help support these challenges, the centralized business support unit (CBSU) has improved it’s data collection and analysis. This work is identifying trends and building benchmarks in service of building a solid workforce management plan that focusses on achieving adequate staffing levels and reducing the likelihood of unfilled shifts and/or overtime.

In addition, employees have a variety of avenues that allow them to identify opportunities to improve their experience in the workplace including peer groups, communities of practice, surveys, and town hall meetings.

Resident safety is a critical component of Peel Region’s Continuous Quality Improvement Program. It is a pervasive theme within our care teams during care conferences and team huddles. Resident safety is also well supported through our corporate and long-term care policies, procedures, and the long-term care performance measurement framework.

Our approach to resident safety includes both prevention activities and robust post-incident follow-up and management. The following examples illustrate some of the work that supports resident safety and incident management.

Prevention

Standardized Documentation: Communication is a critical and foundational element of resident safety. Over the past year, Davis Centre has moved to a structured and standardized documentation approach using SBAR (Situation, Background, Assessment and Recommendation). Embedding this approach into our documentation practices has fostered clearer, more concise documentation that promotes better communication among the care teams.

Daily Continuous Improvement Program: This program allows staff to engage in identifying opportunities to enhance resident safety and clinical care. Potential solutions are brainstormed, prioritized, and the team works to select the most suitable change idea to implement and evaluate.

Post-incident Management

Post Falls Assessment Tool: This tool allows for a comprehensive analysis of the contributing factors that may have led to the fall. The purpose of the tool is to support transparency, learning, and identify areas for improvement.

Medication Incident Management: There are processes in place to mitigate the risk of medication errors and a robust process that follows any medication errors including the completion of a medication error report and a follow-up meeting with the in-home clinical, medical, and pharmacy team.

Review and analysis of complaints and critical incidents: The leadership team reviews and analyses all documented complaints and critical incidents at least once a month. We use the data to identify recurring and system trends to guide quality improvement and risk-management activities.

Violence risk assessments: This assessment is completed after an incident of workplace violence (e.g. resident violent behaviour towards staff) that uses a violence assessment tool that assists in developing strategies and a corrective action plan to mitigate possible recurrence of a similar incident. This is reviewed with The Joint Occupational Health and Safety Committee.

Risk Management Portal: All resident related incidents that pose a real or potential risk to residents are logged in our Risk Management Portal. This includes a tool which analyses contributing factors and potential risk mitigation strategies to consider.

Resident safety remains a top priority for our home. We continue to explore additional processes and changes that may enhance resident safety. We strive to build a just culture where staff feel comfortable coming forward and where we learn collaboratively from errors or incidents and implement action plans to mitigate risk.

In 2023, Peel Long Term Care embarked on a project to bring emotion-based dementia training to first responders in Peel Region Paramedic Services (PRPS), Peel Regional Police (PRP), and Caledon OPP. This project continued the journey in Long Term Care, that began in 2017 with the implementation of the Butterfly Approach which shifts the culture of care for people living with dementia by focusing on their emotional, psychological, and clinical needs.

Recognizing the shifting demographics in Peel, the forecasted increase in prevalence of dementia, and the rate of calls received by police and paramedics, we felt it was important to share our knowledge of dementia and emotion-based approaches to care so that first responders can feel knowledgeable and confident in their interactions with people living with dementia.

Working collaboratively with stakeholders in police and paramedics, we developed and facilitated training for a pilot group of 40 first responders. This training included: characteristics of common types of dementia; the progression of the disease; strategies to communicate with people living with dementia; how to assess situations; how to connect and engage with people living with dementia while moderating the expectations, and how to de-escalate heightened responses during crisis calls.

This project demonstrated innovation in cross-sector collaboration and was an important step in developing stronger connections along the continuum of care in Peel. It reinforced the value of reaching out to partners to work together to achieve a common goal, and created opportunities to highlight services that are interconnected.