How to use this slide deck

1. 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.

2. 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.

3. The Integration of Stroke Best Practice into Long Term Care Resident Care Planning April 2013

4. 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.

5. 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).

6. Ontario Stroke System

7. 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.

8. 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.

9. 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)

10. 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

11. 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.

12. ADDING IT UP • RAI MDS • + Tips and Tools for Everyday Living TM= Best Practice Stroke Care Plans

13. 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

14. 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 Developing the Stroke Care Plans

15. 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.

16. 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.

17. 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.

18. Example – Perception Care Plan

19. 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

20. 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

21. 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: Evaluation

22. 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.”

23. Pilot Project: Feedback • “Tips and Tools for Everyday Livingprovided 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.”

24. 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

25. Pilot Project: Dissemination • Stroke Collaborative 2011& 2012 • Canadian Stroke Congress 2012 • Ontario Gerontology Association Conference 2013 • Ontario Long Term Care Association Conference 2013

26. 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)

27. Implementation Toolkit • Contents: • Project Overview • Stroke Care Plans • Implementation Tips • Frequently Asked Questions • PowerPoint Presentation

28. Project Contributors

29. 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

30. Incorporating Stroke Care Plans into the Care Planning library at this facility Discussion

31. Thank you