eShift – Innovation at Work Presented By: Charlotte Koso - VP Operations South/Central Ontario eHomecare Lead, CarePartners

What is eShift? eShift is an innovative service delivery model initially designed to address a nursing shortage for nursing shift care to children with medical complex needs/parent respite Expanded to include palliative care/EOL care and later also to include eClinic focused on managing patients at home with Chronic Diseases Sensory Technologies Inc. has expanded a variation of this program to USA, UK and France Essentially in Canada utilizes a non-regulated clinician working in partnership with an RN to provide hands-on expert care to patients in their homes

Tech/eShift PSW Certified PSWs with an interest in advancing to providing more complex care to patients Comfortable with shift work and working in partnership with an expert nurse Techs/eShift PSWs work as ‘hands, ears and eyes’ of Directing Registered Nurses Training/education includes: 50 hours of education in classroom including theory, hands-on skills labs, communication labs, role playing, technology labs, certification and recertification requirements Use hand-held device such as an iPhone with access to a portal to document patient information observed and reported by patient and/or family

PSW Orientation – Technology Lab

Examples of Additional ePSW Skills eShift PSWs/Techs have an expanded scope of skills however are not accountable for or able to make any decisions/judgements as to what will be done ePSWs have well-developed observation and reporting skills All tasks are directed each time the skill/task is used (never delegated) Some skills are taught in the classroom and ePSWs are certified initially, annually and then as needed to ensure competence – eg: med administration Other skills are taught for each individual patient eg: oral suctioning and of course pediatric patients teaching is tailored specific to their care needs – always very individual Individualized care is central to this model – ever changing/constantly being refreshed personalized careplan is the heart of the care delivered

Directing Registered Nurses (DRN) Registered Nurses with expertise in pediatric care, palliative care and managing patients living with chronic diseases Well-developed communication skills with a special interest in and knowledgeable how to mentor others – ePSWs Technology savvy – access patient information and provide direction to ePSWs through Sensory Technologies and CarePartners portals Ability to obtain the information required to complete accurate assessments and make sound decisions through gathering information remotely Comfortable being part of a provincial team, working independently from their own homes, providing care to patients in various parts of the province Excellent communicators

DRN Working in Home Office Delegating Nurse DRN Working in Home Office

Critical Factors to Success of eShift Model of Care Specifically developed Policies and Procedures for the eShift Program eShift Managers intimately involved with eShift Program and involved with all new patient admissions, with 24/7 oversight ensuring consistent safe care Monitoring of risk through event reporting and analysis – look for trends, potential deficiencies Team review and review with Clinical Practice & Quality & Risk team before adding new skills for ePSWs Review with DRNs any additional skills/unique requests for specific patients Monthly team meetings with ePSWs and DRNs Well-developed, meaningful and trusting relationships between ePSWs and DRNs Annual Skills Fairs and recertification for ePSWs and DRNs

Successes Significantly reduced unplanned ER visits in last month of life Symptoms experienced at EOL managed effectively thereby reducing suffering, not only physically but also mentally and emotionally Safety of patients being managed through constant monitoring/support while family/caregivers sleep Reduced admission to hospital in last 2-3 weeks of life – less than 2% Prevention of caregiver burnout Reduced grief complications related to the plan of EOL care following what is expected vs a crisis experience Palliative care being delivered by experts in palliative care as compared to newly graduated nurses with limited experience Opportunity for PSWs looking for more challenging work /advancements in their career Opportunity for expert RNs who may find working in the community physically challenging however have a wealth of knowledge in palliative care, pediatrics, chronic diseases, etc.

Summary eShift is an effective, safe and easily implemented patient care delivery model that fully meets the needs of many patient populations Ability to deliver care using eShift is equally effective in remote as well as large urban geographies Interest and eagerness to look at other populations including mental health, additional chronic diseases, post-operative support, etc. eShift is a program that is instrumental in helping to meet the standards and expectations as set out by the Ontario Hospice Palliative Care Network, the Canadian Hospice Palliative Care Association and Health Quality Ontario

Thank you