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

2. 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

3. 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

4. PSW Orientation – Technology Lab

5. 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

6. 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

7. DRN Working in Home Office
Delegating Nurse
DRN Working in Home Office

8. 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

9. 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.

10. 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

11. Thank you