1. IMPLEMENTATION AND EVALUATION OF A CAPACITY BUILDING STRATEGY AT BAYCREST LONG-TERM CARE HOME Alison Corcoran, Advanced Practice Leader – Nursing Maya Hohmann, Research Associate – Program Evaluation Unit Angela Uy, Advanced Practice Leader - Nursing Baycrest Health Sciences June 5, 2014

2. Agenda Background Capacity building at Baycrest  INTERACT ®  Clinical Skills Day Program evaluation Lessons learned

3. According to studies in Canada, what percentage of ED visits by LTC residents are potentially preventable? A. 10% – 15% B. 3% – 6% C. 25% – 55% D. 65% – 72% Use your clickers!

4. ED visits is a priority indicator for the Ministry of Health and Long Term Care Quality Improvement Program (QIP) A.True B.False Use your clickers!

5. Background: ED usage Seniors higher frequency of use - 60,509 ED visits over 12 months Potentially preventable transfers - 25% - 55% MOHLTC QIP 2014-2015 - ED transfer rate a priority indicator - Considerations for future: preventable reasons for transfer

6. Why is action required? Elevated costs $260/ED visit $545/ACSC visit ($386/senior ED visit) Quality of life Iatrogenic illness Loss of functional ability Stress and anxiety

7. What can we do? Improve the identification, communication, and management of acute changes in condition in LTC. 1.INTERACT® tools 2.Build capacity of staff 3.Monitor and evaluate our outcomes

8. What is INTERACT®? A.Banking system B.Online dating service for nurses C.A quality improvement program to minimize aggressive interactions D.A quality improvement program to reduce ED transfers Use your clickers!

9. INTERACT ® Interventions to Reduce Acute Care Transfers (INTERACT ® ) Quality improvement program to reduce ED Transfers from LTC Advance Care Planning tools Decision support tools Communication tools (Stop and Watch, SBAR) Quality improvement tools Ouslander, J., et al. JAGS 2011

10. What are some common potentially preventable reasons for transfer to the ED? A.Pneumonia B.UTI C.Dehydration D.Conjunctivitis E.Answers a, b, and c Use your clickers!

11. Building capacity at Clinical Skills Day Clinical Skills Day (CSD) – an annual, full day clinical education program for registered nursing staff. Interactive curriculum based on the INTERACT® program and Best Practices Enhance capacity in assessing and managing most common reasons for potentially preventable transfers to acute

12. CSD: Implementation Scope of INTERACT® components  SBAR  Introduction to Stop and Watch  Introduction to Care Paths ResponseCard © Technology  TurningPoint 5 Case studies, physical assessment skills, discussion

13. CSD: LTC Attendance Attended Did not attend

14. Evaluation: CSD session averages

15. Evaluation: RN vs. RPN

16. Evaluation: Identify trouble spots CSD SessionQuestion % INCORRECT RESPONSES PRE-TESTPOST-TEST 2 Info to include in SBAR “Situation” Question not included 19.2% 3 Signs/symptoms of dehydration 30.9%26.4% 4 -- 5 Signs/symptoms of pneumonia 20.0%21.4%

17. Art of the possible Accessing INTERACT® - http://www.interact2.net/ Evaluation - Technology vs. paper Integrate education into existing offerings ED Transfers as an organizational priority

18. According to studies in Canada, what percentage of ED visits by LTC residents are potentially preventable? A. 10% – 15% B. 3% – 6% C. 25% – 55% D. 65% – 72% Use your clickers!

19. ED visits is a priority indicator for the Ministry of Health and Long Term Care Quality Improvement Program (QIP) A.True B.False Use your clickers!

20. What is INTERACT®? A.Banking system B.Online dating service for nurses C.A quality improvement program to minimize aggressive interactions D.A quality improvement program to reduce ED transfers Use your clickers!

21. What are some common potentially preventable reasons for transfer to the ED? A.Pneumonia B.UTI C.Dehydration D.Conjunctivitis E.Answers a, b, and c Use your clickers!

22. Contact information Alison Anne Corcoran RN, BScN, MN Advanced Practice Leader – Nurse Baycrest Phone: (416) 785-2500 Extension 3826 acorcoran@Baycrest.org Maya Hohmann MA Research Associate Baycrest Phone: (416) 785-2500 Extension 3319 mhohmann@baycrest.org Angela Uy RN, MN, GNC(C) Quality Partner Baycrest Phone: (416) 785-2500 Extension 3039 auy@baycrest.org