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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.
How to use this slide deck
There are speaker notes for each slide
This presentation is intended to assist with
staff engagement and Stroke Care Plan
implementation. Your Regional Community
and LTC Coordinator is also available to
discuss how s/he might best support your
Home during the implementation of the
Stroke Care Plans.
The Integration of Stroke Best Practice
into Long Term Care Resident Care
Planning
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.
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 longterm care (Price
Waterhouse Cooper 2001).
Ontario Stroke System
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.
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.
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)
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
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
(Rantz et al, 1999)
ADDING IT UP
RAI MDS
+ Tips and Tools for Everyday Living TM
= Best Practice Stroke Care Plans
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
Developing the Stroke Care
Plans
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
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.
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.
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.
Example – Perception Care
Plan
FOCUS
Apraxia
Impaired perception related to stroke as evidenced by
the resident being confused over proper sequence of
steps for eating, grooming, etc.
GOAL(S)
Resident will require
decreased cueing
when dressing
Impaired perception related to stroke as evidenced by Resident will require
the resident having difficulty using common objects
decreased cueing for
even though he/she is aware of what the object is (e.g. grooming
combs hair with a fork)
Resident will require
decreased cueing for
eating
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Use short and simple instructions
while performing tasks
HCA/PSW/Restorative Care/
Therapy Assistants
Plan steps of the task with the
resident
Assist in starting the next step
Break the task into simple steps
and reminders for the proper
sequencing of task
Instruct resident to practice
activities
Provide hand-over-hand guidance
Instruct family on interventions to
increase resident’s task
performance.
Report to the RN/ RPN any
improvements or deterioration in
awareness level.
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
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
Pilot Project: Evaluation
•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: 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.”
“The Stroke Care Plans provided more detail and
were more comprehensive than the other care
plans in our existing library.”
Pilot Project: Feedback
“Tips and Tools for Everyday Living provided 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.”
“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.”
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
Pilot Project: Dissemination
• Heart & Stroke Foundation of Ontario
• Community & Long Term Care
Specialists/Coordinators (Ontario Stroke
Network)
• Stroke Collaborative 2011& 2012
• Canadian Stroke Congress 2012
• Ontario Gerontology Association
Conference 2013
Implementation Resources
Regional OSS representatives are also available
to support implementation through education and
the provision of best practice resources and
expertise.
Implementation Toolkit
• (www.ontariostrokenetwork.ca)
• Regional Stroke Network website.
Implementation Toolkit
Contents:
• Project Overview
• Stroke Care Plans
• Implementation Tips
• Frequently Asked Questions
• PowerPoint Presentation
Incorporating Stroke Care
Plans into the Care Planning
library at this facility
Discussion
Project Contributors
LTC Home Representatives
LTC Home Representatives
MOHLTC
Andrea DeNeire
RAI MDS Coordinat or
Terrace Lodge, Aylmer, ON
Denyse Duke
Director of Care, LTC
Residence St. Louis, Ottawa, ON
Sandra Schmidt
Project Lead
Implementation and Support
Long Term Care Common Assessment Project
(LTCH CAP)
Phillippa Welch
LTC Consult ant
Woods Park , Barrie, ON
Manon Simard
RAI Coordinator
Residence St. Louis, Ottawa, ON
Soo Ching Kikuta
LTCHCA O Program Manager
Natalie Cameron
Registered Nurse
St. Joseph’s Villa, Dundas, ON
Darlene Lawlor
RAO MDS Coordinator
Perth Community Care Centre. Perth, ON
OSN Community & LTC
Coordinators/Specialists
Sylvia Masters
RAI Coordinator
Leisureworld, Brampton, ON
Jackie Maxwell
DOC
Village Green, Selby, ON
Erin Cunningham
Administrator
Musk ok a Landing, Huntsville, ON
Pam Brown
Corporate RAI-MDS Coordinator
Extendicare (Canada) Inc.
Eastern Operations
Alice Jyu
Patient Care Manager
Veterans Centre, Toront o, ON
Ceclia Yeung
APN
Veterans Centre, Toront o, ON
Razane Diab
Acting DON
Cedarvale Terrace, Toronto, ON
Wendy Campbell
Assistant Administrator
Stayner Nursing Home
Marsha Nicolson
City of Toronto Resident Care Director,
LTC Homes and Services
Theresa Savard-Maki
RAI Coordinator
Bethammi Nursing Home, Thunder Bay, ON
Paula Gilmore
Vicky Smith
Donna Cheung
Sharon Trottman
Alda Tee
Jessica Com ay
Gwen Brown
Pauline Bodnar
Sue Verrilli
Jocelyne McKellar
Mark Morris
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
Thank you