Geriatric Mental Health: Research
CERAH, as a Centre of Lakehead University, is accountable to Dr. Rui Wang, Vice-President of Research at Lakehead University. Consistent with the Lakehead University policy for research centres, CERAH’s goal is to undertake and facilitate research and scholarly activities in the area of aging and health. In May, 2010 CERAH underwent a rigorous review conducted by the research office at Lakehead University which has favorably resulted in a Senate approved 5-year renewal (the highest rating to attain). The Centre is presently developing and putting in place a five-year strategic plan commencing 2011-2016.
CERAH researchers and research affiliates are engaged in provincial, national and international research initiatives in the areas of rural health and aging, aboriginal health and aging, hospitals and health services and providing end of life care across the continuum of health services. Most research is community based and applied health service research. The integration of CERAH’s education and research functions provide synergies that advance regionally relevant evidenced-based practice and practice-based research. CERAH research informs education and practice and policy development. The most recent example of this would be the Interprofessional Infection Identification Management Project in longterm care (IIMP-LTC) in Thunder Bay and Sioux Lookout. The quality improvement model has built collaborative interprofessional care capacity within longterm care. The pneumonia protocol developed has and will be profiled at local, provincial and national conferences.
Interprofessional Infection Identification and Management Project in Longterm Care
Executive Summary
The Interprofessional Infection Identification and Management Project in Long-Term Care (IIIMP LTC) was a resident-centred collaborative initiative including Thunder Bay Longterm Interim Care Centre (TBILTC) in Thunder Bay, and William A. George Extended Care Centre, located in Sioux Look Out, and the Centre for Education and Research on Aging and Health (CERAH) at Lakehead University. Funded by theNorth West Local Health Integration Network (LHIN), this IIIMP- LTC project focused on the use of existing resources to transfer evidence-based knowledge into practice (KTP) in order to advance the timely identification and management of pneumonia within long-term care homes. The (KTP)) facilitated and provided additional training for interprofessional and collaborative resident- centred practice. In post questionnaires, and focus groups the participants discussed the collaborative process of the IIIMP-LTC. There was an improved recognition of the roles and responsibilities each health care provider played in providing resident- centred care. The mutual trust and respect amongst each other was improved.
The Alberta Guideline for Diagnosis and Management of Nursing Home Acquired Pneumonia (NHAP) was adapted into a one-page guideline. Education was provided to interprofessional staff as well as residents and families. The method incorporated principles from the Quality Improvement Guide for Long-Term Care developed by the Ontario Health Quality Council.
One of the objectives of the project was to decrease transfer the number of transfers to hospital for residents with pneumonia from 100% to 30% of all identified cases. At the TBLTIC, 82% of all residents demonstrating symptoms consistent with NHAP were treated within the facility and only 18% were transferred to hospital. At William A. George, 100% of residents diagnosed with pneumonia were treated within the home. Additionally, a respiratory outbreak was not recorded at either facility during the tenure of the project.
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Building Capacity for Interprofessional Collaborative Care in Long Term Care (BCICC-LTC) “Bridges to Care” Purpose Funded by the Ministry of Health and Long Term Care through HealthForceOntario, this knowledge-to-practice initiative for LTC aims to facilitate improvements in resident outcomes through the delivery of knowledge-to-practice resources by trained facilitators. The knowledge-to-practice resources support the implementation of LTC best practices using a collaborative, resident-centered approach. Anticipated Outcomes · Improved care and quality of life for residents · Improved satisfaction and quality of work life for caregivers · Increased satisfaction of pre-licensure learners and reinforcement of LTC as a desirable setting for education and employment
Project Overview (January 2009 – June 2010) 1. Project Planning and Resource Development After conducting an environmental scan and needs assessment for each pilot site, the resource development will design tailored knowledge-to-practice resource modules for the following common care issues in LTC: 1. Pneumonia 2. Falls and Osteoporosis 3. Behavioural and Psychological Symptoms of Dementia (BPSD) 4. Medication Optimization 5. Transitioning Care – The LTC and Acute Care Interface 6. Bacteriuria The knowledge-to-practice resources will include collaborative care plans and pathways, short presentations, decision-support tools, and other tools aimed at enhancing practice, collaboration, and communication. 2. Facilitator Recruitment and Training Individuals that are recognized as “change agents” or enablers of best practice and collaboration within or external to a LTC home will act as project “facilitators”. The facilitators will receive training in the use of the knowledge-to-practice resources. 3. Pilot of Resources by Facilitators (Kingston, Ottawa and Thunder Bay) Supported by the resource development team, the facilitators will utilize the knowledge-to-practice resources within the LTC setting with the intent of influencing practice and improving resident-centred collaborative care. 4. Evaluation and Dissemination via Provincial Summit
Thunder Bay Site Decreasing Hospital Visits of Long Term Care Residents Using a Pneumonia Guideline Objective: The objective was to minimize the hospitalization of residents with pneumonia to 30% of all cases. This was considered a fairly aggressive goal based on the previous year statistics. Method: The Alberta Guideline for Diagnosis and Management of Nursing Home Acquired Pneumonia was adapted into a one page guideline/protocol. Education was provided to approximately 95% of all staff as well as residents and families. The method incorporated principles from Quality Improvement Guide for Long Term Care outlined in the guide by the Ontario Health Quality Council. Results: The results to date show that greater than 75% of all residents diagnosed with pneumonia were treated in Pinewood Court. An unexpected success: there has not been a respiratory outbreak since start of the project. Conclusion: Preliminary findings indicate the use of the adapted guidelines for early identification and management of pneumonia decreases transfer of Long Term Care residents to hospital. Geriatric Interprofessional Interorganizational Collaboration Project (GiiC) In an initiative that commenced in 2008, the Centre for Education and Research on Aging and Health ( CERAH ), Lakehead University along with St. Joseph’s Care Group partnered with the five Regional Geriatric Programs of Ontario ( RGPs) and the North East Specialized Geriatric Services to provide knowledge translation of evidenced base practices in geriatrics for inter-professional team members of Family Health Teams, Community Health Centres and multi- faceted Health and Social organizations throughout Ontario. The goals were to advance inter-professional team members knowledge of each others' roles, responsibilities and geriatric knowledge and to foster inter-organizational collaboration in order to more effectively provide quality care for older adults in Ontario. The project was funded by the Ontario Ministry of Health and Long Term Care for one year. During the initiative and at the end of the project a compilation of resources on topics provided during the workshops was developed and placed at the following site as an ongoing resource for providers. The site can be accessed at : http://giic.rgps.on.ca/
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