Wellness, Independence & Quality of Life in Aging

NSM SGS Key Projects

Antipsychotic Toolkit 

On May 30, 2017 the NSM SGS program’s Antipsychotic Toolkit was launched.  This toolkit was developed in partnership with the County of Simcoe and the Royal Victoria Regional Health Centre to promote the appropriate use of antipsychotics among NSM long-term care home (LTCH) residents.  The toolkit was specifically developed as a resource for interested NSM LTCH prescribers (i.e. physicians, nurse practitioners, pharmacists) but is a useful resource for all health service providers.  It promotes a more consistent approach to care while improving resident and system outcomes.

Resources
•   Antipsychotic Toolkit
•   May 30, 2017 Antipsychotic Toolkit Launch 
•   Quick Reference Card A - General Principles for Prescribing Psychotropics for BPSD 
•   Quick Reference Card B - Why is Patient Taking an Antipsychotic ​​​​
 

Behaviour Success Agents 

Between July 2016 and March 2017 Behaviour Success Agents (BSAs) were placed in each North Simcoe Muskoka hospital site – Collingwood General and Marine, Georgian Bay General, Muskoka Algonquin Healthcare (Bracebridge and Huntsville), Orillia Soldiers’ Memorial and Royal Victoria Regional Health Centre .  This short-term project between the NSM LHIN, the NSM SGS program and area hospitals focused on improving the care of hospitalized seniors with cognitive impairment and responsive behaviours.  Thanks to the hard work of all partners, including the BSAs, project deliverables were completed and performance targets were met and surpassed!  To promote a more standard approach to care across the region, the BSAs developed a variety of tools and resources and a Behaviour Support System Community of Practice was established.  In cases where BSAs were involved, there was a reduction in the frequency of the primary behaviour, the use of physical restraints and the frequency of behaviour medication use.  New cases of delirium were identified (a geriatric emergency) and there was improved documentation and care planning.  Several NSM hospitals saw such benefit in the BSA role that they maintained the resource using their own hospital funding.  Other hospitals have built champions and put plans in place to help keep project gains going.



BSA Team (L-R)
Standing: Oleg Belanovsky (Waypoint), Tamara Nowak-Lennard (NSM SGS Program), Jennifer Allison-Hedges (Orillia Soldiers’ Memorial Hospital), Deb Curtis (Muskoka Algonquin Healthcare – Bracebridge Site), Andrew Nicholas (Royal Victoria Regional Health Centre), Annalee King (NSM SGS Program) 
Seated: Erin Johnson (Collingwood General & Marine Hospital), Jennifer Redicki (Georgian Bay General Hospital), Cindy Kosynski (Muskoka Algonquin Healthcare – Huntsville Site)

Resources
•    Behaviour Support Agents Final Report 
•    Behaviour Supports Standard Responsive Behaviour Definitions
 

Complex Case Resolution Process  

In October 2015, a review of area hospital patients found that hospital teams were facing challenges in assessing and managing complex case involving seniors with cognitive impairment and responsive behaviours.  To address this issue, the Complex Case Resolution (CCR) process was rolled-out across the NSM region in September 2016.  The CCR process brings together agencies and providers to resolve exceptional and complex cases related specifically to older adults with cognitive impairment and responsive behaviours.  By using a standardized approach to case review and encouraging a creative and collaborative dialogue between providers and caregivers we hope to improve outcomes for the senior and the system. This process will:
•    Help identify recommendations and develop a plan of care to improve outcomes, including transitions;
•    Improve collaboration and communication between health care providers, seniors and their caregivers; and,
•    Increase the knowledge and skills of health care providers in the assessment and management of complex cases involved seniors with cognitive impairment and responsive behaviours. 

Resources
•   Complex Case Resolution Process 
•   Complex Case Resolution Guideline 
•   Complex Case Resolution Referral 
 

Senior Friendly Hospital Strategy

A senior friendly hospital supports and responds to a senior’s physical and cognitive needs, promotes good health (e.g. nutrition and functional activation), maximizes safety, and involves patients – along with families and caregivers – to be full participants in their care. In 2010, the Ontario Senior Friendly Hospital Strategy was launched to help hospitals understand the five key areas or domains (the Senior Friendly Hospital Framework) that impact the care of hospitalized seniors and their caregivers. In 2011 and again in 2015, NSM hospitals completed a self-assessment in relation to the five domains of the framework.  Since 2011, NSM hospitals have been working to improve their environments for seniors and their caregivers.  With the NSM SGS program in place, leadership for the regional Senior Friendly Hospital Strategy falls under the mandate of the program and is supported by a task force made up of area partners.  

This work is linked to the broader provincial initiative. Currently, the Regional Geriatric Program of Toronto is leading the Senior Friendly Hospital (SFH) ACTION (Accelerating Change Together In Ontario) program.  This knowledge-to-practice process includes 87 hospitals across Ontario.  Two NSM hospitals are currently involved - Georgian Bay General Hospital focusing on the patient experience and Royal Victoria Regional Health Centre focusing on addressing urinary incontinence by reducing the use of catheters.

Resources
•    NSM LHIN Senior Friendly Hospital Strategy Summary Report, June 2011 
•    Senior Friendly Hospital Care in NSM LHIN, February 2015