Changes Affecting How Your LTC Home is Monitored March 2009The Ministry of Health and Long-Term Care is undertaking a major transformation of the way in which the performance of Homes is monitored to ensure the safety and quality of care of residents. The goal of this multi-year project is to have a compliance inspection program that is practical, accountable, and responsive to situations which pose potential risks to residents. An early step in the transformation project has been to develop a set of Risk Indicators that will provide valuable data to assist compliance staff in focusing their inspections on risk areas (e.g. triggers such as prevalence of weight loss.) These indicators will help compliance staff determine risk in long-term care homes, and then develop consistent approaches for action, based on the risks identified. The identification process included an examination of current compliance data and broad consultation with many experts and interest groups such as Concerned Friends. The Risk Indicators identified are as follows. Prevalence of: pressure ulcers daily physical restraints weight loss indwelling catheters bladder or bowel incontinence moderate to severe pain falls pneumonia urinary tract infections wound infection new fractures depression without treatment behavioural symptoms affecting others worsening resident behaviour worsening functioning in daily activities antipsychotic drug use in the absence of psychotic and related conditions anti-anxiety/hypnotic drug use fecal impaction These indicators are based on data from the Common Assessment Tool, a standardized, computerized assess-ment instrument which is already in use in many homes, and is expected to be in all homes by 2010. This tool provides consistent and comprehensive information that facilitates the diagnosis and management of care needs of residents. The following additional Risk Indicators come from other information sources: unexpected death alleged/actual abuse/assault outbreaks emergency/disaster/equipment related injuries injury resulting in transfer or admission to hospital verified complaints leading to unmets availability of meaningful activities medication misappropriation oral health absence of nourishment and/or supplement intake for residents with nutritional risk As mentioned above, the Common Assessment Tool is an essential part of this new system. Other important initiatives that are key to the redesign of the Compliance system include the Compliance Smart Client and the Critical Incident System. The Compliance Smart Client is a new, computerized tool intended to automate the data collection and reporting of work done by Ministry compliance staff. It includes a collaborative web site and tablet computers that are similar to laptops. Compliance staff will be able to refer to reports and write notes on their tablets when visiting a home. The Smart Client tablet technology converts handwritten notes to text, improving accuracy and efficiency. The Compliance Smart Client is expected to be rolled out to all compliance staff across Ontario in the summer of 2009. The Critical Incident System requires all LTC homes to enter their unusual occurrence reports online and is expected to lead to better tracking of incidents and more consistent reporting practices. It has been in effect since April 2008. The Ministry has also developed an Early Warning System which is software that gathers information and enables compliance staff to review and analyze a home's compliance history. The Ministry is moving into the middle phase of this transformation process. There will be changes for the Compliance staff as well as for the long-term care homes. These changes will be supported by an educational program which is currently being planned. The changes will also involve aligning the compliance process with the regulations under the new Long-Term Care Act of 2007. In spite of the upheaval that is part of any major change process, there seems to be a sense of excitement and enthusiasm among many of those involved. Concerned Friends shares that optimism as we look forward to the full implementation of the transformed Compliance System. |