Making the transition from one’s home to a Residential Care facility is a life changing moment that requires thoughtful consideration from everyone involved, including the individual moving into the care facility, his/her loved ones, and care staff. While Residential Care processes have changed in British Columbia over the past few years, the overarching goal of these special and unique facilities remains the same – to provide a caring and comforting home for adults who are no longer able to live safely and independently. Indeed, quality of life for Residential Care residents is greatly enhanced when their environment is safe and the quality of care is the best it can be.

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At Fraser Health (FHA), Elizabeth Findlay, Clinical Director, and Dr. Larry Gustafson, Program Medical Director/Medical Health Officer, are passionate advocates when it comes to quality and safety in Residential Care.  They recognize that along with safety, quality of life for residents includes the opportunity to live with some risk, with least restraints whether physical, environmental or chemical. It is their mission to learn from the information they glean from BC PSLS, share it with each of Fraser Health’s Residential Care facilities, and apply it to support a person-centred culture whereby learning and safety enhance quality of life.

“A real value of BC PSLS is that it’s a tool for learning, and this attribute is becoming more evident all the time,” says Larry. “I think the current emphasis on learning and applying what is learned to the benefit of residents and those of us providing care helps us all with the challenge of safety in the context of a quality, comfortable home in residential care.  Sharing what is learned from situations reviewed is so important.”

Each month, the sub-committee of the Residential Care, Assisted Living and Specialized Populations (RCALSP) program at FHA meets to review the previous month’s safety events. With a focus on learning, Liz and Larry invite one Clinical Manager and their Residential Care Coordinator to join them, supporting continuous learning opportunities for the staff, including how to complete a BC PSLS event, what information is important, and what learning can be taken away and applied to the program, as well as to local sites. In addition, review of the ‘top three’ safety events in Residential Care – falls, medications, behaviour – is part of FHA’s commitment to support and develop the correct programs, care practice guidelines, and policies to improve the quality of services for all.

“Giving all residential staff the ability to see what’s happening in their own facility is very beneficial and rewarding,” says Liz. “We want people to use BC PSLS and recognize its potential. We are on a continuous journey of learning, but it’s worth the time and effort because our staff know that we support them and we’re making improvements in Residential Care together.”

As part of the overall commitment to quality of life, quality of care and safety in Residential Care, Liz and Larry shared that comprehensive Medication Reconciliation has been implemented on admission at all FHA-operated Residential Care facilities, reducing the number of medication-related safety events, and improving overall safety for those living in Residential Care.  In addition, the unintended negative impact of polypharmacy (the administering or taking of multiple medications) is recognized.  Development of medication-related strategies to reduce polypharmacy and thereby enhance the safety, quality of life and quality of care of frail, elderly individuals in Residential Care is now identified as a strategic initiative.

In spring 2014, all of BC’s Residential Care facilities will undergo Accreditation, Canada’s external peer review process to assess and improve patient care based on standards of excellence, and FHA will complete the Required Organization Practice (ROP) for Transitions of Care. BC PSLS data will support Residential Care staff by giving them the tools they need to identify serious medication events, share lessons learned, and make improvements to medication administration processes in Residential Care. FHA is also preparing to distribute a survey to approximately 8,000 families with loved ones living in FHA Residential Care to ask for their feedback about their experiences.

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“FHA Executive is very supportive of BC PSLS,” says Liz. “They know the value of the system and understand how the learning can be applied to a variety of Residential Care settings. BC PSLS is making safety very real for everybody and that is what makes it so effective and positive for Residential Care staff.”

After meeting with Liz and Larry, I walked away with not only a deeper understanding of the complexities of Residential Care, but also a great deal of respect for their unwavering commitment to learning from BC PSLS data and fostering a culture of learning. Certainly, their efforts will not only influence residential care in FHA, but across the entire province, which is particularly important as our population continues to age and the need for residential care services increases.

Elizabeth Findlay is Clinical Director responsible for quality improvement and, along with Dr. Larry Gustafson, is a Co-chair of the Residential Care, Assisted Living and Specialized Populations Quality Committee. For more information about Fraser Health’s quality improvement work in Residential Care, please contact Elizabeth Findlay

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