It’s been a year since the improved and expanded BCPSLS re:act tool was made available for health authorities across BC to identify cases, support investigations, and track outcomes of adult abuse, neglect, and self-neglect.
Just like the healthcare community we serve, we’re passionate about measurement and continuous improvement. So, we’re taking a look at the past year to see what we’ve learned, how far we’ve come, and what impact BCPSLS re:act has had on patient safety in BC.
What have we learned?
First, we should all be very proud of this initiative.
The Canadian Patient Safety Institute, HealthCareCAN, and Health Standards Organization, with support from Patients for Patient Safety Canada, partnered in a recognition program called Excellence in Patient Engagement for Patient Safety. We’re delighted to announce that this program has recognized BCPSLS re:act as a leading practice! The re:act tool is now listed in the Leading Practices Library hosted by Health Standards Organization, an affiliate of Accreditation Canada.
Congratulations to Amanda Brown, Director of the ReAct Adult Protection Program, Vancouver Coastal Health (VCH), and Tammy Simpson, Provincial Coordinator, BCPSLS, who led this provincial group effort!
Amanda and Tammy were thrilled to receive the award, as they strongly believe that information about abuse, neglect, and self-neglect of vulnerable adults is important to report and quantify, and that data is needed in order to understand the scope of the problem, identify trends, and start exploring ways to make improvements.
From left to right: Tammy Simpson (Provincial Coordinator, BCPSLS), Amanda Brown (Director, ReAct Adult Protection Program, VCH), and Sherry Lin (Analyst/Assistant, ReAct Adult Protection Program, VCH)
Secondly, we’ve learned that the type of adult abuse and neglect most frequently reported is self-neglect.
Signs of self-neglect can include poor personal hygiene, a home environment in disarray, multiple interactions with BC Emergency Health Services within a short period of time, or an unexpected change in a client’s ability to self-manage a chronic condition such as diabetes. A client in this situation may require additional supports such as a revised care plan, further monitoring, or admission to hospital.
Another big issue facing BC’s vulnerable adult population is financial mismanagement. Reports of financial abuse or neglect can come from a variety of sources: home care staff may observe that there is little food in a client’s home, a building manager may report that the rent is in arrears, or there may be a family member that suddenly assumes an authoritarian role in the patient’s care. Although it’s not identified as frequently as self-neglect, it can have an enormous impact. In addition to financial losses, it can affect the adult’s access to basic necessities, use of healthcare resources, and individual freedom and rights to decision making when an assessment is needed to determine the adult’s incapability.
But the most important thing we’ve learned about BCPSLS re:act is the positive difference it can make in people’s lives.
Use of the tool encourages healthcare professionals to put on their “adult guardianship hats”, become familiar with identifying cases, and take action to help people who are suffering.
One example of this took place last year at an emergency department in BC. A clinician noticed signs of abuse and immediately connected with a designated responder. The designated responder was able to review records in BCPSLS re:act and identify a long-standing abusive situation. Investigators were then able to complete their investigation and protect the adult from further abuse. Without a resource like re:act, this patient may not have received the support they needed.
In BC, adult guardianship legislation ensures that vulnerable adults have the right to assistance, support, or adult guardianship protection as a result of abuse, neglect, or self-neglect. The regional health authorities and Community Living BC act as designated agencies with a responsibility to receive and act upon reports of this nature.
The first version of BPCSLS re:act was initiated in 2009 when VCH partnered with BCPSLS to develop an online tool to support VCH’s ReAct Adult Protection Program. The initial tool was launched in 2011 within VCH and shortly thereafter in Providence Health Care. Island Health came on board as an early adopter a few years later.
Interior Health has been collecting data on Statutory Property Guardianship for the last two years and will be fully launching BCPSLS re:act this fall after a lengthy stakeholder engagement process. The tool will support communication, further observation, and continuation of investigations. Fraser Health and Northern Health have begun their implementation this summer with the Statutory Property Guardianship module.
In 2016 when the Office of the Seniors Advocate announced that health authorities would be required to submit data on senior abuse and outcomes in 2019, VCH and BCPSLS collaborated once again. The forms were streamlined to contain just the right amount of information to report, track, and trend cases of adult abuse. The revised tool, named BCPSLS re:act, was made available across the province in June 2017.
Why should we re:act?
According to Susan Barr, Specialist, Vulnerable and Incapable Adults at Island Health, if people receive interventions early, they can stay safe and require fewer services down the road.
“Adult guardianship is a holistic view of a patient,” explains Susan. “Rather than focusing solely on an ailment, such as a broken hip, it helps identify other supports for patients who have difficulty getting help for themselves. When designated responders become involved, a different lens is applied that can help prioritize patient needs and inform discharge planning.”
While completing her Master of Public Health degree, Susan’s culminating project focused on clarifying roles and responsibilities for adult protection in BC’s health authorities. She learned that earlier responses may provide opportunities to intervene and prevent additional harm from occurring (Giles, L., Brewer, E., Mosqueda, L., Huba, G., & Melchior, L. (2010). Vision for 2020. Journal of Elder Abuse & Neglect, 22(3-4), p. 375-386). For example, supports can be put in place to enable clients to live at home longer, rather than going to residential care.
One of the most valuable aspects of BCPSLS re:act is its ability to capture reports from all levels of healthcare in one secure repository. Records remain centrally located while they are accessed, reviewed, and updated by designated responders across programs and facilities. In addition, users can upload documentation, such as care plans, that can be shared and updated by investigators as needed.
“BCPSLS re:act has been a great source of information sharing and time saving for me from the very beginning,” says Farimah Shakeri Shemirani, Adult Protection Lead, Social Work, North Shore & Older Adult Mental Health Team. “In my early days, I received a report. I looked up the record in PSLS and learned this was the fourth report we had received for this adult. The background information helped me to identify what changed in the adult’s condition and situation and respond accordingly.”
As a designated responder coordinator, Farimah supports designated responders in their investigations by offering education, consultation, and case reviews. She also assumes the investigator role for referrals that are not already connected to a clinician.
“Every time I receive a report, I check re:act,” adds Farimah. “I check to see if we previously had a report on the adult and if yes, what the outcome of the investigation was. Re:act is a great tool for keeping track of all the reports we receive. It is also a great communication tool for designated responder coordinators and designated responders.”
Meghan McMenamie is the Site Leader, Social Work, for Mount Saint Joseph and Holy Family hospitals within Providence Health Care (PHC). She believes BCPSLS re:act is particularly important for PHC because it facilitates communication between its hospital-based services and the community.
“Re:act provides a forum for us to pass information back and forth with the community,” explains Meghan. “For our high-risk adult protection cases, it’s hugely beneficial for us to be able to tag our partners within community services so the patients and their information don’t get lost.”
BCPSLS re:act also helps provide clients with dignity and person-centred care, as designated responders are able to engage appropriate programs across the continuum to ensure that care providers are on the same page.
“Continuity and consistency are so important,” says Meghan. “Healthcare is at its weakest at transitions, so anything we can do to mitigate risk helps us to provide better care to our patients.”
One year after the provincial launch, it’s exciting to see how health authorities in BC are using BCPSLS re:act to support their adult protection programs.
This spring, Vancouver Coastal Health offered a series of ReAct Reporting System refresher webinars to support designated responders and designated responder coordinators in logging in and tracking their adult protection cases. Another series is planned for advanced practices, such as the handover action to track a client’s journey from community to hospital.
Island Health is developing an adult guardianship community of practice across all programs, with training for new clinicians, ongoing education, and other resources. They have seen over time that the initiative is growing and becoming more widely known and accepted.
Congratulations, again, to everyone who has helped make BCPSLS re:act a success in supporting vulnerable adults in BC!
BC health authority adult abuse and neglect programs: