Speed Networking

Welcome

Caring for Seniors in Residential Care:dignity in the heart, mind, and action

Dignity

“a state, quality or manner worthy of esteem or respect; and (by extension) self-respect. Dignity in care, therefore, means the kind of care, in any setting, which supports and promotes, and does

not undermine, a person's self-respect regardless of any difference.”

(Dignity in Residential Care-Resource Guide)http://www.scie.org.uk/Index.aspx

http://www.dignityincare.org.uk

Culture of Caring

• In residential care and in hospital (48-6)• Core person-directed values are choice, dignity,

respect, self-determination and purposeful living• Changes in organization practices, physical

environments, relationships at all levels and workforce models

“The past and the present don’t have to be the future”“Culture change is a

process not a program”

Culture Change-Positive Outcomes

• http://www.pioneernetwork.net• http://www.edenalt.com

Quality of Care: Improvements in quality indicators most correlated with person-centered principles including use of restraints, weight loss, falls, agitation, pressure ulcers, medication use, time in a bed or chair and re-hospitalizations

Culture Change-Positive Outcomes

Staffing Impact: • Reductions in turnover and sick days • Increased levels of staff satisfaction • Active understanding of culture change and

person-centered principles • Self-motivation, critical analysis, and problem-

solving by front-line staff to incorporate person-centered principles.

Culture Change-Positive Outcomes

Life Engagement: • Increased levels of resident satisfaction• Resident choice in daily activities and routines

(measured by care plans) • Increased levels of engagement (measured by

MDS 3.0)• Emphasis by residents and staff on relationships

and community; descriptions as “home” or “family.”

DIGNITY

CULTURE OF CARE

RELATIONSHIPS AND MEETING NEEDS

MEDICATION USE

ANTIPSYCHOTIC MEDICATION

International UK: Social Movement Call To Action

US: Centers for Medicare and Medicaid (CMS)

• CMS National Partnership to Improve Dementia Care in Nursing Homes

• http://www.nhqualitycampaign.org/star_index.aspx?controls=dementiaCare

A Balanced Approach To Antipsychotic

Medication Use

Antipsychotic Medication Use-Current State

Point prevalence: 35% (regular and prn)Behind the number - considerations:

• Indications: (A) Psychotic conditions-Chronic: e.g. Schizophrenia(B) Psychotic conditions-Episodic: e.g. Delirium(C) Most often not psychotic-e.g. BPSD

• Practice gaps to balance risk-benefit: (A) Dosages, prns (B) Monitoring and review (C) Involving resident and family

THE CALL TO ACTION

~ WILL ~

~ IDEAS ~

~ EXECUTION ~

“The Up and Down”-General Introductions

• People Affected by Dementia: Family, Friends• People Working in Care Facilities• Health Authority Staff Supporting Care Facilities• People Working on Antipsychotic Med Use at Health

Authority Level

“The Up and Down”- Provincial

• MOH colleagues• Seniors Action Plan, Dementia Service Framework,

Dementia Action Plan LINK– www.health.gov.bc.ca/library/publications/year/2

012/dementia-action-plan.pdf• BPSD Guideline and Rollout LINK

– www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf

• GPAC Guideline-Cognitive Impairment LINK– http://www.bcguidelines.ca

“The Up and Down” - Provincial

• Shared Care-Polypharmacy, Transitions in Care • BCPSQ Council Medication Reconciliation• Patient Voices Network: Pilot Project On Effective

Involvement in Res Care-Providence Health, Vancouver• Alzheimer Society of BC• Work Safe BC• Professional and educational organizations• Other

Shared Care Committee Polypharmacy Initiative

Dr. Keith White“Awesome” Physician Lead, SCC Polypharmacy Initiative

Clinical Lead, Medication Reconciliation BCPSQC

What is Polypharmacy?

Too many inappropriate medications?

Too many appropriate medications?

More than 5 medications?

More than 10 medications?

Our DefinitionWhen the theoretical benefits of multiple

medications are outweighed by the negative

effect of the sheer number of medications,

regardless of class of medication or

“appropriateness” thereof.

Polypharmacy is a stand-

alone risk factor for

morbidity

Polypharmacy: What We Know

Average number of meds in RC = 9

Affects Quality of Life & Resident Safety

Decreases in:• Global Health• Cognitive Function

Increases in:• ADE’s• Risk of Falls

Adverse Drug Events

Lead to increased transfers to acute care• 5 or more 10%• 7 or more 20%• 9 or more 30%

Increase in transfers to acute care

Hospitalization-Associated Disability

Hospitalization is a sentinel event that often precipitates disability. This results in the subsequent

inability to live independently and complete basic activities of daily living (ADLs).

This hospitalization-associated disability occurs in approximately 1/3 of patients >70 years of age and

may be triggered even when the illness that necessitated the hospitalization is successfully

treated.

Polypharmacy itself should be conceptually perceived as “a disease,”

with potentially more serious complications than those of the

diseases these different drugs have been prescribed for.

Discharge Summary

Admission Dx: DeliriumDischarge Diagnosis: Urosepsis

PMH:1) Alzheimer’s2) COPD3) IHD4) Hypertension5) Diabetes6) Remote CVA

And No Mention of…

1) POLYPHARMACY

2) HOSPITALIZATION-ASSOCIATED DISABILITY

MedReviewsWhen we do MedReviews…

… we still look at the appropriateness of each individual med in the context of the Resident and fail to address the inappropriateness of the actual Number of Meds in the context of the Resident’s Dignity and Quality of Life.

Chemoprevention

Does not alter the All Cause Mortality!

Summary

Count the Pills!

Realizing the Power of the Opportunity

Step 1

• Create an individual “headline message” by reflecting on the potential benefits we could achieve by working together: What is the most important opportunity for us in improving care with dignity and less antipsychotic medication? (2 minutes)

• Share with your table (2 minutes each)

Step 2

• As a group, collectively discuss and develop a vision of the future of what we can achieve What does this look and feel like?

• Identify themes/similarities and differences from each person’s ‘headline message’. Draw pictures, use written words. Complete on flip chart as a group.

Step 3

• As a group, prepare a 4 minute message to share with the room. Be prepared to present your picture along with a “so what” message: So what does this mean for our work together today?

© NHS Institute for Innovation and Improvement, 2011 (used with permission)

20 min

20 min

20 min

Sharing the Power of the Opportunity

Rapid Fire Presentations: Golden Nuggets in BC

Managing Behaviours in Residential Care Without the Use of Antipsychotics

Dena Kanigan, BScN, RN

Managing Behaviours in Residential Care Without the Use of

Antipsychotics

By: Dena Kanigan BScN RNDirector of Nursing Care Castleview Care Center

Why We Decided to Decrease Antipsychotics at CastleviewWinter 2012: as part of a quality improvement

initiative, I choose to conduct a perspective analysis on the use of antipsychotics at Castleview

After careful and lengthy research I came to a decision: “antipsychotics are chemical restraints”

PharmaNet data indicates that 50.3 percent of PharmaCare Plan B (residential care) patients were prescribed an antipsychotic between April 2010 to June 2011 These data, however, do not provide information about how long each medication was used, or the condition for which these drugs were prescribed.

Prospective AnalysisAIM:

Objective: To reduce the amount of residents onantipsychotics

MEASURE:Outcome Measure/ Indicator: There will fewer

residents on antipsychotics by the fall of 2012.

Current Performance: 39% of residents—February 5, 2012

Performance Goal 2012/2013: To reduce the amount of antipsychotic (under 20%)

Priority: To target residents on antipsychotics who are experiencing negative side effects

Prospective AnalysisCHANGE:

Improvement Initiative: Stage 1: Audit all the MARsStage 2: Research antipsychotic usesStage 3: Prior to discontinuing the medications outline

daily behaviorsStage 4: Discuss with Pharmacist and doctors about

new proposed action for decreasing the use of antipsychotics at Castleview.

Stage 5: Implement policy for all new residents coming to facility; targeting those who arrive on antipsychotics, finding a documented reason for the prescription

Spring 2012 Looking at the DataFebruary 2012: 39% of the residents are on

antipsychotics (considered on the lower side of average)

By reviewing the MAR, and critically looking at antipsychotic use at Castleview:

We were able to decrease the use by 12% with-in 6 weeks, the first residents to be tapered off medications were those prescribed the medication for an “inappropriate behavior”

Examples of Behaviors Typically Not Amenable To Pharmacologic Managementlook at those residents who were being treated with

antipsychotics for any of the following reasons: Wandering

Hiding &HoardingVocally disruptiveRepetitive Activity

Inappropriate (un)dressingInappropriate voidingTugging at restraints

Eating inedible objectsPushing wheelchair bound Resident

Carol Ward MD Sept. 20, 2008

Analyzing the DataWe looked at:

Duration of time on the medication who/where the medication was prescribed if there was any documented reason

There were many residents on antipsychotics with no documentation as to why, thus by May 2012 we had only 20% of residents on antipsychotics.

At that time 6 of the residents had underlying mental illness being treated by the medication.

The rest of the residents were on the medication for behaviors associated with dementia.

Summer 2012 Behavioral Care PlanningJuly 2012

16% on this date- Behavioral Care Planning in-services started at Castleview

Behavioral Care PlanningUsing the model from, Sandra Psiurski,

Castleview created a system of educating staff about behavioral care planning and the use of antipsychotics as a restraint.

How to Behavioral Care PlanHow do we figure out the behaviours? We take a trip down memory lane.

We remember our residents grew up and lived in a different time then the staff who care for them

We understand how a residents past shapes who they are today. We take into account how past experiences influence how residents respond to their current demands of life.

By investigating fully who a resident was and is, a tailored successful care plan for behaviors can be created.

The Process1) What are the residents strengths and

successes2) Define the behaviour (What, when, where)3) Describe what we have done in response to

these behaviours

Intended goal: What you want from the resident and family

Communicate, Communicate, CommunicateThe most important part of this is to communicate to

all members of the health care team and families.* Families are a wealth of information *At Castleview if a resident is being physically

abusive and resistive to care the first course of action is to stop providing care immediately.

*Families need to know the procedures of this, if they come for a visit and their family member is not up for the day.

*Letting families know we are working on it, we have some techniques that do work but ultimately their loved one still has a choice

Explain ClearlyWhen nursing explains the situation in a

manner families understand, they are able to participate in the decision making process:

- your father wants to sleep in, your mother has chosen at this time to not get dressed, your sister does not want to get out of her chair right now

-your family member has lost almost all of their ability to make choices, he/she is still a strong willed adult with the right to choose

Quality of Life Over Quantity of TimeAt Castleview we constantly talk to staff and families about

quality of life.Quality of Life includes: autonomy, comfort,

control over life, dignity, respect and engagement in meaningful activities and relationships

We investigate residents tirelessly before involving the doctor in interventions. If a doctor is involved, we attempt to source out medical reasons for the behavior; medications of other classes are tried first (pain, depression)

Staff and families realize now an antipsychotic is a chemical restraint, and will ultimately sedate them. Once sedate their ability to enjoy any part of life is seriously compromised.

Finding What WorksThis part of the care planning process is time

consuming but very rewarding for all staff members:

monitor staff interaction while a resident is experiencing a time of a behavioral challenge; watching multiple times, chart what works and does not work, finding the pattern

make a 5-7 step care plan to manage a specific behavior, staff know once created this is the plan to follow

***this process can take hours, and days***

Fall 2012All but 2 residents are tapered and taken off

antipsychotics. Other residents with behavioral

challenges have been investigated, triggers found, care plans created

Staff still leave some residents at times, residents still have the right to choose the direction of the day

Staff are recognizing the negative side effects suffered by residents from antipsychotic use: sedation, increased falls and unfortunately we have three residents with TD (tardive dyskinesia)

Case in PointA new male resident hits the care-aides during brief changes

every time, I have many incident reports on my desk. Care aides are refusing to do care, the wife has tried to be present he still lashes out. His wife comes everyday to visit and assist with lunches. By monitoring care, speaking with wife and speaking to direct care staff I discover:

He was in Europe during WWII, he yells during care to stop hurting him, he has said out loud to the staff he was abused by male German soldiers when he was nine, distraction only works sporadically, having a male in the room makes him very tense

I was able to tailor a care plan with only a soft calming female voice speaking, this works 99% of the time. He is not sedated and he gets to enjoy his wife’s visits

Winter 2012Currently there are two residents (4%) on

antipsychotics:both have been tapered and failed, both have a diagnosed mental illness

that was present prior to the onset of dementia.

***I had to start an antipsychotic on a resident in December, the side effects were detrimental and very easily seen by all staff

Thought for the DayIT IS BETTER TO SPEND TIME NOW TO GET

THE RESIDENT TO BE SUCCESSFUL THAN TO FIGHT THEM FOR THE REST OF THEIR LIFE

Sometimes getting a resident to do something different and be successful, opens up a new world to them , and for you....

ReferencesH. C. Kales, K. Zivin, H. M. Kim, M. Valenstein, C. Chiang, R. Ignacio,

D. Ganoczy, F. Cunningham, L. S. Schneider, F. C. Blow. Trends in Antipsychotic Use in Dementia 1999-2007. Archives of General Psychiatry, 2011; 68 (2): 190 DOI: 10.1001/archgenpsychiatry.2010.200

A REVIEW OF THE USE OF ANTIPSYCHOTIC DRUGS IN BRITISH COLUMBIA RESIDENTIAL CARE FACILITIES http://www.health.gov.bc.ca/library/publications/year/2011/use-of-antipsychotic-drugs.pdf

Accommodating and Managing Behaviours in Dementia Decisional and Practice Support for BPSD 28 February 2012

Behaviour Management and Care Planning: Power point by Psiurski, Sandra

Rapid Fire Presentations: Golden Nuggets in BC

Behavior Reduction Across the Spectrum for Seniors (BRASS)

Sandy Psiurski, RPC, RPN

Youngsters of All Ages Enjoy the Carnival!

REACH FOR THE BRASS RING – Carousel game to get a prize...

Abstract meaning – to live life to the fullest

Photo from Nationalgeographicstock.com

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Behavior Reduction Across the Spectrum for Seniors...B.R.A.S.S.

Sandra Psiurski, RPC, RPNJanuary 2013

Definition of Restraint• A medication is considered a restraint when it is used for:

– convenience or discipline– prevention or restriction of movement– not required to treat a medical condition– for symptoms/disorders not approved by Health Canada

• Medications used as chemical restraints include sedatives and analgesics, antipsychotics (typical and atypical), or a combination of both.(HSAG, 2012)

• A medication is NOT a restraint when it is used :– treat symptoms of a psychiatric diagnosis such as psychosis

associated with schizophrenia.– as part of a specific care plan to address a behavior. The plan

must include physician order, assessments, reviews, and revision

BRASS project• To enable residential facilities to better manage

behavioral incidents on-site and prevent admission to hospital

• To reduce the use of antipsychotic medication as a first line of treatment for persons with behavior

• To develop confidence and capability of front-line staff by using internal core behavior teams to review behavioral incidents

• Provide consultation services to residential facilities, both IHA & private partners as needed

PILOTS• South Okanagan - 3 facilities• Education of staff

– VBS – ½ hr increments throughout the day 2 days per week

– Hamlets – 1- 1.5 hr increments every other week– CTW - Initial intensive training 7 hr per day x 3 days

• Complete referral information and submit to consultant

• Internal Core Behavior Team– Meet weekly to review residents identified with behavior– Develop list of investigative questions to answer– Develop / Revise care plan

CONSULTATION• Receive referral and collateral information• Write a summary of the information • Provide facility with questions or concerns gleened

from reviewing information• Request additional information from facilities as

needed• On occasion – go to the location to conduct a

review of behavior, staff needs, and chart review• Make recommendations as to care plan and

collaboration efforts needed to address issue (med reduction with physician/psychiatrist, etc)

EDUCATION

• PIECES 3 question template• Gathering H.I.S.T.O.R.Y.• Life Timeline• Collateral information from other sources• Review Medications• Rule out medical cause (PAIN, visual disturbance,

etc.)• Follow P.I.E.C.E.S. ( Physical, Intellect, Emotion,

Capability, Environment, Social Self)• Assessment tools

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You can’t know where you are going if you don’t know where you’ve been

• WE DON’T HAVE ANYONE WHO CAN PROVIDE US WITH HISTORY

• Hmmm… do what anarchaeologist does – DIG FOR IT

The Archaelogical Dig

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CREATE A TIMELINE

Born 1929 – Age 83

Raised during the Dirty 30’s, dustbowl, poverty

Fought in the (forgotten) Korean War 1950 – 1953 Aged 21 - 23

Was a young adult, got married, Canada opened first TV station, TV dinners arrived, Drive in diners and theaters were the place to go…cool cars….

1940 – 1965 period of rebellion, lawlessness, prohibition, rationing didn’t end until 1954

Raised children through the 50’s & 60’s , Dr. Spock, self – esteem, different cultural focus

TV SHOWS – MORE THAN JOHN WAYNE!MUSIC – ROCK N ROLL – MORE THAN ELVIS!

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You don’t have to have an absolute understanding of everything before you develop a plan …. not all plans will work… part of trying something new is to find out what

DOESN’T work … no attempt is wasted time

• (PhysOrg.com) -- Researchers from the University of Wyoming …incorporate spiders' silk-spinning genes into goats, …to harvest the silk protein from the goats’ milk for …have several medical uses…artificial ligaments and tendons, eye sutures, and for jaw repair. The silk could also have applications in bulletproof vests and improved car airbags.

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Please tell me what is going onin the next two slides….

-What is the behavior-What is the cause-What is the likely reaction of the person you see…

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WHAT AM I SAYING?

Why Do Babies Cry: I need a restI need food I need to be changedI’m too hot/cold I need held / lonelyII need to be comfortable (clothing) I don’t feel well

I don’t know but something isn’t right!

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WHAT AM I SAYING?

DESCRIBE vs DEFINE

Describing behavior is what you OBSERVE and HEAR in REAL terms.

Joe began pacing the halls, talking to himself, getting louder and yelled, “SHUT UP! I SAID SHUT UP!” There was no one near him at the time.

VS. Agitated

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She’s Not My Mike• Residents with dementia or cognitive problems often

associate workers and actions with what they know from the past.

• They have trouble with memory, so the association provides them comfort

• Go with the flow..... accept it... help them feel at ease

Cause and Effect

• There is a cause to every behavior. To become good at behavior management, one must become creative in exploring the cause.

• For example: A woman scratched a claws the staff, tries to hit them on bath day as they are going down the hall…

• WHAT WILL YOU DO

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SOLUTION TO BATHING• 1) Think in the residents’ era and history

– What was bathing like for them– How often did they bathe in the past– Many elderly people NEVER learned to swim –

their education was that water could kill them!– Elderly often do NOT tolerate water in their face

due to the last point– As we age, our skin gets thinner and more

sensitive to pain, hot & cold, pressure...• Is the water in the shower too hot/cold• Is the water hurting them, feeling like you are pelting

them with a hail rather than water

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LET’S GO SKINNY DIPPIN’Why might this have worked?1) Fun

2) Risqué3) Don’t throw the baby out

with the bathwater!

(Learn your history)

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MOUSETRAP !

TAKE 30 seconds – THINK ABOUT THE STEPS TO SET A MOUSE TRAP

EASY RIGHT?

HOW MANY STEPS DOES IT TAKE?

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PREVENTION vs. ADDRESSING

• Do you have 15 minutes to prevent a behavior or 2 hours to document why a behavior incident occurred?

Challenges of Collecting Data

Challenges of Collecting Data cont’

LICENSING REPORTING

• Only incidents that result in hospitalization or need medical attention by a physician or nurse practitioner are reported.

• All minor to moderate harm is not reported to licensing unless it relates to abuse

Aggressive Violence as Cause of Injury Trend (White data DW)

May-11

11-Jun11-Jul

11-Aug

11-Sep

11-Oct

11-Nov

11-Dec

12-Jan

12-Feb

12-Mar

12-Apr

12-May

12-Jun12-Jul

12-Aug

12-Sep

12-Oct

TotalOK 16 12 11 7 19 11 8 19 11 16 11 16 12 13 12 17 20 9 240IH West 14 13 16 33 20 20 22 17 20 26 14 15 12 27 24 17 12 13 335IH East 5 6 9 11 13 10 7 13 7 16 19 14 14 8 7 8 4 5 176Total 35 31 36 51 52 41 37 49 38 58 44 45 38 48 43 42 36 27

Average rate of incidents per month

May 2011 - April 2012

May 2012 -October 2012

IHA Total 43 39

IH West 19 17

IH East 11 8 OK 13 14

May-11

11-Jun

11-Jul 11-Aug

11-Sep

11-Oct

11-Nov

11-Dec

12-Jan 12-Feb

12-Mar

12-Apr

12-May

12-Jun

12-Jul 12-Aug

12-Sep

12-Oct

0

10

20

30

40

50

60

70

OKIH WestIH EastTotalLinear (To-tal)

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Sandy PSandra Psiurski, RPC, RPNSpecial Populations Project CoordinatorIHA, Westview Place, ECUN550 Carmi AvenuePenticton, BC V2A 3G6250-492-4000 Ext 2684 Office   250-488-3429  Cell250-770-7561 Fax   sandra.psiurski@interiorhealth.ca

Questions?

Rapid Fire Presentations: Golden Nuggets in BC

A-MOP: An Antipsychotic Medication Optimization Program for Long Term Care

Janice Robinson, NP

January 18, 2013

Janice Robinson, MN, NP(A),GNC(C) Clinical Nurse Specialist/Nurse Practitioner

The Lodge at Broadmead, Victoria, BC

Fiona Sudbury, BScN, MHSc, GNC(C)Director of Care

Fiona.Sudbury@broedmeadcare.com

How low can you go?: Antipsychotics in residential care – the clinical limbo

Objectives

Share a snapshot of The Lodge at Broadmead team’s journey to apply best practice dementia care.

Provide information on a quality improvement initiative to reduce antipsychotic medications.

Stimulate discussion and information sharing regarding the future of medication optimization for frail older adults.

The Lodge at Broadmead

Population served

Many Veterans 65% male Average age 88 50% move in from

hospital ALOS ~ 18 mos ~80% mod - severe

dementia

Care Team Residents & Family Members Health Care Workers Licensed Practical Nurses Registered Nurses Therapy Services Social Workers Nurse Practitioner Family Physicians Consulting Geriatric Psychiatrist

Dignity

Knowing the person Maintain their comfort – this includes

their psychosocial and spiritual comfort Partnering with families Path of Least Resistance

Dementia Care

“Supportive Pathways” Education for all staff

Clinical Program of best practice Behavioural Care Guidelines Person-centered philosophy of care Dementia Friendly environment

Medication Optimization Program

When people move-in & regular review of medication

Beer’s list audits Staff education and

good practice guidelines

Policy development

Antipsychotic Concerns!

A-MOP – QI project

Lodge

Residents

RegularOrder

Regular & PRN

Order PRN Only Total

Total 225 20 31 22 72

% 9% 14% 10% 33%

23%

ResultsContext for the prescriptions

Indication for use: 73% - Dementia (AD, VaD, Mixed) 27% - Other psychiatric diagnoses

Rationale documented for 83% of residents Most common reason - aggression and/or risk to

self or others Care plan review

57% had non-pharmacological strategies identified

Medication history 40% had been trialled on a lower dose in past

As the QI project went along…

During the project time frame - 19 people move in with a prescription for an atypical antipsychotic [38% of new admissions in a 8 month period]

8 current residents had a NEW atypical antipsychotic prescription initiated

Project Outcomes - Prescriptions July 1, 2011 – March 15, 2012

25 residents - drug discontinued 16 residents - dosage reduced 8 residents - dosage increased 8 residents – new order for atypical

antipsychotic drug initiated 14 residents died

Comparison of Atypical Antipsychotic Use – Time 1 & 2

T2 225 12 33 13 58 % 5% 15% 5% 25%

20%

Time

Residents

RegularOrder

Regular & PRN

Order PRN Only Total

T1 225 20 31 22 72

% 9% 14% 10% 33%23%

Project Impacts

Clearer picture of atypical antipsychotic drug use in this care home

Better understanding of which individual “people” are prescribed these medications and why

Increased team awareness of the risks and good practice principles for use of atypical antipsychotics

Made us look at what our assessment and care planning

Can we get lower?

Auto stop for PRNs not used Continued assessment of the person –

health status and unmet needs Provide non-pharmacological

interventions including using the path of least resistance with personal hygiene

Start using other medications classes?

How low is low enough?

A 50% decrease will be 12-15% at TLAB [33 residents]

Will those people be the folks who require these medications or will in just be a “number” to look at – who are the numbers

Are we treating people or are we trying to met a numbered benchmark?

Final thoughts - Dignity

Is it dignified to have a person in psychiatric distress or experiencing an un/under treated psychosis related to brain disease from dementia?

Achieving Our Vision – Developing our Framework

for Action

Achieving Our Vision

At your table – reflect on the following questions:

“What are your thoughts and ideas on the principles for this initiative to work under?”

“How best can we work together and support each other in our efforts to improve care?”

15 min

The Good, Bad and Ugly –

Identifying our Strengths and

Challenges

At your tables, discuss the following 2 questions:

“What will help to make the work to improve care happen/be successful?” (10 minutes)

“What could get in the way of making this happen/be a success?” (10 minutes)

20 min

Identifying our Strengths & Challenges

Sharing our Strengths & Challenges

Each table to share ONE strength and ONE challenge

Strategies for Action: how can we deliver a

dignified future for seniors in residential carewith less antipsychotic medication

Four Discussion Groups – pick the table the interests you most!

• #1: How can we come together to learn and share effectively? (e.g., webinars, learning sessions, online community etc)

• #2: What learning content is of most interest to you? (e.g., behaviour management strategies, polypharmacy, med rec, provider support, etc)

• #3: How do we ensure that residents and families are at the centre of our work?

• #4: How can work ensure we align with all that is going on? (e.g., Ministry of Health priorities, Division of Family Practice priorities, health authority strategies, Dementia Action Plan, Seniors Action Plan, etc)

30 min

Action Planning –Commitments for Moving Forward

Step 1

• Reflect as a group on these questions:

• What have we learned today?• What are you most encouraged about?• Where is the potential?• What needs to happen next to take this agenda

forward?

Step 2

• What can you commit to doing to contribute to moving this agenda forward?• Record on a post-it note and post on the flip chart at

the back of the room

© NHS Institute for Innovation and Improvement, 2011 (used with permission)

20 min

10 min

Commitments for Moving Forward

Starting the Shift: next steps

Questions?

rescare@bcpsqc.ca