Developing a More Resident-Centred Care Model with Nursing Advantage Canada

All areas of healthcare are becoming more patient-centric, but the development of resident-centric care plans may be more evident in environments dedicated to long-term care (LTC). While most people engage with healthcare services for short periods, recipients of LTC may engage with the healthcare machine for the rest of their lives. Because of this, it's critical for healthcare homes to understand how to create and prioritize a holistic approach to incoming residents—especially regarding their initial screening.

Today, many LTC organizations have made significant strides towards an accessible, all-encompassing model of resident care, and UniversalCare has led the way. UniversalCare Canada Inc. was established in 2010 and is a family-owned organization. The team at UniversalCare provides operational, clinical and development consulting services to the senior living sector. We are a Canadian management company for LTC and retirement home settings, including independent living, assisted living, and memory care. We rely on an interdisciplinary team to deliver resident-centric care to clients and care for more than 2,380 residents in 30 buildings. In addition, we have 11 properties under development. 

As an organization, we take great pride in managing and working with all types of ownership groups that include hospitals, not-for-profit faith-based organizations, not-for-profit cultural organizations, not-for-profit Indigenous organizations, for profit organizations, and municipal homes. Our experience enables us to understand the current opportunities and challenges that the homes may experience, while maintaining their local identity and priorities. We are part of the home’s Interprofessional Team.

Our pillars of success include today’s practices, residents and family needs, and staff support. UniversalCare became the first RNAO Best Practice Spotlight Organization Host in the world. 

I presently work as the Vice President of Quality and Clinical Services. My job is to ensure higher-quality resident experiences by performing annual reviews, enabling staff development, and monitoring leadership and accountability measures. 

Revitalizing Our Initial Assessment with Evidence-Based Practices

Part of my role involves looking for ways to improve configurations and implement different solutions, and one of the more recent improvements we made was to our admission assessment.

For resident admissions, our staff used to complete many different screening assessments, and many of our older screening tools, including that for fall prevention, wandering, and elopement potential, had to be completed separately. The entire process took between five and six hours to complete. There was a lot of overlapping information between the various assessments, but it was difficult for our team members to move back and forth between them. That all left room for inconsistencies to appear from one assessment to the next, reducing our data quality.

Clearly, our older admissions process no longer served our staff and faculty well. And apart from the process-based difficulties, we wanted an optimized tool that would offer a more holistic view of incoming residents. Incorporating a psychosocial and personal well-being assessment into the medical and physical questions would get us closer to our goal of becoming more resident-centric. That's recently become possible through a partnership between RNAO (Registered Nurses' Association of Ontario) and PointClickCare.

A working group was established, co-led by PointClickCare and RNAO with 22 senior nurses—including myself—with expertise in the long-term sector to develop evidence-based Clinical Pathways based on its Best Practice Guidelines (BPG). The RNAO Clinical Pathways are designed to standardize the care provided in long-term care homes in accordance with the Fixing Long-Term Care Homes Act of 2021. 

That same year, RNAO and PointClickCare came together to help LTC Homes comply with all documentation and program requirements, which led to an integration with Nursing Advantage Canada from PointClickCare. I have worked alongside PointClickCare for more than 15 years, and I am intimately familiar with its solutions and software. I knew this integration would be a great way to ensure our project with RNAO would benefit residents and staff in LTC settings across Canada.

Understanding Clinical Pathways in Nursing Advantage Canada

Nursing Advantage Canada allows users to access standardized and evidence-based assessments that provide a wealth of information about individual residents. The platform also facilitates comprehensive and timely documentation that automates data collection, reducing the burden on staff members. 

When a resident comes to a LTC Home, a member of the registered nursing staff will open the RNAO Clinical Pathways tool within Nursing Advantage Canada and answer a series of standardized questions. These questions will guide the user to other questions and suggestions, eventually drilling down to a final clinical suggestion. Clinical suggestions provide recommendations to registered nursing staff and other providers that better accommodate a resident's physical, mental, and emotional needs. For example, if a resident has a history of digestive upset, the clinical suggestions may recommend the inclusion of a dietitian in the care plan. In another scenario, residents with reduced or limited mobility may receive physical therapy as a clinical suggestion. 

There is additional value to be found in the smart design of RNAO Clinical Pathways in Nursing Advantage Canada. One answer will automatically populate information depending on the user's selection. It may even pre-populate data based on the first few screening questions. For example, if a user indicates the resident may have a fall risk, the tool will encourage a care plan that incorporates universal precautions for fall prevention. 

Once the user has completed their assessment and answered all the questions in the RNAO Clinical Pathways tool, the suggested plan of care is active and accessible to care providers. All staff members now have the appropriate information to ensure this plan is fulfilled while delivering a fast, accurate, and resident-specific model of care that leads to better outcomes. 

The RNAO Clinical Pathways assessment process also aligns with existing legislation and compliance requirements. The program generates progress notes, which serve as evidence for MDS compliance protocols and ultimately summarize the status of the resident, where they are in their care plan, and any potential development changes or plans. 

Nursing Advantage Canada has several unique features that provide plenty of value to our business, but the clinical suggestions are my favourite. It's such a drastic difference from our previous method to have information neatly organized in a centralized location at the end of the assessment, and it's very clear what the next steps are and when referrals are needed. This easily accessible information enables much better collaboration between residents and our staff without worrying about misinterpretation in documentation. 

Smarter Assessments Lead to Increased Satisfaction 

The smart, standardized assessments within Nursing Advantage Canada have streamlined workflow for our entire staff. While our previous process required up to six hours of documentation, RNAO Clinical Pathways cut this time by two-thirds. Today, documentation for our initial screening process takes a nurse up to two hours to complete. The improved workflow provides a better experience for residents as they acclimate to our homes.

It's also been less taxing on our staff members, giving them more time to spend with residents in other ways. Our nurses have also become more engaged and confident in decision-making processes due to using these smart assessment tools. Our staff can create more competent care plans and address any questions with streamlined follow-up services, including referrals. 

Since adopting Nursing Advantage Canada, we have retired all other screening tools and outdated legacy assessments. This move has also eliminated the care silos that arose from separate evaluations. Everyone is on the same page much earlier. 

UniversalCare has also seen an enormous increase in satisfaction. Since the time we started integrating with Nursing Advantage Canada, we've seen up to 20% rise in resident/family satisfaction with care. Although this is partly due to our measuring stakeholder satisfaction differently than before, we cannot ignore the role that Nursing Advantage—and the power of standardized and evidence-based technologies—plays in that picture. 

The Importance of Technology in a Resident-Centred Care Model

UniversalCare has been building a culture of resident-focused excellence for years. We keep this in mind when addressing all policies, tools, and procedures, and we continuously provide our staff with the right tools to deliver the highest quality care possible. We start each treatment program with the care residents need and use hard evidence and all best practices to administer their care effectively. Our work is more than just clinical administration; it's about promoting a culture of individualism that affects each one of our residents. 

But moving to a resident-centred model of care is only possible with the help of collaborative technology. Using Nursing Advantage Canada from PointClickCare has helped us on this journey while fostering better relationships between residents, family members, and nursing staff. It helps us keep residents' goals and wishes at the forefront of care plans and determine how each home can support them through intelligent communication and actions. 

Our new assessment process is key to all of this. It's the future of long-term care.