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Multipurpose Service Collaborative LHD Consumer Advisory Councils July 2016 Jenny Preece, Rural Health Network Manager Rural Health Network Principles of Care for Living Well in Multipurpose Services
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Page 1: Multipurpose Service Collaborativefallsnetwork.neura.edu.au/wp-content/uploads/2016/01/P... · 2016-09-19 · Leisure activities and Lifestyle . Project Objectives ... Maintain links

Multipurpose Service Collaborative

LHD Consumer Advisory Councils July 2016

Jenny Preece, Rural Health Network Manager

Rural Health Network

Principles of Care for Living Well in

Multipurpose Services

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60 MPS

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Background

MPS are ‘hospitals’ providing Community Health, Emergency and

Inpatient Care, as well as Residential Aged Care for people who call

MPS ‘home’.

National Safety and Quality Healthcare Standards Accreditation

Homelike Environment

Role of the person in their own care (person-centred)

Cognitive Impairment

Hydration and Nutrition

Leisure activities and Lifestyle

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Project Objectives

Principles of Care for Living Well in MPSs

To enhance Quality of Life, lifestyle and wellbeing

for people who call MPSs ‘home’.

To support staff capability in providing

individualised care and a person-centred culture

for residents within MPS.

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MPS sites visited Local Health

District MPS Build Status

Inpatient

Beds

Aged

Care

Total

Beds

Co-Located

Services

Mid North

Coast LHD Dorrigo

Operational 1998 – Rebuild

6 21 H/L 30 Government

Access

Southern NSW Braidwood

Operational 1993- Refurb

5 27 H/L 32

Murrumbidgee Gundagai

Operational 2012- Rebuild

12 18 H/L 30 MOU manage

private RAC

Western NSW Warren

Operational 2000- Rebuild

12 30H/L 42 GP

Western NSW Grenfell

Operational 2001- Refurb

7 28 35

Northern NSW Nimbin

Operational 2004- Rebuild

7 11 18 GP

Far West NSW Balranald

Operational 2010- Rebuild

8 15 23 GP

Murrumbidgee Berrigan

Operational 2008- Rebuild

4 10 14 Private RAC

HNE LHD Manilla

Operational 2011- Rebuild

12 40 H/L 52 GP/Health

One

HNE LHD Tingha

Operational 2008- Rebuild

0 8 8 No Acute

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Baseline Data – Survey Results

More people are being admitted into high care due to the increase in

community support strategies.

Almost 25% residents in all MPS have dementia

76% MPS have either a Diversional Therapist or Activities Officer (from

8 – 30 hrs per week)

66% have external Medication Review Process

Majority of MPS had Allied Health up to 8 hrs per week, but none had

designated hours for the Residential Aged Care Section.

30% of the MPS had an Aboriginal resident (1 or 2 residents)

0% of MPS had a structured Aged Care Specific Education calendar.

Workforce – Nurses find it difficult to move between acute and RACF

(focus of care on clinical need)

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Diagnostic Feedback – 5 themes

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1. Person Centred Care

Care Delivery

Family Involvement, independence and choice, access to

medical care, staff respect, resident meetings, links to community

Access to outdoor space

Care Planning

A need for standardised documentation sets - aged care

assessment and care planning

LHD forms and care plans are acute - not appropriate for aged care

Social Profile and Advanced Care Directives

Pre-admission information - Resident Handbook, Welcome Pack

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Outdoor environment

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2. Leisure and Recreation

Diversional Therapist/Activities Officer hours are limited

Recurrent theme of general ‘boredom’

Lack of transport availability/access for outings

There is difficulty recruiting volunteers due to LHD policy and

aging population

There are limited or no activities offered on the weekends

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3. Food and Nutrition

Pre-packaged food has a low level of satisfaction

Only 3 of the 10 MPS cooked meals on-site!

Residents, carers and staff report ‘home cooked meals’ are best

Flavours, aromas, textures and choice perceived as lacking with

pre-packaged meals

Often excessive waste reported with pre-packaged meals

Restrictions on outside food being brought in for residents

No BBQs

Menus have little variation and rotate on a fortnightly basis –

“same old every week”

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3. Food and Nutrition

Pre-Packaged Foods

Jams and Sauces

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3. Food and Nutrition

Which meal is

home cooked?

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4. Access to Multidisciplinary Services

1. Staff resources

Limited allied health services

Physiotherapy – mobility assessments, exercise groups

Dietitian – Dietetic review for Residents

Social Work – Bereavement support

Pharmacist – Medication Review

2. Model of Care

Staff have difficulty changing from acute ‘clinical ‘ care to a

‘well’ aged care focus when working across the MPS

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5. Workforce

3. Aged Care Expertise

Limited or no Aged Care specific Education

There is general anxiety around dementia care for

residents (risk)

4. Networking between MPS sites

Benchmarking and sharing of resources

Professional Development (case studies, grand

rounds, journal clubs)

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A Private RACF: Reflections

All staff are required to undertake a minimum Certificate III in Aged

Care (TAFE)

A strong family-like environment, pet friendly, care plans reviewed

every 3 months

Emphasis on Diversional Therapy and bus outings

High level of satisfaction with meals (cooked on-site)

Similar Issues to MPS’s:

Workplace Health and Safety Policy: Food Safety

Meal time routine too restrictive:

“breakfast too late at 8am / dinner too early at 5pm”

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Principles of Care

The Resident is respected as an individual

The Resident is informed and involved.

Regular Case Conferences and family involvement

Consistent rostering – build 1 on 1 relationships

Cultural shift away from acute ‘clinical’ care to individualised ‘wellness’ care

Marketing and Promotion / LHD MPS Websites

Develop generic Welcome Pack on admission / Resident Handbook pre-

admission

Resident’s meetings

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Principles of Care

The Resident participates in Assessment and Care Planning

The Resident lives in a homelike environment.

‘Living’ Care Plan – Activities of daily living

Introduce top 5

Develop common data set (aged care assessment, Social Profile, Advance

Care Plans)

Ready access to outdoor spaces

De-institutionalise environment (daily routines): language of ‘home’

Address physical layout of facilities to create a welcoming atmosphere

Streamline Volunteer recruitment process

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Principles of Care

The Resident can access meaningful recreational and

leisure activities.

The Resident has an enjoyable dining experience

Share activities calendars (between MPS or with private RACFs)

Maintain links to community and community transport

Certificate IV in Leisure and Health (AIN or AHA)

Meal Presentation – tablecloths, condiments on the table, smaller tables

Flexible meal times – choice and control (kitchenettes, snack cart)

Bring back the BBQ!

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Principles of Care

The Resident has access to multidisciplinary services

MPS Leadership enables expertise in Aged Care

Access MBS Item Nos

Access Private Providers (Priv. Health Insurance)

Increase uptake of Telehealth (Referral and Peer support)

Quarantine Allied Health hours for Residential Aged Care

Strengthen the profile of Aged Care as a Speciality - Build capability:

Minimum Cert 111 in Aged Care

MPS Network streams – Aged Care leadership and education

Build relationships with private RACFs

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Where to from here?

Toolkit

MPS Principles of Care

Resource Guide

Self-Assessment Tool

Evaluation Package

Broad Consultation July

Implementation - Clinical Innovation Program $$

- Collaborative EOI September

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Living Well in an MPS: A Collaborative Improvement Process

A collaborative is a process to spread and adapt existing knowledge to multiple settings to achieve a common aim. Sites leverage off each other’s learning to achieve a greater collective level of improvement.

AIM:

To deliver patient centred care and enhance lifestyle, independence and wellbeing for people living in an MPS, and their families. To support staff capability in providing individualised care and a person-centred care culture within MPSs.

EOILearning

Set One

(3 days)

Learning

Set Two

(1.5 days)

Learning

Set Three

(1.5

days)

Write up &

share

successful

strategies

Plan

DoStudy

Act Plan

DoStudy

Act

Action

Period (3

months)

Action

Period

(3

months)

Community of Practice

Web-based PDSA Sharing

Monthly Reporting

Fortnightly site support calls

Up to 20

sites

recruited

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Living Well in an MPS


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