Central East Community Care Access Centre Wound Care Journey Central East CCAC & VHA Home HealthCare

Transcription

1 Central East Community Care Access Centre Wound Care Journey Outstanding care every person every day Central East CCAC & VHA Home HealthCare

2 We began our wound care journey Because of the Growing demand for community care of wounds Inconsistent approach to wound care across the CECCAC region Escalating costs for wound care supplies So in 2009, CECCAC embarked on a pilot to improve the wound care provided to our patients Thursday, June 26,

3 Goals of pilot: Provide equal access to advanced wound management for patients and advanced technologies (adhere to Canada Health Principles) Use resources appropriately with clinical and fiscal accountability Quality and evidence informed wound care Ensure wound care was informed by quality and evidence Provide right level of care with appropriate provider Manage wounds efficiently and proactively to prevent complications or progression Engage patients in their care and well being Ensure consistent care driven by evidence based practice Thursday, June 26,

4 What we did Strategically designed and included multiple levels of participants (CEO to front line staff and service providers) in pilot Developed a Wound Care Steering Committee Analyzed present state in collaboration with our Service Providers Held a planning day with CECCAC staff and Service Providers and developed a project plan Developed a communication strategy (physicians, hospitals other stakeholders) Thursday, June 26,

5 Outcome of the Pilot Validated data through consulting group (patient chart reviews) and internal measurement (computer based) Capacity and processes Clinical outcomes Did the use of advanced dressings improve clinical outcomes? Impact on health economics Quality of life Thursday, June 26,

6 Outcome of the Pilot Frequency of daily dressing changes decreased to 25% (from 40% originally) where interventions were implemented Length of stay decreased to 13 weeks (from 50 weeks). Reduced dressing changes and nursing visits Thursday, June 26,

7 Wound Care Program Because of positive results from the pilot CECCAC issued a Request for Proposal in late 2009 Awarded the contract to the successful respondent Rolled out the program to CECCAC (including education, training, communication to all stakeholders) Moved to advanced dressings for community patients with wounds. This positively impacted: quality of life clinical outcomes budget Thursday, June 26,

8 Wound Care Program We continue to evaluate and monitor our progress to ensure the sustainability of the program As a result CECCAC noted an area of our wound care program related to the management of patients with maintenance/non-healing wounds that required further development Thursday, June 26,

9 Maintenance Wound Care Initiative In 2013 CECCAC issued an Expression of Interest Looking for a partner to assist in improving maintenance wounds/ non-healing wounds for our patients. VHA Home HealthCare was selected to work with CECCAC on this initiative Thursday, June 26,

10 Wound Care Journey VHA HOME HEALTHCARE & CENTRAL EAST CCAC

11 Goal of Maintenance Wound Care Initiative Develop and pilot service delivery nursing model that: Helps patients with maintenance wounds achieve independent wound care and safe discharge from CCAC service Includes the patient, family and health care team Can be implemented across all of Central East to all its Service Providers Thursday, June 26,

12 VHA Proposed Model for Wound Maintenance Enable patients with non-healable maintenance wounds to independently manage own wound care Build on the principles of self-managed care Support patients and/or their family caregivers to acquire skills, knowledge and ability to tend to wound maintenance independent of the CCAC Positively affect patient experience Thursday, June 26,

13 What VHA Did Developed a Project Working Group Developed teaching aides Self management pathway Client & nursing toolkits Developed assessment tools Mobility for wound self care Mini mental assessment Designed nursing orientation and training Choices & Changes workshops Reviewed Interdisciplinary Team role in wound care - OT, PT, Dietician Thursday, June 26,

14 The Pathway Reviewed all clients on-admission & those with non-healing wounds Week 1-4 Discuss expectations and plan for discharge Introduced self-management concept Week 4-8 If wound not showing signs of healing by 20% -30%: Discuss long-term plans with patient and/or caregiver Identify feasibility of managing wound independent of the CCAC Reinforce not giving up on healing Re-assess plan of care/consult Thursday, June 26,

15 The Pathway WEEK 8 <60% Slow Healing Assess for Self Management Pathway (SMP) Send communication with results to GP/CCAC Not appropriate for SMP Transition to clinic? Continue with care as per CCAC wound pathway up to week 18 If no healing at week 18 transfer to maintenance pathway Patient can t manage Contact CCAC Patient back on regular pathway Re-assess at: Week 12 Patient/Family appropriate Provide education to patient and give client tool kit Patient able to manage Transition to Self Management Pathway Week 18 Thursday, June 26,

16 Self Management Pathway Post 7-day Visit Managing well Not managing well Progress to 30 day Re-assess needs consult? visit Provide education/support Re-assess pathway appropriateness If patient back on track revisit in 7 days if no concern revisit in 30 days If risks identified after post support visits, re-assess self-management appropriateness Thursday, June 26,

17 Self Management Pathway Post 30-day Visit Managing well Progress to 90 day visit Not managing well: Address patient concerns Reinforce education Resume regular service short term to manage complications Re-assess if pathway appropriate Thursday, June 26,

18 Self Management Pathway Post 90-day Visit Managing well: Independent with care Discharge from service Not managing well: Reassess patient condition and management of care Thursday, June 26,

19 Current Data & Statistics 60 patient assessments completed 9 patients successfully moved to self management 1 patient was in progress; developed a fistula, currently not on pathway 1 patient - mother taught care; going to alternate care setting for ongoing monitoring 1 patient - in process; expected discharge to self management in July 2014 Thursday, June 26,

20 Current Data & Statistics 60 patient assessments completed (con t) 8 - cognitive concerns 6 - co-morbidity conditions 15 - dexterity issues/can t reach wound most common 6 - other physical limitations 5 - patient/spouse refusing to participate in care ( heightened anxiety/fear, further support required) 7- discharged; wound healed Thursday, June 26,

21 Lessons Learned Process & Practice Lessons Both parties (CCAC Care Coordinators & VHA nurses) need information at the same time to ensure common understanding of project Early communication to health care team pivotal to success Patients on service for a long time (pre-project) verses new patients faced greater challenges transitioning to self management Discharge to self management may not be permanent as patients may move between independence and need for CCAC care Thursday, June 26,

22 Lessons Learned Education Needs Education needs to include plan for creating an optimal learning environment to enhance client s confidence/reduce anxiety about learning new selfmanagement skills Self management education is important for orienting new hires and ongoing education Service provider organizations should establish clinical champions Thursday, June 26,

23 Patient and Nurse View Thursday, June 26,

24 Patient and Nurse View Thursday, June 26,

25 Next Steps Complete pilot evaluation Gather information from patients, care coordinators, nurses and physicians on experience and process improvement ideas Possible Outcomes Collaboration with VHA to expand the maintenance wound care program to other nursing service providers across CECCAC Thursday, June 26,

26 Questions? Central East CCAC & VHA Home HealthCare Thursday, June 26,