What is the Canadian Institute for Health Information?
The Canadian Institute for Health Information or (CIHI) is an organization with a mandate to share information that supports improvements in healthcare, health system performance and population health across the continuum of care. For long term care, CIHI reports on a series of key quality indicators that are based on data submitted by organizations across the country. This information allows us to benchmark our performance against other organizations, provinces, and the country, and to create actionable plans to continuously improve the quality of care and services provided to our residents.
Increased transparency and support for quality improvements.
Recognizing the value of transparency, having comparable public data supports our efforts to improve the quality of care in our communities by ensuring they are always informed by data and best practices.
Evidence-based decisions
While this information is only being reported publicly this week for our Enhanced Care communities in Nova Scotia, as an organization, we have been measuring and analyzing our quality indicators internally for several years and have been using this information to make evidence-based decisions on clinical practice and continuous improvements. Specifically, we have seen improvements in the following indicators:
- Worsened Pressure Ulcer
- Worsened Physical Functioning
- Worsened Depressive Mood
We have also recognized three areas of focus for quality improvement initiatives and have active action plans in place to make improvements in these areas.
Falls in the Last 30 Days
- Every resident fall is reviewed at weekly risk management meetings and analyzed for appropriateness of interventions
- Interdisciplinary planning for individual solutions for those who experience multiple falls
Restraint Use
- We have made significant improvements but are committed to further improving our practices
- Education for all team members on data collection and accuracy
- Collaborative approach to determine appropriate use and alternate interventions
- Education and communication with residents and families on risks versus benefits
Potentially Inappropriate Use of Antipsychotics
- Educate team on dementia care, personal expressions, and antipsychotic risks.
- Monitor and address changes in residents’ moods and expressions with non-pharmacological interventions.
- Conduct routine interdisciplinary medication reviews to assess necessity, side effects, and interactions.
- Gradually reduce medication doses to assess symptom management at lower doses or without medication.
Clinical indicators are informed by a standardized assessment tool
All residents are assessed using a standardized assessment tool called the Long-Term Care Facilities (LTCF) Assessment. Assessments are completed by our clinical team members on admission, every 90 days, and when a resident experiences a significant change in their status.
Here are the types of quality indicators that are measured:
- Falls in the Last 30 Days: This indicator looks at how many long-term care residents fell in the 30 days leading up to the date of their quarterly clinical assessment. Falls are the leading cause of injury for seniors and contribute to a significant burden on the health care system. Residents are at a higher risk of falling if they have a history of falls or are taking certain medications. Preventing falls increases the safety and quality of care of residents.
- Worsened Pressure Ulcer: This indicator looks at the number of long-term care residents whose stage 2 to 4 pressure ulcers have worsened since the previous assessment. Pressure ulcers can happen when a resident sits or lies in the same position for a long period of time. Immobility may be due to many physical and psychological factors, neurological diseases like Alzheimer’s and improper nutrition or hydration. Careful monitoring is required to ensure good quality of care.
- Potentially Inappropriate Use of Antipsychotics: This indicator looks at how many long-term care residents are taking antipsychotic drugs without a diagnosis of psychosis. These drugs are sometimes used to manage behaviours in residents who have dementia. Careful monitoring is required, as such use raises concerns about safety and quality of care.
- Restraint Use: This indicator looks at how many long-term care residents are in daily physical restraints. Restraints are sometimes used to manage behaviours or to prevent falls. There are many potential physical and psychological risks associated with applying physical restraints to older adults, and such use raises concerns about safety and quality of care.
- Improved Physical Functioning: This indicator looks at how many long-term care residents improved or remained independent in transferring and locomotion. Being independent or showing an improvement in these two activities of daily living (ADLs) may indicate an improvement in overall health status and provide a sense of autonomy for the resident.
- Worsened Physical Functioning: This indicator looks at how many long-term care residents worsened or remained completely dependent on transferring and locomotion. An increased level of dependence on others to assist with transferring and locomotion may indicate deterioration in the overall health status of a resident.
- Worsened Depressive Mood: This indicator looks at the number of long-term care residents whose mood from symptoms of depression worsened. Depression affects quality of life and may also contribute to deteriorations in activities of daily living (ADLs) and increased sensitivity to pain.
- Experiencing Pain: This indicator looks at how many long-term care residents had pain. The consequences of pain include increased difficulty with activities of daily living (ADLs), depression and lower quality of life. The prevalence of persistent pain increases with age, and proper treatment of pain is necessary to improve the health status of residents.
- Experiencing Worsened Pain: This indicator looks at how many long-term care residents had worsened pain. Worsening pain can be related to a number of issues, including medication complications and/or improper management of medication. Careful monitoring of changes in pain can help identify appropriate treatment. Worsened pain raises concerns about the resident’s health status and the quality of care received.
Visit the CIHI website to view quality indicators for Shannex licensed long-term care communities in Nova Scotia.