Table 1 Phases of EKWIP-HF pilot
Phase | Elements | Actions |
|---|---|---|
Phase 1: address knowledge gaps Target: PSWs and RPNs Observers: MDs, RNs, administrators Month 1 | Small-group interactive education sessions held at each LTC home | Importance of HF: basic physiology and impact on residents and health system Clinical Skills: recognize possible HF: -Classical and atypical symptoms (changes in cognition, mobility and function) -Edema and other basic symptoms and signs -Understand importance and meaning of weight changes -Understand course of HF, including acute and chronic aspects Procedural skills: -Rationale and methods for regular weights and reporting -Rationale for HF medications disease modifying vs. symptom control with diuretics -Understand role of the MDS 2.0 and Clinical Assessment Protocols |
Educational resources | PowerPoint of education material Pocket cards | |
Phase 2: develop communication processes for HF Target: PSWs and RPNs Observers: MDs, RNs, administrators Month 1 | Workshop Develop/adapt processes for better communication between PSW and RPN | Review current communication processes and identify barriers and reasons for breakdown, framed in the context of HF (e.g. workload, staff scheduling, staff role). Develop/adapt communication processes focused on key episodes of HF care: shift change, physician rounds, new admissions, ad hoc identification of acute resident health deterioration, and measuring and tracking weights. Define required staff roles for the new processes (may be unique to each home). Define process uptake indicators to measure fidelity (e.g. communication logs for shift change and communication of weight changes, weight tracking tools) |
Phase 3: implement communication processes and consolidate knowledge Target: PSWs and RPNs Observers: MDs, RNs, administrators Months 2 to 3 | Communication process implementation and consolidation | Audit and feedback Audit mechanisms -Bi-weekly on-site observations by research assistant (shift change, work day) -Review of documentation of process uptake indicators -Weekly feedback from MDs, RNs and administrators about their observations Feedback: monthly meetings of PSWs and RPNs with research team to: -Review observations and identify potential changes to communication or documentation processes -Resolve knowledge and communication problems that have arisen Engage staff and encourage autonomy in conducting own audit and feedback reviews. |
Phase 4: address knowledge gaps Target: MDs, RNs Month 3 | Small-group interactive education sessions | Topics as in phase 1 (tailored to role), as well as: Clinical skills: physical assessment -Additional focus on volume assessment and determining “dry weight” Procedural skills: -Role of diagnostic testing -Appropriate prescribing, including adjusting diuretics based on weight changes -Discussing Advance Care Planning |
Phase 5: full interprofessional integration Target: all clinical staff Observers: administrators, residents/families Months 3–6 | Bedside teaching (six monthly sessions) | Sessions to take place during regular LTC physician visits and -Will take no more than 30 min -Include physician, nurses, PSW, and other staff assigned to a resident with HF With resident consent, bedside clinical assessments will be conducted with the LTC team present and participating. Case will be discussed and care management and communications plan will be developed by the team. Sessions will be facilitated by the expert clinicians, with the aim to promote greater engagement and autonomy by the LTC team. |
Case conferences (six monthly sessions) | Conferences to take place during regular LTC physician visits and will consist of a discussion of a resident’s case with HF. Initially, conferences will be facilitated by the HF and LTC expert clinicians, with the aim to promote greater engagement and autonomy by the LTC team. |