Improving the lives of patients at personal care homes in Winnipeg and beyond

 

The Problem

For years, healthcare providers at the Winnipeg Regional Health Authority (WRHA) have collected data to assess the needs of elderly men and women who reside at the organization’s 38 personal care homes. The data—known as Minimum Data Set (MDS) and Resident Assessment Instrument (RAI)—are compiled four times a year. The improvement team investigated whether this data could be be used to help front-line providers improve care for residents and reduce costs for the WRHA.

The Solution

Joe Puchniak and Cynthia Sinclair – Managers with the WRHA Personal Care Home Program – focused their EXTRA improvement project on determining if this data could reveal insights on the use of antipsychotic medication to treat residents for dementia. More specifically, they sought to uncover whether the use of such drugs could be reduced without inducing adverse changes in residents’ behaviour. With the support of Arlene Wilgosh, CEO of the WRHA, the project achieved success beyond the team’s expectations.

“It was a pleasure to help lead a project that resulted in improved quality of life for residents, and reduced financial cost to the healthcare system.”
–Joe Puchniak Manager, Client Affairs, Alberta Canadian Institute for Health Information

Results and Impacts

Puchniak and Sinclair discovered that facilities where residents with dementia reported markedly lower use of antipsychotic drugs, relied on the ‘Physical, Intellectual, Emotional, Capabilities, Environment, and Social care model’ or P.I.E.C.E.S™. The P.I.E.C.E.S approach encourages staff to treat patients by looking at not only their health files, but also their personal histories, such as their former careers.

During the six-month improvement project, of the 70 residents already on antipsychotic medications, 27 percent (19 patients) were taken off of their medication. This translates to a 25 percent reduction of antipsychotic medications for the total resident population. This was also achieved without causing any increase in behavioural symptoms or rise in the use of physical restraints.

Decreasing the overall use of these drugs at the pilot site has enabled it to save $10,000. Given these impressive results, Puchniak and Sinclair put a business plan forward to expand the improvement to the remaining 38 personal care homes in the Winnipeg Regional Health Authority

The Spread

One in three long term care residents in Canada is on antipsychotic medication without a diagnosis of psychosis from a physician. Choosing Wisely Canada has identified the use of antipsychotics as a first choice to treat behavioural and psychological symptoms of dementia as a common practice that could expose patients to harm. Focusing on data and patient history to replace medication with creative solutions like recreation for residents with dementia is a good idea worth spreading.

In 2014, CFHI announced the Reducing Antipsychotic Medication Use in Long Term Care collaborative – one of two pan-Canadian collaboratives in the Spreading Healthcare Innovations Initiative. These collaboratives bring together organizations to make sustainable changes that improve patient experience and outcomes, better coordinate approaches to complex health needs and maximize healthcare efficiencies. CFHI is providing funding, coaching, educational materials and tools, and other support to 15 teams from across Canada to reduce the inappropriate use of antipsychotic medications in long term care facilities, among people with dementia. Cynthia Sinclair and Joe Puchniak have joined as faculty on this collaborative to help other organizations adapt and implement the approaches that worked so well in Winnipeg. Residents at over 50 facilities across Canada are expected to benefit through improved health outcomes, better quality of life and reduced risk of falls.

“The use of antipsychotic medications as a first choice to treat behavioural and psychological symptoms of dementia is a practice that can seriously harm patients. That’s why the Canadian Geriatrics Society is encouraging healthcare providers, patients and their caregivers to ‘think twice’ as part of the Choosing Wisely Canada campaign. We’re pleased to see that the Canadian Foundation for Healthcare Improvement is supporting teams to make evidence-informed decisions that improve patient care.”
–Dr. Karen Fruetel, Vice-president, Canadian Geriatrics Society, a member of Choosing Wisely Canada



Cynthia Sinclair image Cynthia Sinclair
Director of Care
Fred Douglas Lodge
Winnipeg, MB
Joe Puchniak image Joe Puchniak*, MSW, CHE
Manager of RAI/MDS & Decision
Support with the Personal Care Home
Program, Winnipeg Regional Health Authority,
Winnipeg, MB
Arlene Wilgosh image Arlene Wilgosh, CEO
Winnipeg Regional
Health Authority
Winnipeg, MB

*Please note that Joe Puchniak is now Manager, Client Affairs - Alberta, with the Canadian Institute for Health Information, Victoria, BC.

To learn more about this project please contact or the EXTRA program, visit www.cfhi-fcass.ca/EXTRA