Implementing and sustaining evidence-based practices in long-term care.

Clinical BPGs

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    This new guideline is designed to apply to all domains of nursing practice, including clinical, administration, and education, to assist nurses to become more comfortable, confident and competent when caring for clients undergoing care transitions. It is important that nurses, working in collaboration with the interprofessional team promote safe and effective care transitions. Care transitions depends on effective communication and coordination of client care by all interprofessional team members and with the client, their family and caregiviers.

    This guideline is endorsed by Accreditation Canada.

    Registered Nurses’ Association of Ontario. (2014). Care Transitions. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Care_Transitions_BPG.pdf

    This work is funded by the Ontario Ministry of Health and Long-Term Care.

     

    French translation - Transitions des soins https://rnao.ca/sites/rnao-ca/files/TransitionsDesSoins-RNAO.pdf

     

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    A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

    Registered Nurses Association of Ontario (2022) Gap Analysis-Care Transitions. Toronto. ON

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    This guide provides an interview process from introduction to closing that supports accurate and comprehensive medication information is communicated consistently across transitions of care.

    Reference: Institute for Safe Medication Practices (ISMP) Canada, In collaboration with SaferHealthcareNow (2012). Best Possible Medication History Interview Guide. Retrieved August 8,2016 from https://www.ismp-canada.org/download/MedRec/SHN_medcard_09_EN.pdf

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    The Health education fact sheet supports resident/family to understand that they are an important part of the health-care team. Speaking with members of the health-care team will help them get the information they need to understand any changes in their health and what it means for the situation.

    Reference: Registered Nurses’ Association of Ontario (2014). Care Transitions. Toronto, ON, Canada: Author. http://rnao.ca/bpg/guidelines/care-transitions

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    A quality improvement initiative looks at communication during shift report identifying 4 key themes as opportunities to improve upon. Improvement outcomes are shared in the article.

    Reference: Johnson C.,Carta, T., & Throndson, K. (2015) Canadian Nurse. Communicate with me: Information exchange between nurses. Retrieved from https://www.canadian-nurse.com/articles/issues/2015/march-2015/communicate-with-me-information-exchanges-between-nurses

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    This article looks at communication as being a key culprit in compromising patient safety in hand-over. Suggestions are given for strategies on how to approach hand-overs from shift to shift consistently, how to include patient and family along with potential barriers

    Reference: World Health Organization. (2007) Patient Safety Solutions. Communication during patient handovers. 1 (3). Retrieved from https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/patient-safety-solutions/ps-solution3-communication-during-patient-handovers.pdf?sfvrsn=7a54c664_4&ua=1

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    Nurses have ethical and legal obligations for obtaining consent. The ethical obligations related to consent are discussed in the Ethics practice standard under the section Client Choice. This practice guideline replaces and updates the guide produced in June 1996 after the legislation, the Health Care Consent Act (HCCA) and the Substitute Decisions Act (SDA), was enacted. This practice guideline provides an overview of the major features of the legislation, pertinent definitions, the steps nurses need to take to obtain consent and the Guidelines for Nurses Advocating for Clients Found Incapable of Making Certain Decisions. It replaces an earlier Guide to the Health Care Consent and Substitute Decisions Legislation for RNs and RPNs. It does not address consent under the Mental Health Act.

    Reference: College of Nurses of Ontario Practice Guideline (2009) Consent Retrieved from http://www.cno.org/globalassets/docs/policy/41020_consent.pdf

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    Practice standards are documents that help nurses understand their responsibilities and legal obligations in order to make safe, effective and ethical decisions in nursing practice. This practice guideline outlines when nurses have the appropriate authority and competence to perform a particular procedure.

    College of Nurses of Ontario. (2018). Practice Standard: Decisions About Procedures and Authority. Toronto, ON, Canada: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/41071_decisions.pdf

    Copyright © College of Nurses of Ontario, 2020

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    This paper from the Institute for Safe Medication Practices in Canada (ISMP). A multi-incident analysis of delayed medication doses after transitions of care.

    Reference: Institute for Safe Medication Practices in Canada (2016) Delayed Treatment after Transitions of Care: A Multi-Incident Analysis Retrieved from https://www.ismp-canada.org/download/safetyBulletins/2016/ISMPCSB2016-07-DelayedTreatment.pdf?utm_source=safetybulletin&utm_medium=email&utm_campaign=sbv16i07#page=1

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    This tips and tools guide is designed to assist you to better understand and learn how to plan, provide, develop and sustain interprofessional health care in your work environment.

    Registered Nurses of Ontario ( 2014) Developing and Sustaining Interprofessional Health Care: Tips and Tools for Health-care Teams, Toronto. ON retrieved fromhttps://rnao.ca/bpg/resources/developing-and-sustaining-interprofessional-health-care-tips-and-tools-health-care-tea

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    Les présentes lignes directrices sur les pratiques exemplaires, Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système sont conçues pour favoriser des milieux de travail sains. L’objectif de l’élaboration de ces lignes directrices était de déterminer les attributs des soins interprofessionnels qui permettront d’optimiser les résultats de qualité pour les patients/clients, les fournisseurs, les équipes, l’organisation et le système. Les présentes lignes directrices déterminent les pratiques exemplaires pour faciliter, améliorer et maintenir le travail d’équipe ainsi que la collaboration interprofessionnelle, et pour accroître les résultats positifs pour les patients/clients, les systèmes et les organisations. Elles sont fondées sur les meilleures données probantes existantes; lorsque ces données étaient limitées, les recommandations ont été fondées sur un consensus basé sur des opinions d’experts.

    Association des infirmières et infirmiers autorisés de l’Ontario. (2013). Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système. Toronto, Canada: Autheur. Récupéré: http://rnao.ca/bpg/language/d%C3%A9veloppement-et-maintien-des-soins-de-sant%C3%A9-interprofessionnels-optimisation-des-r%C3%A9sul

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée d'Ontario.

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    Practice standards are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the regulatory and legislative requirements for documentation.

    College of Nurses of Ontario. (2008). Documentation, Revised 2008. Toronto, ON: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/41001_documentation.pdf


     

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    This learning module reviews documentation and how it is important component of nursing practice and interprofessional documentation that occurs

    Reference: College of Nurses of Ontario (2010) Documentation- Learning Module. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learning-modules/documentation-2010/

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    Practice standard are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the ethical values and practice standards that the nursing profession in Ontario must uphold. It also provides scenarios of ethical situations in which there is a conflict of values.

    College of Nurses of Ontario. (2019). Ethics [PDF file]. Retrieved from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf

     

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    This table is a theoretical framework to understand the psychological stages individuals may go through as they adapt to a transition

    Reference: Registered Nurses’ Association of Ontario (2014). Care Transitions. Toronto, ON, Canada: Author. http://rnao.ca/bpg/guidelines/care-transitions pp22

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    This resource provides guidelines that support, give direction and improve services for adults with a developmental disability when applying to, moving into and residing In a Long-Term Care Home. It outlines the importance of planning, choice and consent and adults with developmental disabilities receiving appropriate developmental services and supports in a LTC home. Following these guidelines demonstrates the integrated and co-ordinated approach to care within and between the Developmental Services (DS) and LTC home sectors.

    Reference: QUEEN'S PRINTER FOR ONTARIO, 2012-14 - LAST MODIFIED: OCTOBER 18, 2017. RETRIEVED OCTOBER 31,2017 FROM https://www.health.gov.on.ca/en/public/programs/ltc/dsguidelines/ 

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    This article describes the challenges involved and potential solutions for improving the quality of transitional care.

    Reference: Fancott, C. (2011). The Change Foundation. Interventions and measurement tools related to improving the patient experience through transitions in care: A summary of key literature. Retrieved from http://www.hqontario.ca/Portals/0/modals/qi/en/processmap_pdfs/resources_links/care%20transitions%20literature%20review.pdf

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    Cette ligne directrice sur les pratiques exemplaires en soins infirmières et infirmiers est un document détaillé comportant les ressources nécessaires au soutien de la pratique basée sur des données probantes. Un milieu de travail sain, c’est un milieu de pratique qui maximise la santé et le bien-être des infirmières, des résultats de qualité chez le patient ou client, le rendement de l’organisation et du système, et les retombées sociales, y compris des collectivités en meilleure santé.

    Association des infirmières et infirmiers autorisés de l’Ontario (2013). Lignes directrices sur le développement et le maintien du leadership infirmier, (2em Ed.). Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/language/lignes-directrices-sur-le-d%C3%A9veloppement-et-le-maintien-du-leadership-infirmier

     Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée d'Ontario

     

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    Med Rec is a formal process to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. This site provides information that can support medication reconciliation policies and procedures within organizations.

    Reference: Institute for Safe Medication Practices (ISMP). (2012). Medication Reconciliation. Retrieved from http://www.ismpcanada.org/medrec/

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    The Medication practice standard describes nurses’ accountabilities when engaging in medication practices, such as administration, dispensing, medication storage, inventory management and disposal.

    Reference: College of Nurses of Ontario (2015) CNO Practice Standard-Medication Retrieved from http://www.cno.org/globalassets/docs/prac/41007_medication.pdf

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    This website will assist families when an individual with dementia is looking at transitioning to long-term care. The Alzheimer Society of Canada webpage has resources for the following areas to support decision-making:

    • Considering the move to LTC Home
    • Preparing for a move
    • Handling moving day
    • Adjusting after a move
    • Caregiver stress assessment checklist
    • LTC Home evaluation checklist
    • What to bring on moving day checklist
    • Transition to LTC e-learning module
    • All about me

    Web Address: http://www.alzheimer.ca/en/Living-with-dementia/Caring-for-someone/Long-term-care

    Reference: Alzheimer Society of Canada (2016)“ Alzheimer Society of Canada, Long Term Care” retrieved from https://alzheimer.ca/en/help-support/im-caring-person-living-dementia/long-term-care/moving-long-term-care

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    Nursing is a profession that is focused on collaborative relationships that promote the best possible outcomes for clients. These relationships may be intraprofessional, with multiple members of the same profession working collaboratively to deliver quality care within and across settings. This practice guideline focuses on three factors—the client, the nurse and the environment—to support nurses in making decisions that are specific to their intraprofessional responsibilities when providing client care.

    Reference: College of Nurses of Ontario Practice Guideline (2014) RN and RPN practice: The Client, the Nurse and the Environment. Retrieved from http://www.cno.org/globalassets/docs/prac/41062.pdf

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    This webcast is based on the RN and RPN Practice: The Nurse, the Client and the Environment practice document which discusses concepts that apply to RNs and RPNs in all roles in all practice settings.

    Reference: College of Nurses of Ontario (2013) RN and RPN practice: The Client, the Nurse and the Environment. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/rn-and-rpn-practice-the-nurse-the-client-and-the-environment-webcast/

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    This best practice guideline focuses on collaborative practice between RNs, RPNs and NPs and fostering healthy work environments for these nurses.

    Registered Nurses’ Association of Ontario. (2016). Intra-professional collaborative practice among nurses. Toronto, ON, Canada: Author. Retrieved from: https://rnao.ca/sites/rnao-ca/files/bpg/Intra-professional_Collaborative_Practice_042017.pdf

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    This nursing best practice guideline will address the therapeutic relationship and its central importance to nursing practice

    Registered Nursing Association of Ontario (2002) Establishing Therapeutic Relationships. Toronto, ON Retrieved from Establishing Therapeutic Relationships | Registered Nurses' Association of Ontario (rnao.ca)

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    The aim of this guideline is to provide evidence-based recommendations for registered nurses, registered practical nurses and other health-care providers to facilitate client centred learning that promotes and enables clients to take action for their health.

    Registered Nurses Association of Ontario ( 2012) Facilitating Client Centred Learning . Toronto. ON Retrieved from Facilitating Client Centred Learning | Registered Nurses' Association of Ontario (rnao.ca)

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    This toolkit offers resources to support the use of SBAR. SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured.

    Reference: Institute for Healthcare Improvement (IHI) : SBAR Toolkit (2016) Retrieved September 29,2016 from http://www.ihi.org/resources/pages/tools/sbartoolkit.aspx

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    The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
    The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.

    Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)

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    At the core of nursing is the therapeutic nurse-client relationship. The College's Therapeutic Nurse-Client Relationship, Revised 2006, practice standard describes the expectations for all nurses in establishing, maintaining and terminating a therapeutic relationship.

    College of Nurses of Ontario. (2006).  Therapeutic nurse-client relationship. [PDF document]. Retrieved from https://www.cno.org/globalassets/4-learnaboutstandardsandguidelines/prac/learn/modules/tncr/pdf/tncr-chapter3.pdf

     

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    Cette feuille d’information de l’ASSSP vise à offrir aux parties du lieu de travail de l’information qui peut contribuer à améliorer la transition des pratiques thérapeutiques. L’amélioration de la transition des soins peut améliorer la sécurité des employés et des clients.

    Reference: http: Public Services Health & Safety association (2017). Retrieved October 31, 2017 from http://www.pshsa.ca/products/transition-des-soins-batir-un-systeme-plus-sur/ 

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    This Public Services Health & Safety Association (PSHSA) Fast Facts is intended to provide workplace parties with information that can help improve transition of care practices. Improving transitions in care results in improved employee and client safety.

    Reference: Public Services Health & Safety association (2017). Retrieved October 31,2017 from http://www.pshsa.ca/products/transition-of-care-fast-fact/ 

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    This 15 minute Public Services Health & Safety Association (PSHSA) web tutorial describes the transition of care process, challenges and opportunities to improve practice when supporting those going through a healthcare transition of care.

    Reference: http: Public Services Health & Safety association (2017). Retrieved October 31,2017 from http://www.pshsa.ca/product/transition-of-care/ 

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    Stroke patients are among the largest patient population receiving long-term care. The transition by stroke survivors and their families is known to be a stressful and challenging time as they adjust to new roles, altered functional and cognitive abilities, and changes in living setting for patients admitted to long-term care following an acute stroke. This Transition of Patients to Long-Term Care Following a Stroke Canadian Stroke Best Practice Recommendations identify what is required to have a successful transition.

    Reference: Canadian Stroke Best Practice Recommendations. Managing Stroke Transitions of Care (July 2016). Retrieved from: http://www.strokebestpractices.ca/index.php/transitions/transition-of-patients-to-long-term-care-following-a-stroke/

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    This Care Transitions change package provides information that can be used sequentially to complete a specific task (or series of tasks), or can be used selectively and independently, depending on the user’s needs. This package includes an overview of transitions of care, four (4) key evidence-informed change concepts, and a deeper dive into the change concepts.

    Reference: Health Quality Ontario (2013)Transitions of Care: Evidence Informed Improvement Package Retrieved September 1,2016 from http://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-transitions-en.pdf

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    This CNO document discusses nurses’ role when working with unregulated care providers.

    Reference: College of Nurses of Ontario (2013) Working With Unregulated Care Providers Retrieved from http://www.cno.org/globalassets/docs/prac/41014_workingucp.pdf