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

Fight the Flu: A Person and Family Centred Approach

By: Michelle Douglas RN, Connie Wood RN, BScN, MN

Highland Wood, Haliburton

The beginning of flu season marks a time for long-term care home Directors of Care (DoC’s) to consider how best to prevent flu outbreaks.

“I see the loneliness in the residents’ eyes when visitors are restricted during an outbreak, and I just know in my heart I have to do everything I can to keep the doors fully open,” says Michelle Douglas, DoC of Highland Wood, a 30 bed long-term care home.

“The obstacles that an outbreak can put on a home, can feel insurmountable,” says Michelle. “If the prevention efforts are done properly and messaging is clear, the chances to avoid an outbreak are better.”    

DoC’s need to identify a key champion to lead flu prevention strategies before flu season begins. A team effort is needed so it is be important to develop strong partnerships with residents, families, volunteers and staff.

 “When you want to encourage vaccination, you need a passionate champion to get everyone on board”, says Michelle.  I read the RNAO best practice guideline Person-and Family-Centred Care and recommendation 6.1 resonated with me. It gave me the idea to deliver a holistic and inclusive influenza prevention plan. I realized to make it work I have to demonstrate leadership and commitment to avoid an outbreak. Best practice also advised me to be inclusive in my plans to build a healthy work environment. So, I became the champion.”

It was easy for Michelle because she has a passion and a background in infection control. In partnership with the Occupational Health and Infection Prevention and Control Nurse, the family counsel and residents counsel, and  awareness prevention program began.  After looking at the previous year’s data, it was determined to improve immunization rate of staff by 20 per cent, volunteers by 10 per cent and to offer immunization to the resident’s and staff’s family. They also boosted the hand washing education, audits and signage.

The person and family centred influenza prevention program began at Highland Wood with the launch of a “Family Day Vaccination Clinic.” Families of the residents and staff were invited to attend a clinic held during the month of October. Snacks and drinks were offered as a way to celebrate the cooperative effort. The DoC was first in line for the vaccination.

Foundational work included educating residents, staff, volunteers and family on influenza, the vaccine and how to avoid an outbreak.  An auditing hand washing team was struck. Hand washing was put at the forefront and, during the influenza season, scrutiny was heightened. 

“Staff attendance at the clinic was lower than I would like and this presents a challenge when the theme of the campaign is to avoid an outbreak,” says Michelle. One way she addressed the issue was to work with the Occupational Health and Infection Prevention and Control Nurse to offer alternative arrangements so that getting immunized was effortless.  Extra effort was spent reminding everyone to wash their hands and visitors were coached to not visit the home when ill. 

Highland Wood had no outbreaks the winter of 2017-2018. “Maybe it is good luck”, says Michelle. The immunization rates are conservative and hand washing audits are exceptional.

The rate of staff immunized rose from 43 to 62 per cent while the rate of the residents’ remained stable at 54 per cent. This year, 54 per cent of the volunteers and families were immunized. Staff sick days decreased substantially and were seen in the budget. Hand washing audits before resident to resident environment contact showed a compliance rate of 90.6 per cent.

“We have a few areas to continue to work on,” says Michelle. “One is to develop the hand hygiene auditor’s skills to provide constructive feedback”. She also identified the need to encourage part-time staff not to come to work when ill.

One of the best ways to keep the residents safe is to provide vaccination and embrace a person-and-family-centred care approach. The families appreciated the availability of the clinic while they were visiting and the children of the staff were happy to get vaccinated with their parents.

Highland Wood is one of the few homes in central east LHIN who did not face an outbreak this winter. “The best ways to avoid an outbreak is to increase vaccination rates and be diligent about hand washing,” says Michelle.  She adds, “By taking a person and family centered approach to prevent an outbreak, you are making the residents healthier and you are protecting them from getting sick. This benefits not only the resident but the home as a whole.”

-About Highland Wood-

Highland Wood is a 30-bed not-for-profit home in Haliburton, Ontario in the Central East LHIN. It is affiliated with Haliburton Highlands Health Services