Grandview Lodge had a higher percentage of falls by residents compared to the provincial average of 16.1% during the period of July to December 2017.
Under a provincially mandated health care plan, all Ontario long term care homes must provide a Quality Improvement Plan (QIP) and develop criteria that will improve service delivery to residents. These improvements are reviewed and submitted on a quarterly basis and Grandview Lodge receives feedback based on provincial comparison date.
The three criteria, which must be measured monthly, are resident falls, use of restraints and anti-psychotic medication.
21.1% of Grandview residents have had a fall during the six month time frame, but only one had a negative outcome (fractures). During the same period last year 20.5% had a fall but three of them resulted in hip and arm fractures. Increased use of falls mats is credited for the fewer injuries in 2017.
Many of the falls are happening to people who have cognitive difficulties, the report says. They fall while self-transferring out of bed, some forget to use their walking aids, or their health has declined.
Staff are now working on reducing the falls themselves. Two or more falls a month by a resident triggers an in depth review to determine whether additional toileting or other care is needed, whether medications are associated, and sleep assessments for 72 hours to monitor sleep patterns and restlessness for all new residents.
11.2% of Grandview residents use wheelchair seatbelt restraints, compared to the provincial average of 4.8%.
Some of this relates to families trying to protect their loved one, who may insist if a wheelchair has a restraint, it should be used. “Buckle up for safety” campaigns are ingrained in our minds, the report says, and it is often very difficult to obtain consent from families to have the seatbelt removed. The term “restraints” also applies to such things as bedrails.
Annual reviews assess patients’ changing condition that may warrant the removal of restraints and ongoing education of families around restraints is continuing. In addition, new residents transferred from hospitals often arrive with a restraint in use. Staff will not remove it until they have evaluated the resident to ensure it is safe to do so.
34.6% of Grandview residents are on antipsychotic medications without a diagnosis of psychosis or other related conditions, compared to 29% last year and the provincial average of 20%.
Staff is at a loss to determine why, however note many new admissions from home or hospital arrive with an antipsychotic already in place. Discontinuing the medication without proper reduction and observation is unwise, and it takes time to work through whether they need it. Much of the usage at Grandview is short term. Sometimes alternative treatments have failed and an antipsychotic is a last resort.
The nursing team, pharmacist and physicians are reviewing the use of this medication to evaluate whether an anti-depressant may be more appropriate for patients with dementia who do not have a psychosis diagnosis. In addition Behavior Support Ontario, a provincial resource of professional staff, is working closely with Grandview Lodge staff to assist in the reduction of anti-psychotics. Medications will continue to be reviewed to ensure they are effective.
It was noted residents are more frail when they enter the home and staff regularly speak with other homes to see how they handle the issues.