Abstract
BackgroundNursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred.MethodsThis study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data.ResultsMost teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams.ConclusionsOur coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended.
Highlights
Showing that care aides can effectively lead these initiatives;
Demonstrating that PDSA training to support these initiatives should emphasize the interconnected nature of AIM development, care plan implementation, and measurement;
Five of the seven SCOPE teams focused on reducing dementia-related responsive behaviors, 1 team focused on reducing pain, and 1 focused on improving resident mobility (Table 3)
Summary
1.7 million North Americans reside in nursing homes [8], and at least half of these residents have some form of age-related dementia often combined with additional impairments such as difficulties completing daily tasks, responsive behaviours, and frequent incontinence [9,10,11]. This vulnerable group requires complex health, personal, and social care, provided in ways that has meaning for residents [12] and that emphasize the importance of relational care and quality of life [13]. While media have highlighted the significant challenges with nursing home care during pandemic times [14,15,16], the quality of care provided in this sector has been recognized as suboptimal for decades, and many groups have called to improve nursing home structures and care processes [17,18,19,20,21]
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