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Written by Marie Van Bergen, Clinical Nurse Educator, Fellburn Care Centre

How a new tool is helping to prevent unnecessary transfers to Emergency from a residential care facility.

A new tool is being used in residential care facilities that serves as an early warning indicator that a resident's health is deteriorating.  These indicators are helping staff make informed decisions when contacting a doctor for symptom management in alignment with the resident’s goals of care. The PREVIEW ED tool has helped Fellburn Care Centre show a notable decrease in the rate of transfers to Burnaby Hospital Emergency Department.

The tool was piloted in Fellburn Care Centre in February 2016 in a 55-resident unit.  Care aides were the primary care providers responsible for completing the tool. The importance of the tool was soon recognized by both the care aides and the regulated staff. Basically, the tool supported the staff to make earlier and better decisions when presented with declining health of the residents.

Two examples of residents who benefited from information gathered from the tool:

Resident A (DNR) had a high score of 10 on the tool. Her health status began to decline. This triggered several important changes in care. Dehydration and aspiration pneumonia were the initial focus for medical management, with treatment that included intravenous fluids and broad spectrum antibiotics. This resident had a history of pneumonia that had resulted in transfers to the Emergency Department multiple times. The resident’s doctor met with her family and explained that she was not likely to recover from her current condition. Medical Orders Scope of Treatment (MOST) status was addressed and she passed away peacefully in our facility surrounded by her loving family and friends.

Resident B  was assessed using the tool, which triggered the urinary system indicator. Poor urine quality had become routine for him but a culture and sensitivity test was ordered to rule out urinary tract infection. A quadriplegic with neurogenic bladder, staff wondered if the condition of his urine might be normal for him and initiated a short-term care plan featuring some simple measures. It was successful and in this case, the tool assisted in refining a nursing care plan to address the resident’s particular acute needs in a residential care setting.

The tool is proving to be a worthwhile aid in decreasing visits to Emergency in all but the most severe circumstances.

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