Since 2015, VHA Home HealthCare (VHA) has been a designated Best Practice Spotlight Organization (BPSO), a credential awarded by the Registered Nurses’ Association of Ontario (RNAO) which recognizes success in implementing Best Practice Guidelines and providing the highest level of professional practice and delivering evidence-based care across all disciplines.

The BPSO designation is reviewed every two years for potential renewal. As VHA looks forward towards the next designation cycle (2021-2023), here’s a look back at the organization’s BPSO journey, and the two Best Practice Guidelines (BPGs) the team successfully implemented from 2019-2021.

“We see the responsibility of being a BPSO as an honour,” said Matt Wong (seen above), VHA’s Manager of Professional Practice and BPSO lead. “To build our community of practice, my team and I foster organization-wide enthusiasm around our BPGs as a leadership opportunity to effect change at an organizational level that will have a positive impact on client care.”

From 2019-2021, one of the Best Practice Guidelines VHA has implemented is Strategies to Support Self-Management in Chronic Conditions.

“We felt this BPG would be really beneficial to the VHA population. If you look at the health history of most of our clients, anywhere from 90-95 per cent of them have at least one chronic disease,” said VHA’s Sara Fung (seen above), Professional Practice Specialist and BPG lead.

Chronic diseases refer to any conditions that are long-term (diagnosed for 6 months or more) and that can’t be cured. Some examples include diabetes, heart disease, and arthritis.

“By implementing this BPG, we were able to rollout a sustainable plan of action to better support staff and their clients and families,” added Sara. The development of the plan involved Sara and a committee including a client partner and rehab, personal support and nursing staff and it focuses on four key areas:

1. Choices and Changes workshop, which provides clinicians with efficient and effective tools to help them to motivate patients’ health behavior changes and adherence to treatment plans.
2. External client-facing website on Chronic Disease Self-Management accessible at www.vha.ca/cdsm, which provides accessible information about common chronic illnesses and illness-specific resources, finding a regulated healthcare provider, health literacy, advocacy as a client and caregiver, improving quality of life, managing multiple chronic illnesses, caregiver resources and support, community resources, mental health and advance care directives.
3. A mandatory screening tool for depression because those living with chronic conditions are at increased risk of depression. Additionally, motivation/behavioural changes to support chronic disease management can be difficult when someone has depression. As of December 2020, all VHA nursing clients are screened for depression upon their initial visit.
4. Internal Chronic Disease resource hub that can easily be accessed on Nursing and Rehab clinicians’ mobile devices or laptops for accurate, up to date information. Topics include a diabetes client education checklist and diabetes teaching guidelines, skills to practice and a summary of intervention techniques. Staff can also sign up for the Choices and Changes monthly workshops on this page.

The second guideline that VHA implemented from 2019-2021 is Preventing Falls and Reducing Injury from Falls, Fourth Edition. This edition of this BPG expanded its scope to include all adults at risk for falls and receiving care from nurses and other health-care providers across the health-care continuum, including those living in the community.

“According to recent research, falls are the most commonly occurring, preventable client safety event occurring in home care,” said Kathy Sidhu (seen above), Interim Vice President, Quality, Best Practice and Education and BPG co-lead alongside Nursing and Personal Support Professional Practice Specialist Janet Chan.

“Having a robust falls management and best practice program is key to preventing falls and fall-related injuries, which can result in increased emergency department visits, hospitalizations and functional decline.  A focused effort on falls prevention for our adult population enables our clients to live as safely and independently at home for as long as possible, with the greatest functional abilities,” she added.

A previous edition of the Falls BPG was among the first guidelines adopted by VHA in its BPSO journey in 2014. With the revised version released in 2017, Kathy, Janet and her team felt it was a good chance to assess the sustainability of VHA’s previous practices and check for further improvements that could be made to the program. Under Kathy and Janet’s leadership, the team completed a gap analysis to determine if there were areas that could be addressed.

“One opportunity for us was to move to a standardized and validated falls risk assessment and we did just that by introducing the “Missouri Alliance for Home Care” (MAHC-10) tool to our regulated health professional groups servicing adult clients,” Kathy said.

This work also included implementing an organization-wide policy to address falls management practices. The BPG efforts were driven by a committee with representation from multiple regions and disciplines and most importantly – included a client partner who contributed lived experiences and input all along the way.

As a BPSO, not only do guidelines need to be met and sustained over time, VHA also contributes learnings and evidence-based findings with the wider nursing community through panels, conferences, published research, and by submitting anonymous data to RNAO’s database to inform decisions and policy across sectors. VHA also acts as a mentor to other partners and home care agencies that are beginning their BPSO journey.

“Another important marker of success as a BPSO is the presence and growth of Best Practice Champions. From 2020 to 2021, VHA increased its trained champions from 46 to 177, which is very exciting to see,” said Matt.

“Although the RNAO is of course a nursing association, as the BPSO lead, I am glad that their program has taken a broad perspective so I am able to bring together our talented interdisciplinary teams to adopt BPGs across the circle of care,” he said.

To date, VHA has implemented seven Best Practice Guidelines over three terms as a BPSO. In its upcoming review, VHA will be opting to implement two new BPGs: Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour and Preventing Violence and Harassment and Bullying Against Health Workers.

To learn more about this work at VHA, visit https://www.vha.ca/commitment-to-quality/bpso/.