CAMH commits to three-year implementation of RNAO BPGs

On Jan. 31 of this year, RNAO was proud to announce that the Centre for Addiction and Mental Health (CAMH) renewed its commitment to implement RNAO best practice guidelines (BPG) and rejoin its Best Practice Spotlight Organization® (BPSO®) program. This agreement re-affirms a commitment to providing dignified evidence-based, person-centred care to people seeking support for mental health and substance use issues. 

“CAMH is thrilled to be renewing our partnership with RNAO as a BPSO,” says Dionne Sinclair, vice president of clinical operations and chief nursing executive at CAMH. “As a global leader in mental health, CAMH is committed to using best evidence and best practices to inform everything we do. We know that engaging in RNAO’s globally-acclaimed best practice guidelines program will help us advance care for patients and their families.” 

“Nurses know that mental health is essential to everyday health. RNAO and CAMH share a vision of increasing access and supports for anyone seeking care for mental illness and substance use,” says RNAO’s CEO Dr. Doris Grinspun. “We are proud to partner with CAMH once again as they continue their journey towards guideline implementation and sustainability. We commend them for their commitment to clinical excellence and evidence-based practice.”

Read more about the announcement in the full media release. 


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An innovative palliative approach to care at St. Joseph’s

St. Joseph’s Care Group in Thunder Bay, Ontario (St. Joseph’s), an RNAO Best Practice Spotlight Organization® (BPSO®), is using evidence-based practice and innovation to address its clients’ holistic care needs and improve their quality of life.

Many St. Joseph’s clients are living with serious and progressive diagnoses that would benefit from a palliative approach to care. Current literature focused on best practices highlights the benefits of incorporating a palliative approach to care for individuals living with serious and progressive diagnoses – as early as the time of diagnosis and especially within the last 12 months of their lives. 

St. Joseph’s staff recognized that early identification of clients who could benefit from a palliative approach to care would improve the quality of care they receive. They determined there needed to be a process in place to identify all clients who would benefit from a palliative approach to care and that it should occur at the time of admission. 

So, the collaborative practice team, regional palliative care program and in-patient rehabilitative care division partnered together on this joint initiative. The nursing professional practice and BPSO lead, in collaboration with a nursing informatics specialist in the information systems department, created a pathway for early identification of palliative care needs, using the nursing admission assessment and a new advanced care planning intervention. 

Why expend the effort? Because when palliative care needs are identified earlier in the illness trajectory, it may improve the client’s care and quality of life in many ways, including

•    providing opportunities for advance-care-plan and goals-of-care discussions
•    providing opportunities for education to improve clients’ understanding of their illness
•    initiating care-plan changes to support their needs, address symptoms and promote comfort 
•    allowing clients, families and care partners time to prepare for the end of life
•    reducing hospital transfers and unnecessary emergency department visits

St. Joseph’s prioritized the early identification of palliative clients as part of its quality improvement plan in alignment with its mission of recognizing and addressing unmet needs and with a focus on continual quality improvement. 

What is the new intervention? 

To gather the new data, a section was added to the nursing admission assessment intervention in Meditech. The new section was set up with both a forced question and prompts. The question requires nurses to document a “yes” or “no” response to determine whether their client would benefit from a palliative approach to care. If the answer is “yes,” an onscreen prompt then appears to add the new advanced care planning intervention.  

The new assessment question provides nurses with a simple way to quickly gauge which clients will benefit most from a palliative care approach following the intervention. As a result, clients, their loved ones and care partners, including front-line staff, have more precise information and more time. And best of all, this means better quality of life for the patient. 

The palliative care floor and program at St. Joseph’s have provided clients with palliative and end-of-life care for years. This innovation ensures that even more clients will benefit from this forward-looking approach in other departments of the hospital. 

In the project’s initial planning phase, the project team partnered with a regional RNAO best practice consultant to complete a gap analysis based on RNAO’s best practice guideline, A Palliative Approach to Care in the Last 12 Months of Life. Recommendations from this analysis regarding early identification helped provide a framework for this quality improvement initiative.

Implementation was a collaborative effort by nursing and allied health professionals and RNAO best practice champions. This included BPSO co-leads Tanis Banovsky, RN, the nursing professional practice lead, and Trisha Wilson, a social worker and performance improvement lead for the Northwest Regional Palliative Care Program.

RNJ spoke with RN Sarah Lynne Myllyaho (pictured below), a best practice champion employed at St. Joseph’s at the time*, regarding how the new early identification process and intervention helps.

“A palliative approach to care is appropriate for anyone facing, or at risk of facing, a progressive life-limiting illness at any point and at any time. It does not depend on the client’s prognosis or life expectancy. Palliative care is proven to be more effective when started earlier. Therefore, early identification of clients who could benefit from a palliative approach to care while at St. Joseph's Care Group is very important. It allows us to provide holistic care, treatment, support and resources to ensure the best possible quality of life and wellbeing for our clients and their families/care partners. Identifying these clients during admission creates an opportunity to provide palliative care alongside other therapies, as well as better define and establish client goals of care.”

(*Note: Sarah Lynne Myllyaho is now employed as a nursing practice leader in professional practice at the Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario.)