Luther Court is a campus of care located in Victoria, BC. It has 60 complex care beds, 58 assisted and independent living apartments an adult day centre for those living in the community and a wellness centre. Faced with various staffing issues, changes staffing legislation and increasing complexity of clients, Luther Court developed a staffing model that maximizes the scope of practice of the three main disciplines, RN, LPN, RCA (resident care aides), providing care in a long term care setting. Each discipline works to its identified scopes of practice integrating seamlessly across a continuum of care. Additional features of the staffing model enhance communication with families and other health professionals, enhance client safety, improve care outcomes and support staff learning needs. The staffing model was developed after careful study and review of the needs and issues, implemented using a change model and evaluated regularly from a number of vantage points. Measurable objectives were identified: 1. Quality: improved care decisions that more accurately meet client needs, improved communication with families, increased collaboration among staff, and increased input by team members in decision-making. 2. Patient Safety: improved preventive care- pressure ulcers, falls, chronic disease, pain improved accountability, night time calls. Results of Quantitative Indicators: 1. Safety: falls reduced below provincial average; pressure ulcer reduced below provincial average; lowered medication variances from pre-model implementation; and reduced ER/hospitalizations. 2. Efficiency: lower staff attrition; and increased appropriateness of skills. 3. Accessibility: improved physician response time; reduced family complaints regarding communication. Monitoring and audits are carried out by family surveys, annual review of night calls from LPNs, chart audits, pharmacy reviews of medication variances, and Accreditation Canada Workplace survey. Overall, the quality of care as measured by the chart and care plan reviews shows increased appropriateness and timeliness of care interventions. Family and physician reporting indicate support for the most responsible nurse (MRN) role. Even as physician recruitment in Long term care facilities becomes more difficult, Luther Court has managed to solidify its physician cohort. The Executive Director has been told that one reason is the MRN-physician model. The Health Authority has taken interest in the model that Luther Court has pioneered, as it provides a viable alternative to their standard model, and Luther Court has demonstrated that outcomes are as good as or better than outcomes realized by facilities following a more traditional staffing approach. The model is now seen as an innovative approach to meeting the needs of increasingly frail clients, increasing staff, family satisfaction, improving care outcomes and wise use of scare resources.

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