Deer Park Villa Exceeds Goals with Teamwork and Creativity

Deer Park Villa, a 39 bed long-term care home located in Grimsby, Ontario and Year One Residents First participant, started its quality improvement journey with an aim to reduce the occurrence of pressure ulcers in the home from 12% to 5% by September 30, 2010, a goal they handily achieved with the help of the home's Residents First quality improvement training.

Deer Park's QI team began by using a Fishbone diagram, one of the tools Residents First participants learn to use to understand the root causes of the five ulcers in the home and how to address them. This analysis determined that some of the ulcers were hospital inherited, while also uncovering two potential contributors to the ulcers acquired in the home: inconsistencies in toileting routines and inconsistencies in ensuring that residents who needed to lie down in the afternoon to relieve pressure were doing so. The team implemented several care delivery changes to address these issues. They created a Turning and Repositioning Schedule, using the Plan Do Study Act cycle (another tool taught to Residents First participants), applying the schedule first to a few residents on one shift and then, after the team had evaluated its impact using a PDSA template, rolling it out to other residents and other shifts.

The team also created individual care plans for all residents. Following a thorough assessment, plans developed included an afternoon PM Rest Schedule and a Toileting Schedule for residents requiring these interventions. Encouraged by the definitive of success these efforts, the QI team created a second aim statement to further reduce pressure ulcers, to 2.5% by December 31, 2010-a goal they also achieved.

Key to Deer Park's success was their understanding of the need to not just make change but to sustain it. To help accomplish this, the team created an awareness campaign directed at all staff, residents and families, to keep the issue top of mind. Even residents in the home's supportive housing unit got involved, sewing what staff affectionately refer to as "bum buttons" out of nylon stockings. Although cute, these three dimensional buttons worn by staff played a serious role in the project. "Families would ask what it was about," says Sylvia Bleyswyk, Manager of Resident Services and Programs. "The project greatly improved awareness among staff, families and residents, and it was a very positive experience for everyone."

Bleyswyk adds "the pressure ulcer project was about teamwork within the entire Deer Park community. Now everyone is looking forward to our next quality improvement project." Clearly, Deer Park was not only successful in reducing pressure ulcers, along with the time and costs associated with caring for these wounds, they also created an environment where quality improvement is becoming part of the culture-and that is what Residents First is all about.