With his team by his side, Resident Assessment Instrument (RAI) Supervisor, Ernesto Kho, has changed the way staff at Providence Manor, Providence Care’s long-term care home, think about documentation and how they work to effectively complete the task while on the go.
Ernesto joined the team in August 2022 and had the unique opportunity to improve Providence Manor’s case mix index (CMI) performance. Case mix index reflects the diversity and complexity of care needed for residents in the home and is closely tied to documentation.
“Staff working in health care tend to desensitize, especially if they have known a resident for a number of years. So, when they see a behaviour, it has become so normalized to them that they don’t document it. This can lead to a below average or low case mix index,” explains Ernesto.
Case mix index is essentially a snapshot that helps staff understand how much care, on average, a resident requires. These needs are laid out in individualized care plans.
When staff are able to effectively and frequently document residents care requirements and behaviours, the easier it becomes for staff to support residents to function at their highest potential. Accurate and detailed documentation of behaviours resident needs is critical when it comes to auditing quality of care, compliance and funding from the Ministry of Long-Term-Care.
A high CMI means that on average, residents need a higher level of care and require funding to match their care requirements. A low CMI means a resident needs less care and it may mean the organization receives less funding because the average level of care needed is lower. Providence Manor was struggling with a low CMI that didn’t reflect the care needs of residents in the home, and Ernesto and his team knew that improvements could be made.
Ernesto took a watch-and-learn approach to see where improvements to documenting could be implemented. With the help of his team, he discovered that staff needed more information on how to document and they needed to be able to document wherever they were in the home. Adding mobile technology and improving network connectivity throughout the home, along with documentation education, were his first orders of business.
“Once we identified the issues causing a below average CMI, I gave myself a year to turn things around. The better picture you project in terms of data and documentation, the more resources we receive. It really is a see-saw effect,” explains Ernesto.
As fate might have it, Ernesto had already experienced a similar situation in his previous role as RAI Assessor at Providence Care Hospital. Ernesto’s work was instrumental in Providence Care Hospital moving from 63rd place to maintaining the fourth best case mix index of 72 mental health institutions in Ontario. His passion and dedication to documentation and data has proven instrumental in leading the team at Providence Manor to improve their case mix index quickly.
“We started with Montreal 5, the secure resident home area (RHA). It is the most complex RHA especially as it relates to documentation, as residents have Dementia and Alzheimer’s. It is also more difficult for staff working on Montreal 5 to document because they simply can’t always be behind closed doors in the nursing station documenting. We needed to give them mobile access; so we started off by providing five iPads to document anywhere, anytime.”
With the support of Providence Care’s Information Technology department, computer and wireless connectivity was improved throughout the home and a number of laptops and iPads were re-purposed from other areas within the organization.
Ernesto, along with his coworker Katrina Jackson, RAI Assistant Supervisor, developed a rigorous schedule to accommodate education for all staff. The pair joined staff from every shift to ensure they were receiving appropriate hands-on documentation education..
“We really reinforced through our education that documentation is everyone’s responsibility. It is not just up to the clinical staff. Environmental Services, Recreation and Food and Nutrition staff are often the eyes and ears of the RHA’s. We rely on them to report any behaviors to the Charge Nurse, who then properly documents it.”
And the work hasn’t stopped at education either. Ernesto and his team perform frequent audits, ensuring documentation accuracy.
Within 14 short months, Providence Manor’s case mix index more accurately reflects the needs of residents, moving from 30th place (out of 37 other long-term care homes) to 13th, with a goal to break into the top 10 in early 2024.
“Consistency and quality documentation is key. Staff now receive reports every three months and we break it down by each RHA. This has led to some friendly competition amongst the staff, who are collectively striving to continue improving,” says Ernesto.
Accurate data is essential to providing high quality care and the Providence Manor team has made impressive strides toward change. They successfully embraced new workflows and more thorough documentation in a short amount of time. Congratulations to the entire team!
