RNAO, PointClickCare digitize LTC resident assessments

A partnership between the Registered Nurses Association of Ontario and PointClickCare, of Toronto, has been shifting the resident assessments done in Ontario’s nursing homes from paper to digital.

In the process, the transformation has resulted in faster and more accurate assessments, as nurses and other professionals make use of automated and standardized electronic forms.

It has also led to remarkable rates of satisfaction from the users.

“Everyone I’ve talked to has had a good experience with the digital admission tool,” said Tess Romain, president and CEO of Partners Community Health, which opened Wellbrook Place, two long-term care homes in Mississauga, Ont.

With a combined capacity of 632 beds, the two sites were opened last November. By the end of February 2024, the organization had filled 550 of those beds.

“The [PointClickCare] system is very efficient, and the nurses just have to follow the prompts. That way they don’t miss any questions,” said Romain.

The patient assessment tool is integrated into the PointClickCare resident management system, an electronic patient record solution for LTC. Romain noted that PointClickCare is fully mobile and can be used by staff and clinicians on their notebook computers and smartphones.

Moreover, the solution offers a dashboard, providing long-term care managers and planners with real-time information about the residents coming into their homes, comparisons over time, and comparisons with other facilities if the organization has more than one site.

Nurses at the facility told Romain that they wouldn’t have been able to move 550 residents into the new centre – the largest LTC in Canada – so quickly without the use of an automated admissions tool. “It used to be done on paper,” she said. “There’s no way they could have brought in so many residents using pen and paper.”

On the regulatory front, long-term care homes in Ontario and most other jurisdictions must send data from various kinds of assessments to government health departments. For years, it was done on paper.

In addition to information that must be collected for government purposes, most LTC homes have strived to incorporate evidence-based practices into their documents, to create the best care plans for their residents.

Historically, this was done on an ad hoc basis, with many organizations dedicating staff and countless hours to re-inventing the wheel – basically recreating what others had done, with their own spin on it.

“Staff would be assigned to research and create assessments,” said Stuart Feldman, senior vice president and market leader, Canada, at PointClickCare. “The efforts were not always well organized, and what they came up with was not always long-term care based. They’d take what they could find. And it could take hundreds of hours.”

In response, in 1998 the RNAO’s CEO, Dr. Doris Grinspun, envisioned a program that would create Best Practice Guidelines (BPG) for use throughout the province.

It was funded by the Ontario’s Ministry of Health and launched in 1999 to provide the best available evidence for patient care across all health sectors and settings, with more than 50 guidelines developed to date.

While still on paper, these assessments became known as the best available.

“They’ve had tons of success with them, including outside of Ontario,” said Feldman. “They’re used in many non-English-speaking countries,” which acquire them and have them translated.

What PointClickCare did, however, was to start digitizing these evidence-based assessment tools and incorporating them into its own system, which is widely used in the nursing home and post-acute care sector.

In Canada, PointClickCare is deployed in 2,600 homes, with very extensive usage in Ontario, Alberta and British Columbia.

PointClickCare is also deeply entrenched in the United States, where it has 27,000 deployments in LTC homes.

In the U.S., care facilities have long been incentivized to include digital assessments in their systems as a quality and performance measure. As a result, PointClickCare has been offering the feature there for years and has expertise in integrating them with its clinical and administrative systems.

Its recent partnership with the RNAO has been a quick success. In 12 months, the digitized admissions tool has been adopted by nearly 170 long term care homes in Ontario. “One-third of the province is already using it.”

“We’re told that it’s reducing admission times by 30 to 60 minutes for each resident,” said Feldman. “And the homes are starting with best practices right at the gate.”

Under the agreement with the RNAO, the association – along with partners like InterRAI – creates the content and PointClickCare produces digital versions that are integrated into the electronic patient record system.

It’s a three-year contract that extends until March 2026. The goal at that point is to have all 600 or so of Ontario long-term care facilities using the tool.

This digital solution is known as RNAO Clinical Pathways. As the RNAO website notes, “RNAO Clinical Pathways are based on BPGs (best practice guidelines) and delivered by PointClickCare’s new Nursing Advantage platform. They promote safe, high-quality resident care, improve staff efficiency and support legislative and regulatory compliance.”

Feldman said discussions are under way with other provinces, to introduce the computerized tool there, too. “Many Ontario operators have homes in other provinces, so they know the benefits,” he commented.

Deborah Johnston, director of Canadian healthcare strategy at PointClickCare, observed that standardized assessments are powerful tools because “they let the data tell the story” by answering the key questions.

Using standardized assessments, clinicians are no longer using only personal observations, but can rely on time-tested best practices. “It’s evidence-based care,” she said.

The admissions assessment tool is one of several that’s currently available in digital form. Others include:

• Pressure ulcer risk scale
• Palliative performance scale
• My personhood summary
• Delirium screening, assessment and management
• Resident and family centred care
• Falls screening, assessment and management
• Post falls assessment
• Pain screening, assessment and management
• Opioid therapy

Coming soon, Johnson said, are:

• Heat risk assessment
• Re-admission assessment
• Palliative screening assessment and management
• End of life care
• Dementia screening assessment and management
• Depression screening assessment and management

PointClickCare has been training new users on the tools in waves, with 30 to 70 customers congregating at one time, on three occasions each year. They work with their peers and with RNAO trainers and become well versed in the use of the RNAO Clinical Pathways.