Living Well in a Multipurpose Service
The Living Well in MPS Principles of Care have been developed to support staff in providing care for residents of Multipurpose Services (MPS); not as patients in hospital, but as people living in their home.
The Principles of Care aim to:
- Enhance quality of life, independence and wellbeing for people living in an MPS , and their families.
- Support staff capability in providing an individualised person-centred care culture for residents within MPS , not based on clinical need but based on lifestyle and enablement.
Background
MPS s are unique health care facilities providing small rural communities with a combination of Emergency, Acute, Community based and Residential Aged Care services. There are 64 MPS s spread across NSW and more planned, providing ‘hospital’ services for rural communities and also 'home' for hundreds of older people.
In 2014, an Australian Commission on Safety and Quality in Healthcare (ACSQHC) consultancy identified gaps not being assessed in MPS Residential Aged Care services as:
- Provision of a Homelike Environment
- Role of the Person in their own care
- Cognitive Impairment
- Hydration and Nutrition
- Leisure activities and lifestyle.
In 2016 the Agency for Clinical Innovation developed the Living Well in an MPS Toolkit consisting of:
- Eight Principles of Care – evidence based Principles translated into practice
- Self-Assessment Checklist – for MPS Teams to identify where they are doing well and where they would like to improve with a spreadsheet to generate and action plan
- Resource Guide – tips, templates and websites to assist implementation of the Principles
- Principles in Practice Report
Principles of Care
The provision of a homelike environment; including lifestyle, leisure and activity options, nutrition and independence are crucial components contributing to wellness.
The Principles of Care have been developed to support staff in providing care for residents of MPS; not as patients but as residents living in their home.
Using the Collaborative Implementation Approach for achieving the Principles
Over 2017, twenty five MPS Teams were supported using the Institute for Health Care Improvement Collaborative model to implement the Principles of Care and achieve rapid, small scale improvements and share experiences. The pure Collaborative methodology (depicted below – including learning sets and action periods) was further enhanced through implementation strategies, such as weekly coaching (regarding content, action plans, staff engagement, resistance etc.), site visits, communities of practice, data collection and reporting and other methods of creating networks between participating sites and other state-wide partners. Additionally, a secure online PDSA Portal was developed as a central repository for the 25 teams to share experiences, resources and to leverage off each other to fast track implementation. Throughout the year, over 470 Plan-Do-Study-Act Cycles across the eight Principles of Care were completed and continue to be available to all MPS sites across NSW.
By participation in the Collaborative process of sharing successful and unsuccessful strategies, an accelerated collective level of improvement was achieved. Trialing small changes and building up to widescale implementation of successful strategies has proven to assist with building a culture for continuous improvement across the facilities.
Key resources
- Sunflower Tool (to build a social profile)
- Interim Care Plan (for completion at entry to care for respite or residential aged care )
- Residential Aged Care Activities of Daily Living Care Plan
- HealthShare NSW Fact Sheets (backyard chickens, composting, home grown produce, food being brought in)
- Acknowledgement of Risk Form
- Dorrigo Care Day Plan
- Manilla Health Service Resident/ Family Rounding Agenda Template
- Manilla MPS Resident Profile
- Peel Cluster Volunteer Information Booklet
- The Aged Care Flow Chart - designed to support a consistent approach to pre-admission, admission, assessment and transfer of care
- PDSA Template
- Referral Form for Allied Health Services under Medicare
- Notification of Risk Form
- Our Residents don’t live in our workplace, we work in their home Poster
- Newsletter Template
- MPS Outcomes Infographic
- MPS Collaborative Infographic
- Family Conference evaluation form
NB: Any resources are available for use, but it is advisable to check with your LHD when planning a Plan-Do-Study-Act (PDSA) Cycle to ensure compliance with LHD Policies and Procedures.
These are the 25 MPS sites across NSW who participated in the Living well in an MPS Collaborative over 2017. Invitation is now extended to all NSW MPS teams to share and implement successful strategies captured throughout the Collaborative Year via the PDSA Portal.
If you are yet to receive a login, or would like further information, please contact Jenny Preece .
To assist MPS teams in accessing the Portal and running their own PDSA Cycles to implement small scale changes in their MPS a PDSA Portal Fact Sheet is available.
Benefits
- Statewide final evaluation demonstrated an average improvement of 20 – 40% across all 8 Principles of Care. The Principles with the greatest achievement were Recreation and Leisure, Positive Dining Experience and Homelike Environment, with most MPS’s integrating community activities with residential living to maintain connectivity and meaningful relationships. Examples include: school visits, BBQs, Volunteer led outings and Men’s Sheds creating raised vegetable gardens, chicken coups and restoring outdoor furniture.
- Widespread uptake of person-centred care has involved residents and families in case conferencing, care planning and decision making based on lifestyle and individual daily routine and choices.
- Resident and carer / family Quality of Life indicators were collected and analysed using validated outcome measures with residents reporting a marked improvement in relationships, independence and physical wellbeing, and staff reflecting a cultural shift away from care based on clinical need to care based on lifestyle and enablement.
Living Well in MPS Principles of Care are embedded as a resource in the revised NSQHS V2 Guide for Multipurpose Services and Small Hospitals as implementation strategies to support staff in meeting Standard 5; Comprehensive Care. safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/nsqhs-standards-second-edition/
Evaluation
Read the Evaluation Report. This evaluation, in 2019, used a series of questionnaires, completed by residents, carers, family and staff, self assessments, audits, staff interviews and administrative data to examine the extent that the standards were implemented, resident, carer, family and staff experience and benefits to the healthcare system. Outcome measures were collected through the use of the Older Persons Quality of Life Measurement (OPQoL) tool. The focus of this is on specific domains of quality of life, wellbeing, independence and relationships with others.
Further information
Please contact Jenny Preece, Rural Health Network Manager - 02 6692 7716 | 0427 568 249.