Training
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Training on CAP usage
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• Mandatory onboarding training
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Online or in-person
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Yes, with minor concern of shifting the focus from other health concerns in LTC (e.g. pressure ulcers)
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• Train the trainer – with follow-up support with multiple touchpoints, feedback, and regular positive reinforcement
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• Train the early change adopters to be trainers
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Environmental restructuring
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Culture change
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• Change the social context by empowering PSWs, volunteers, and families
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LTC home policy and practices change
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May not be acceptable to some due to sharing of power.
Potential side effect of individuals performing tasks out of their scope.
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• Changing model of care to better include physicians and pharmacists
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• Consistent staffing
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• Promote team responsibility and promote inclusivity
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Resident-centered care
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• Sharing the CAP or assessment results with residents and families
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Electronic portal.
Resident-family conferences
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Family sharing portal may be costly to develop.
May not be practicable, effective, or acceptable due to cost and lack of interest or availability for some families.
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• Family and resident-led huddles with staff during quarterly and annual reviews
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• Working with family to balance individual rights, autonomy, freedom, and safety
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Physical restructuring
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• Physical modifications to the LTC home to reduce fractures and promote collaboration (e.g. handrails, open space)
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Physical changes to the layout of the LTC home
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Not discussed
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• Making the CAP easily accessible to all members on the care team
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Virtual dashboard
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Not discussed
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Minimize any increase in workload
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• Standardized process once a high FRS score is generated
• Integration of the CAP into the existing processes (e.g. annual care conferences)
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Care processes
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Yes
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Enablement
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Software features
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• Software add-on with the following features: flags staff only when meaningful changes occur, provide easy access to historical data, identify actionable things, perhaps targeted to person who can implement
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Software
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Development time may not be practicable.
Side-effect: alarm fatigue taking away attention from other health conditions.
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Modeling
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Building modeling into training
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• Case-study
• Build into education by role-playing
• Collaboration with multiple disciplines during the training stage to model real-life
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In-person,
videos
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Not discussed.
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Education
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Education for staff
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• Resources & materials tailored to different roles, easy to access to reference tool that can be taken to bedside and used as part of training e.g., on tablet, on website
• Patient-focused education for staff with simple and clear messaging
• Take an interprofessional approach and improve physician involvement
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Micro-learning and E-learning sessions,
annual in-service,
professional advisory meetings
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More affordable if it’s online. Potential side effect of people burning out from training and time taken away from staff.
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Education for residents and families
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• Importance of guidelines and how to advocate for following guidelines
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One-page pamphlet with actionable items,
resident-family conferences
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Yes, as long as it is targeted to those at high fracture risk, available in multiple formats, factually accurate, and easy to understand.
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Persuasion
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Persuasion through stories
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• Highlighting patient stories / identifying an important problem to show the impact of fractures
• Value proposition by storytelling
• Highlight reduced workload and increased QoL related to guideline usage
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Posters or videos
Social media and announcement channel or screen in LTC homes
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Yes, as long as the visuals are made for the home, include gender and racial diversity, available in multi-media formats, and changed regularly
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Incentivization
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Social reward
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• Recognition from organizations (i.e. Osteoporosis Canada)
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Acknowledgement from organization – hard (i.e., plaque) or soft (i.e., seal of approval on website) copy
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Not discussed
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Material reward
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• Award the ward with the lowest fracture rate
• Flip case-mix funding to incentivize functional improvement, since the current case-mix model decreases that incentive
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Financial, food (e.g., pizza party), material good (e.g., t-shirts)
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Not discussed
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Coercion
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Public benchmarking
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• Public benchmarking, against Canadian provinces or other countries
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Publicly accessible online dashboard
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Potential side effect of underreported cases.
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Restriction
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Regulations
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• FRS score and associated care plan as criteria for use of osteoporosis medication
• Ministry of Health mandates use of up-to-date Fracture Risk Assessment and Prevention Tools
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Policies and procedures
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Not discussed
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LTC = Long term care
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FRS = Fracture Risk Scale
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CAP = Clinical assessment protocol
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