PoET’s mission is to help Ontario long-term care residents receive the care they want and can benefit from, through alignment with Ontario’s consent obligations.
The PoET Project is an award-winning, Accreditation Canada Leading Practice initiative that works directly with long-term care homes to support residents, staff, physicians and substitute decision-makers align decision-making with Ontario’s rules related to consent, capacity, and substitute decision making. These rules are stated in the province’s Health Care Consent Act, and they apply throughout Ontario – including in long-term care homes.
PoET works with long-term care homes to co-design and implement change ideas that result in lasting cultural change towards alignment with residents wishes, values and beliefs and what is clinically indicated. PoET directly supports residents’ access to care that they both want, and can benefit from.
Participating Long-Term Care Facilities
Thank you to our PoET homes for participating in our quality improvement project. Once a PoET home, always a PoET home. If you have participated with us and would like to be included on this map, send us an email.
We conducted an assessment that considered data from William Osler Health System as well as information from long-term care homes in the Central West Local Health Integration Network (CWLHIN).
The patterns identified in the data and the challenges described by the long-term care home staff suggested there were opportunities to improve decision making prior to transfer.
We worked with three long-term care homes to better understand the consent-related errors and what could be done to reduce them. Our interventions focused on education and consultation.
Despite our efforts transfer patterns changed very little during this time. We did learn, however, that most long-term care homes used a “Level of Care” form that can promote consent-related errors and transfers to hospital.
Further Tests of Change
We worked with early adopter homes in the CWLHIN to remove the “Level of Care” form and test changes designed to align decision-making with Ontario’s Health Care Consent Act.
The Accreditation Canada Leading Practice (2016) “Individualized Summary” was first developed and tested as a replacement for the “Level of Care” form during this time.
Through the IDEAS (Improving and Driving Excellence Across Sectors) 9-day Advance Learning Program we better understood the quality problem we were focused on. We also learned how we could better collaborate with long-term care home staff in order to design and test change ideas.
Our work from this program earned us the IDEAS Alumni Award (2015).
We adopted the name “PoET” (Prevention of Error-Based Transfers) to refer to our work, and launched the project in 8 long-term care homes located in the CWLHIN. These homes adopted a common measurement plan and began using the Individualized Summary for all new admissions.
This year (FY 15/16) we saw a 56% decrease over FY 12/13 in the number of long-term care residents who died in an Osler hospital and were sent there at least one other time in the 2-month period prior to death.
Data from this year (FY 16/17) continued to show a decrease over FY 12/13 data in the number of long-term care residents who died in an Osler hospital and were sent there at least one other time in the 2-month period prior to death (41%).
Five more long-term care homes joined the project, and changes were sustained in the original 8 participating homes.
This year PoET also received a CWLHIN Quality Award—Honourable Mention (2017) and a place on the Minister’s Medal Honor Roll (2017).
FY 17/18 data continued to show a sustained decrease over FY 12/13 data in the number of long-term care residents who died in an Osler hospital and were sent there at least one other time in the 2-month period prior to death (59%).
In 2018 we also launched the PoET Provincial Training Program, with 13 long-term care homes from 6 different LHINs participating.
PoET Southwest Spread Project
In the Fall of 2019, the PoET Southwest Spread Project (PSSP) began. This project is a joint venture between William Osler Health System and the Department of Family Medicine at McMaster University, and is supported by a financial contribution from Health Canada. This project facilitates the further spread and evaluation of PoET in Ontario.
PSSP and Covid Response
Due to the Covid 19 pandemic declared in March 2020, PSSP shifted to support long-term care homes through the pandemic and provide virtual opportunities for implementation, evaluation, and spread.
Despite the pandemic, PoET continued to spread in Southwestern Ontario (Mississauga, Halton, Hamilton, Niagara, Haldimand, and Brant areas).
Further Spread of PSSP
PSSP became an option for long-term care homes in the Central Region of Ontario in Spring 2021.
In response to the pandemic, the PSSP team started to offer further online options for long-term care home residents, families, staff, and physicians across the province, including our 15&5 and 20&10 sessions, focusing on a single issue related to consent, capacity, and substitute decision making.
Provincial PoET Program
Using the virtual model we developed in response to the Covid 19 pandemic, we will be able to offer three streams of the PoET Program (Initiation, Refresh & Recertification) to long term care homes across the province of Ontario.
This program will become available in Fall 2022.