AFTER-HOURS CALL REVIEW

In February we hosted the review sessions for the Victoria and the Saanich Peninsula after-hours call group. After gathering and analyzing the data from every call made in 2023, we were able to pick up on general trends within the community. This year there was a significant uptick in calls made after-hours for urinary concerns. While this could be for a number of reasons, it signals to us that the community could benefit from some education surrounding UTI’s in long-term care. One particular resource we are very proud to have is the UTI training module on our website, consisting of an informative short video and a collection of outside resources. This can be utilized as a way of educating new and/or temporary staff who may not have a full understanding of the specific nature of addressing UTI’s in the elderly population.

RESOURCES FOR SUSPECTED URINARY TRACT INFECTIONS

One of the most common reasons for calls to the Long-term Care Initiative’s after-hours on-call group is “suspected UTI”. To help ensure our residents receive the most appropriate treatment, please review Choosing Wisely Canada recommendations and other supporting documents available on the LTCI website.

Some key points from the documents:

• Perform a clinical assessment, documenting the signs and symptoms of a UTI, looking for alternative explanations for change in clinical status
• Use nursing interventions including offering sufficient fluids, toileting regularly, analgesics as needed
• Don’t use urine dipsticks to diagnose a UTI
• Avoid antibiotics unless the minimum criteria for a UTI are met
• If antibiotics are ordered, reassess after a few days to check antibiotic sensitivity results and that resident is improving
• Prior to calling a medical provider:
  • consider what you think the problem is, narrow in on what is needed, and outline the rationale behind your thoughts
  • have available the resident’s chart, MOST, and MAR, as well as any recent labs, and a list of contingency medications

Choosing Wisely Canada:

• Antibiotics for Urinary Tract Infections in Older People: When you need them–and when you don’t.

Additional Resources:

• Care of the Resident with a Suspected Urinary Tract Infection in Long-term Care
• To help nurses prepare to call a medical provider: Long-term Care Initiative’s UTI SBAR
• The Long-term Care Initiative’s Urinary Concerns training module (a short video)
   

LFP PAYMENT MODEL

As many of you have likely heard, the FPSC has recently implemented and expanded the LFP payment model to include facility-based care. The stated purpose of the LFP payment model is to help meet the priorities raised by physicians in a Doctors of BC engagement survey and in response to an urgent need to retain and attract family physicians by making clinic-based longitudinal family practice sustainable and rewarding. Given the erosion of office-based longitudinal primary care, and the 900,000 BC citizens without a family physician, the LFP is a welcome change to the family physician landscape. We commend the intention behind the LFP program and its creation. Focused Long-term Care Family Physicians (LTCFPs) who do not meet the eligibility criteria of 250 community patients are excluded from the LFP and are to continue to use fee-for-service and receive the per bed LTCI stipend. The Victoria-South Island Long-term Care Initiative (Vic-SI LTCI) Steering Committee has been advocating for these physicians be allowed access to the LFP payment model to ensure continuous quality primary care and attachment for the 28,000 LTC residents in BC. Physicians with the same training and similar work should not be paid with such a different philosophical and functional structure.

If you have any questions about the LFP, please don’t hesitate to reach out to the LTCI Program Manager Jessica Swinburnson at Jswinburnson@victoriadivision.ca

PHYSICIAN SHORTAGES IN BC

As we all know, there is a desperate need for more physicians in BC and in long-term care. One way of addressing this issue is recruiting doctors who have trained in other parts of the world. Did you know you can become an assessor and host an international physician in your clinic as they train? For more information on the requirements and how to become an assessor, head here.

COMMUNITY OF PRACTICE

The Community of Practice Working Group, spearheaded by our own Dr. Ian Bekker, is a dynamic environment where new physicians can come to learn, and experienced physicians can come to share (and likely learn some new things too!) The meetings are lighthearted and fun, while supporting the vision of continual improvement of long-term care for all. The next meeting is coming up this Spring, mark your calendars for a lively and stimulating educational evening with your peers!

LTCI PROGRAM TEAM UPDATES

WELCOMING CATHERINE RYAN

We recently welcomed NP Catherine Ryan to our team. Many of you will know Catherine from her extensive career in LTC. We’re very excited to add her expertise and insight to the LTCI program team!

SAYING GOODBYE TO FIONA

Sadly, we are saying goodbye to a long-time friend and colleague Fiona Sudbury as she commits fully (ish) to retirement. As sad as we are to see her go, we know she has a vibrant life to get back to. Have the best time on your next bike trip through Europe!

SAYING SEE YOU LATER TO JESSICA

LTCI Program Manager Jessica Swinburnson will be on parental leave starting in July. Look out to connect with her temporary replacement!

MAID ASSESSMENTS

Due to staffing shortages, hospitalists will have to stop their MAID consult service which will likely result in a growing waitlist. If you have not done a MAID assessment before, you can learn about the process here by creating an account and searching MAID. If you have a patient who is requesting MAID and you have done as much in the way of assessments as you can please refer them to the MAID Coordination Centre where cases are prioritized based on acuity, not location.

NEW LTC PLACEMENT FORM

The new long-term care placement process launched earlier this year. Let us know how the process has been going for you by going to the VDFP website and checking out their poll: ‘How Is the New Long-Term Care Placement Process Working?’

MENTAL HEALTH LEGAL FORM CHANGE

As of February 1, 2024, the legal form required to authorize involuntary admission under the BC Mental Health Act (MHA) has changed. Only Form 4.1 (First Medical Certificate) and Form 4.2 (Second Medical Certificate) will be legal to authorize involuntary detainment of patients. For more information, head to the Island Health website here.

ADDICTIONS SPECIALIST REFERRAL

Did you know that you can consult with LTC! physician Dr. Alicia Pawliuk for geriatric addictions advice? You can submit this referral form with the reason for consult section filled in with ‘Geriatric Addictions Consult: Dr. Pawluk.’ Referrals through GSS are for non-urgent issues and consults can take generally 4-8 weeks. For urgent issues, she is able to give physician-to-physician advice by telephone. You can reach out directly to the LTCI team here for more information on this and how to contact her directly.

CURRENT OPPORTUNITIES

The below LTC sites are seeking an MRP, please get in touch if you are interested:

• Aberdeen
• Amica on the Gorge
• Glenwarren Lodge
• Gorge Rd LTC
• Sunset Lodge
• The Heights at Mt View
• The Summit
• The Priory

Do you know any family physicians looking to wind down their practices within the community but aren’t quite ready to retire? Or do you know any recently graduated family physicians looking to gain experience? Please spread the word about the rewarding experience that long-term care can provide and have them reach out to the LTCI at victoriasouthisland.ltci@victoriadivision.ca for more information!

MISSED IT?

Have you missed any of our virtual learning series events? Recordings and slides on our most recent Learning Series Event, “Alcohol Use Disorder in Long-term Care” with Dr. Chris Stuart, Dr. Alicia Pawluk, and Dr. Chris Blashko on April 11^th can be requested by emailing our LTCI program team. Previous events can be found on our resources page.

RESOURCES

VDFP has launched a new streamlined website Check it out here.

The Victoria and SP After-hours Coverage Guides have been updated on our website. View them on our BPE tools page here: Victoria & Saanich Peninsula

Dementia Care Best Practice Resource.

Updates to the Suture Kits can be found here.

Dementia Road Map Brochure

View the LTCI COP Guideline: Polypharmacy here.

Find the link for each region’s After-hours Call Group poster and the most recent after-hours SBAR on our website here.

Island Health's most revent Medical Staff Bulletin can be viewed here.

The Medical Education and Resource Committee (MERC) has endorsed these three following required learning modules required learning modules for medical staff. 

• Mental Health Act training
• Confidential Information Management training
• Violence Prevention training

EVENTS

May 16, 2024: Cultural Safety in Healthcare: 'Past, Present, and Future Perspectives with Simon Brascoupé.' More info here.

May 21, 2024: @5:00-6:30PM LTCI Learning Series: 'Urinary Concerns in Long-term Care,' a  virtual presentation by Jennifer Carefoot with the Provincial Academic Detailing Team. Learn more and register here.

May 23, 2024: @7:00-9:00PM Welcome and Thank You evening with VDFP at the Inn at Laurel Point. Join them to pay tribute to retiring colleagues, offer a warm welcome to new ones, and celebrate Greater Victoria’s amazing medical community. View the flyer and RSVP here.

May 31 & June 1, 2024: 6th annual BC Substance Use Conference is happening at the Marriot Vancouver this year with the theme ‘From Idea to Implementation: Putting Evidence, Experience, and Ways of Knowing into Action.’ Head here for more information.

June 5, 2024: @9:00AM-12:30PM 'GriefWork: Growing from life's inevitable losses,' a virtual event which discusses how to help patients cope with the pain of some of life’s inevitable losses. 9.0 MainPro+® credits. More info here.

June 12, 2024: @12:00-1:00PM LCHQ Webinar: 'Patient and Family Engagement in Sustainable QI.' For more information and to register, visit the Health Quality BC website.

June 13, 2024: @5:00-6:30PM LTCI Learning Series: 'Opiods' with Dr. Chris Stuart, Dr. Alicia Pawluk, and Dr. Chris Blashko. For more information contact the LTCI team here.

LOCAL CULTURAL EVENTS

May 9, 2024: @5:00-9:00PM Free art evening at the Greater Victoria Art Gallery every Thursday. More into here.

May 4-October 5: @9:00AM-3:00OPM James Bay Farmers Market. Open rain or shine every Saturday through the summer. See details on their website.

June1-9, 2024: Ocean Week Victoria has multiple events occuring around Greater Victoria. View more info here.

June 21-30, 2024: Jazz Fest Victoria. View the artists line up and details on this popular event here.