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Monday, 18 February 2013

Elephants with Pearls: Annual Education Day

The HNHB Long Term Care Nurse Led Outreach Team is thrilled to announce the theme of their 5th Annual Spring Educational event as “Elephants with Pearls.” This event will be taking place on May 16, 2013 at the Courtyard Marriott in Hamilton, Ontario. It is destined to be one of the most inspirational, fun, and innovative educational events of the year! Several speakers are lined up for a day of revisiting the tough topics of healthcare that requires courageous approaches. There topics include: Leadership, bullying, teamwork, alcohol misuse and dementia, health care consent act, music heals, and preventing burnout and promoting self care! This is one day you won't want to miss. Stay tuned for more details.

~ Lisa


Friday, 9 September 2011

Election 2011

Our provincial election is 25 days away on October 6, 2011. 

Please make yourselves informed!

The RNAO and GNA Hamilton Chapters are hosting a pre-election dialogue on health and social issues.  Party leaders have been invited.

Date:  September 14, 2011
Time: 7pm-9pm
Location: Hamilton Spectator Auditorium, 44 Frid Street, Hamilton
Cost: FREE (registration required)

For more information and to register, please follow this link.


Friday, 2 September 2011

Need Resources?

If you need a good place to start looking for geriatric resources, try here.

Have a wonderful long weekend!


Friday, 26 August 2011

2nd Annual Niagara LTC Education Day

Just go with the Flow and Take a Breath!
An assessment of UTI and COPD in Long-Term Care
October 19, 2011
0800 - 1600

Welland Hospital Auditorium
65 Third Street, Welland ON

Event Details:

  • Registration is $20 per person.
  • Parking is $5 at Welland Hospital. 
  • Lunch and breaks are included. 
  • There will be no registration at the door. 
  • Please register by September 28. Register Early! Space is limited to 50.
Please comment on this post with your email address for a brochure and registration form.
 The day will include:

0800 - 0825 Registration

0825 - 0830 Opening remarks

0830 - 0930
Melissa Northwood, NCA
Preventing UTIs in Long-Term Care

0930 - 1030
Angela Woodcock, Life Labs
Obtaining urine and sputum specimens and completing lab requisitions

1030 - 1045 BREAK

1045 - 1145 Jennifer Burgess, RN
Respiratory Assessment

1145 - 1245 LUNCH

1245 - 1345 Dr. J. Bertley
Identifying COPD and Controlling Symptoms using Canadian COPD Guidelines

1345 - 1445 Diane Michaud, RT
The importance of bronchodilators and proper inhaler techniques

1445 - 1500 BREAK

1500 - 1600 Justine Marsh, RT
Oximetry, Oxygen, ABGs and Funding

Friday, 19 August 2011

Pneumonia Prevention

Respiratory illness is one of the most common and debilitating illnesses for older adults. Pneumonia can cause severe illness, hospitalization and death. Prevention of pneumonia is very important. But, what is pneumonia?

Pneumonia is an infection of the lungs often causing fluid accumulation, mucous production and inflammation.

Bacterial Pneumonia
Caused by bacterial pathogens, transmitted from person to person.

Viral Pneumonia
Caused by flu or cold virus.

Aspiration Pneumonia
  • Generally not witnessed
  • 50% occurs during sleep
What does it mean to aspirate?

Aspiration is when food, drink or saliva enters the lungs.  It happens very easily.  Let's take a look at this video.  During the last swallow, you should notice the person aspirate with just a small drop of fluid entering the trachea.  Notice that the person didn't even cough? 

What does pneumonia look like?

Pneumonia can look different for each resident.  It is very individual, but here are some things to look for and report to the Nurse if you see them:
  • New or increased shortness of breath
  • New or increased cough
  • New or increased sputum production
  • A rise in body temperature
  • Pain with coughing or breathing
  • Change in skin colour or temperature
  • Change in level of alertness, sleep and energy
  • Confusion
  • Falls
  • Incontinence
  • Decreased appetite
So how do we prevent?

  1. Immunizations. Pneumovax should be given every 10 years for persons over the age of 65, potentially earlier for those who have compromised immune systems.
  2. Good hand washing.  Sounds simple, right?  It is, but most of us still get it wrong.  Before contact with residents and after.  Staff, residents, family, volunteers.  EVERYONE.
  3. Good infection control.  If a resident has pneumonia, staff need to wear a mask as part of droplet precautions.  Ask housekeeping staff to pay more attention to affected rooms, shared bathrooms, railings and other common areas.  Have the resident eat seperately at meals.  Droplets can travel a long way, putting tablemates at risk.
  4. Good mouth care.  Huh?  Yes, good mouth care.  Remember that 50% of all aspiration pneumonias occur during sleep and that generally they are unwitnessed.  Good mouth care will keep oral bacteria at a minimum and prevent bacteria-ridden saliva from infecting the lungs.  Good oral care before and after meals is also priority.  No toothpaste or mouth rinse if they have trouble swallowing please!
  5. Keep them moving.  Residents who have pneumonia or are susceptible need to keep moving.  Even if they do require more rest, try for at least 30 minutes of "up time" twice a day.
  6. Keep them hydrated.  Fluid intake is very important.  Offer fluids by mouth and often, using small amounts at a time.  Know the resident's favorite drinks and thicken if necessary.  Monitor fluid balance (that is, how much they've had to drink and how much they've urinated).  Talk to the Nurse about hypodermoclysis as an option to treat mild to moderate dehydration.  Medications may need to be adjusted if someone is dehydrated.
  7. Safe feeding techniques. 

  •  Ensure that the resident is positioned upright in their chair for meals at 90 degrees.
  • Ensure that the resident is alert for meals. Lethargy, or tiredness, during meals is not safe. Check with the RN if in doubt.
  • Before starting to feed the resident, ensure their oral cavity is clear of any debris or mucous. Check with the RN if they are very congested, and might require suction.
  • When feeding the resident, provide only ½ tsp at a time. Ensure all fluids (even soups) are thickened to the consistency that is prescribed (nectar, honey or pudding).
  • Allow the resident a slow pace and lots of time to swallow. Ensure their mouth is empty before offering the next spoon. It may be helpful to offer them an empty spoon in between to elicit another swallow.
  • Do not mix flavours with the resident’s meals. Keep all foods separate. A distinct flavour helps the resident better recognize the food in their mouth and swallow safely. (It also makes food more enjoyable!) If the resident still takes a minced diet, make sure that textures are not mixed as this may cause choking.
  • If the resident is pursing their lips shut as you approach with a spoon (snout reflex), try a cold spoon kept in ice water on their lips to cue them to open their mouth.
  • If the resident starts to cough during meals, stop feeding and report to the RN. If they refuse to eat, try smaller more frequent meals during the day.
  • After each meal, even if only a few spoons were taken, use oral swabs to ensure their oral cavity is clear of any debris or mucous.
  • Always ensure the resident is upright for at least 45 minutes after eating. The resident has a delayed gastric emptying time that poses risk for them to aspirate.
~Jennifer Burgess RN, BScN, GNC(C)

Friday, 12 August 2011

Falls and the Frail Elderly

Falls is a concern in the frail elderly residing in long term care homes (LTCHs). Safer Health Care Now, a Canadian initiative to provide safe health care in all health sectors reports that 40% of all admissions to LTCHS are a direct result of a fall. Additionally almost half of all elderly residents residing in LTCHs fall every year; 1/3 of those who fall develop serious injury. Furthermore, those who do fall are at higher risk for future falls and injury (

There are many factors to consider for the prevention of falls in the frail elderly. An elderly person who has fallen may become tense, fearful, embarrassed and discouraged. These emotions increase the risk of falling and it is important to discuss these feelings with your family member and the LTCH team.

The common risks of falling in the elderly include:
• Previous history of falling
• Decreased muscle tone
• Loss of hearing
• Diminished sensation in feet
• Vision problems (glaucoma, macular degeneration and/or cataracts)
• Disorders that affect balance, i.e. osteoporosis, arthritis, diabetes and Parkinson’s disease
• Dementia including wandering and agitation
• Bladder and bowel problems
• Certain medications
• Improper footwear
• Clutter and obstructed walkways
• Poor lighting
• Trip hazards and slippery floors

Family members can help with prevention of falls in the frail elderly. At time of admission to a LTCH it is important to advise LTCH staff of history of falls. History of a fall places a person at high risk to fall again. If your family member is at risk for falls, please inquire with the LTCH staff about “hip protectors”. These are special devices worn under clothing that can be effective in reducing injury if a fall occurs. Ensure your family member is wearing proper footwear. Avoid slippers and athletic shoes with deep treads. Thin, non-slip soles, proper fitting, low heels are preferred. Limit amount of clutter your family member has in the room. Personal items from home are meaningful, however furnishings, knick-knacks may create mobility hazards.

Prevention of falls in the frail elderly is a team effort. Clear, concise communication between dieticians, housekeeping, nurses, pharmacists, physicians, physiotherapists, recreation therapists and family members will provide opportunities to develop strategies to prevent a fall from occurring. We welcome your input and involvement.

~Nora VanDalen RN(EC)

Friday, 5 August 2011


The Nurse Led Outreach Team (NLOT) is currently a team of 6 Nurse Practitioners and a Registered Nurse. We work through the Hamilton Niagara Haldimand Brant (including Burlington) Local Health Integration Network (LHIN). Our team is created to serve the frail elderly living in Long Term Care Homes (LTCHs) within the LHIN. The NLOT is an extra support offered to augment the role of the physician. We visit LTCH homes providing clinical support to residents and families as well as offering educational sessions for nursing staff.

We serve the frail elderly by providing clinical assessments and offering treatment options which may assist in the avoidance of a hospital transfer. We understand that transferring to hospital is a traumatic experience for both resident and family members. We are available to nursing staff of the homes to offer an in-depth assessment which might prevent the transfer. We offer flexibility to respond to urgent calls throughout the day, Monday to Friday.

There are many diagnostic tests and treatments available to residents in LTCHs previously available only in hospital. For instance after a fall, x-rays can be ordered and done in the homes; ultrasounds to diagnose blood clots can also be completed by mobile companies in the homes. Hypodermaclysis, a treatment option for rehydration, especially during an acute illness such as pneumonia, can be arranged in most LTCHs.

Our team is divided to cover different regions within the LHIN. Hamilton including Stoney Creek and Ancaster are serviced by and Dave Farr, Christine Fric and Nora Van Dalen; region of Niagara, is serviced by Laurie Angle and Laura-Dawn Moule. Brantford is serviced by NPs Dave Farr and Heather Prescott. Burlington is serviced by Nora Van Dalen. The Registered Nurse, Jennifer Burgess is responsible for capacity building through ongoing education of nursing staff in the homes.

Please stay in touch as we begin to share our journey across the LHIN and share what resources we have with you!