The British Columbia Patient Safety & Learning System (BCPSLS) has developed an online tool to assist regional health authorities in identifying cases, supporting investigations, and tracking outcomes of adult abuse, neglect, and self-neglect.
BCPSLS is the web-based system used by healthcare professionals across BC to report and learn from adverse events, near misses, and hazards. Its mission is to make healthcare safer by fostering a culture of safety, shared learning, and continuous system improvement.
Left to right: Tammy Simpson (Provincial Coordinator, BCPSLS), Amanda Brown (Director, ReAct Adult Protection Program, VCH) and Sherry Lin (Analyst/Assistant, ReAct Adult Protection Program, VCH)
The online tool used to support vulnerable adults is called BCPSLS re:act. It was first launched in 2011 as a partnership between BCPSLS and Vancouver Coastal Health (VCH) to support VCH's ReAct Adult Protection Program. In 2017 the tool was revised, streamlined, and made available to regional health authorities across the province.
So, what have we learned so far?
First, we've learned that BCPSLS re:act is a leading practice in Canada.
In 2018, the Canadian Patient Safety Institute, HealthCareCAN, and Health Standards Organization, with support from Patients for Patient Safety Canada, awarded BCPSLS re:act a Leading Practice within their Excellence in Patient Engagement for Patient Safety recognition program.
Second, we've learned that the type of adult abuse and neglect most frequently reported is self-neglect.
Signs of self-neglect can include poor personal hygiene, a home environment in disarray, multiple interactions with ambulance services within a short period of time, or an unexpected change in a client's ability to self-manage a chronic condition such as diabetes. A client in this situation may require additional supports such as a revised care plan, further monitoring, or admission to hospital.
Another big issue facing BC's vulnerable adult population is financial mismanagement. Although it's not identified as frequently as self-neglect, it can have an enormous impact. In addition to financial losses, it can affect the adult's access to basic necessities, use of healthcare resources, and individual freedom and rights to decision-making when an assessment is needed to determine the adult's incapability.
But the most important thing we've learned about BCPSLS re:act is the positive difference it can make in people's lives.
Use of the tool encourages healthcare professionals to put on their "adult guardianship hats", become familiar with identifying cases, and take action to help people who are suffering.
One example of this took place last year at an emergency department in BC. A clinician noticed signs of abuse and immediately connected with a designated responder. The designated responder was able to review records in BCPSLS re:act and identify a long-standing abusive situation. Investigators were then able to complete their investigation and protect the adult from further abuse. Without a resource like re:act, this patient may not have received the support they needed.
According to Susan Barr, Specialist, Vulnerable and Incapable Adults at Island Health, if people receive interventions early, they can stay safe and require fewer services down the road.
"Adult guardianship is a holistic view of a patient," explains Susan. "Rather than focusing solely on an ailment, such as a broken hip, it helps identify other supports for patients who have difficulty getting help for themselves. When designated responders become involved, a different lens is applied that can help prioritize patient needs and inform discharge planning."
One of the most valuable aspects of BCPSLS re:act is its ability to capture reports from all levels of healthcare in one secure repository. Records remain centrally located while they are accessed, reviewed, and updated by designated responders across programs and facilities. In addition, users can upload documentation, such as care plans, that can be shared and updated by investigators as needed.
Meghan McMenamie is the Site Leader, Social Work, for Mount Saint Joseph and Holy Family hospitals within Providence Health Care (PHC). She believes BCPSLS re:act is particularly important for PHC because it facilitates communication between its hospital-based services and the community.
"Re:act provides a forum for us to pass information back and forth with the community," explains Meghan. "For our high-risk adult protection cases, it's hugely beneficial for us to be able to tag our partners within community services so the patients and their information don't get lost."
BCPSLS re:act also helps provide clients with dignity and person-centred care, as designated responders are able to engage appropriate programs across the continuum to ensure that care providers are on the same page. "Continuity and consistency are so important," adds Meghan. "Healthcare is at its weakest at transitions, so anything we can do to mitigate risk helps us to provide better care to our patients."
As use of BCPSLS re:act spreads through the province, it's exciting to see how health authorities in BC are using the tool to support their adult protection programs.
Congratulations, again, to everyone who has helped make BCPSLS re:act a success in supporting vulnerable adults!