Northern Health has been incorrectly reporting the extent of daily physical restraint use in long term care facilities for years, the Prince George manager of long term care facilities said.
A Canadian Institute for Health Information (CIHI) report says Northern Health had 24 per cent of long-term care residents in daily physical restraints during 2014-15, the most recent year numbers are available, compared to the provincial rate of 9.6 per cent and the national rate of 7.4 per cent.
"So last year, when I became aware of the discrepancy, I was like 'That's huge, what's going on?'" said Gregory Marr, Northern Health's manager of long term care, assisted living and short stay programs for Prince George.
"We implemented a new model last year. Basically, most staff had it in their minds a seat belt is a restraint. Walking through Gateway today you see about half the people who live here are in wheelchairs and all wheelchairs have a seat belt."
According to the CIHI report, 32.4 per cent of Gateway residents were placed in physical restraints daily in 2014-15, the second highest rate in Northern Health only to Fort. St. John's Peace Villa that reported 40.1 per cent of residents in daily restraints.
The focus on the new training and education model is to make sure staff understand the definition of restraint.
"Is it preventing someone from doing something they otherwise could?" said Marr.
"Does that person have the ability to be mobile? So there's a bit more to it that determines if a seat belt is actually a restraint.
"So we did a lot of work with staff and when I looked over the last three months of our data for Gateway we're at 4.8 per cent so we're right in line now with where we'd expect to be and honestly the main contributing factor was a misunderstanding - and it's a historical misunderstanding - as to seat belt equals restraint."
While Marr points to the incorrect reporting of restraint use as the main cause of Northern Health's high numbers, one outside specialist is questioning that explanation.
Dr. Samir Sinha, the director of geriatrics at Mount Sinai Hospital and the University Health Network Hospitals in Toronto as well as the expert lead of Ontario's Seniors Strategy, said incorrect reporting could be only part of the cause.
"Obviously the northern authority as well as the B.C. government and the patients and providers in those local communities want to be giving the best care they can, but right now the data that they're producing is not reflecting that they are doing so," Sinha said.
The information that is being reported by Northern Health is data being shared with the world, he added.
"It's really important to report data correctly because right now there is a perception that there's inappropriately high utilization," Sinha said. "But if staff are indeed reporting correctly then maybe a different response is needed to make sure staff and families there are feeling supported so that we can try and see if we can actually meet a better rate of restraint use in those homes."
Marr said the reason he didn't notice the reported restraint use numbers going out to CIHI was that his focus has been elsewhere in the three years he's been manager for Prince George's long term care facilities.
"The main thing I focus on day-to-day is that we're delivering person-centred care and person-centred care is evidenced by having individual care plans and that's done regularly and it's updated and having staff delivering unique person-centred care to every single person who lives here and not just generic care," Marr said.
Data like the numbers seen in the CIHI report for restraint use is powerful, since it provides an overview beyond focusing on individual cases, Sinha said.
"Because it behooves all of us to say what's happening in these homes," he added.
"If it's simply a reporting issue then let's fix that, but if it's not a reporting issue and it's an actual care issue, then let's make sure that the staff in those homes have the resources and tools they need so they can provide the best possible care for the residents."
Each person who is in a long term care facility goes through a process called the resident assessment instrument or RAI, from which 100 elements are used to create a comprehensive profile of a client, according to Andrea Palmer, regional manager, public affairs and media relations for Northern Health.
Staff whom conduct the assessments do two-days of mandatory training that provides education.
"Those education sessions focus on the coding conventions of all the different items within the RAI assessment, including use of restraints," Palmer said.
"So restraint definition and coding conventions involving restraints are just examples of many areas of focus in the RAI assessment. Because it tends to be a problematic section in ensuring consistent interpretation, extra time is spent on these items in particular."
Sinha said he's sure the B.C. Ministry of Health would probably love to see all of its homes performing equally well.
"There's no reason why if we're providing inequitable care in one part of the province I'm sure everybody would be motivated to say what is it exactly that we need to do - it could be a staffing issue, could be a knowledge and skills gap. It could be a reporting issue so let's use this opportunity to figure it out because we owe it to the residents in those communities to make sure we can provide them with the best possible care. And that's the power of data."
Education for all Northern Health staff is continually available and updated often, Palmer said.
"In addition to targeted training we have very recently implemented a Community of Practice for RAI," Palmer said.
The team consists of representatives from all long-term care facilities who lead and share best practices regarding restraint use and other residential health care practices, she added.
There will now be a quarterly review across Northern Health to monitor restraint use and address concerns and issues.
"Part of that review will include targeted data cleanup," Palmer said. "We hope to see an improvement in reporting numbers in the next reporting period."
CIHI compiles and reports health region data on an annual basis, she added.
