Our Journey into the World of Controlled Acts

When I stepped into the world of Developmental Services (DS) a little over 12 years ago, I was a new nurse coming from acute care.  I was captured by the impact that community agencies could have on the quality of life of individuals living with special needs.  What began as a stepping stone in my career, turned into a long-term passion and commitment.  I believe in what the Ottawa Rotary Home and other DS agencies stand for, in what we are trying to accomplish, and in the values which guide us.

I began as a front line nurse here at the Ottawa Rotary Home.  I was working alongside Developmental Service Workers (DSWs) who were trained to administer medications and perform other medical procedures that I had always known to be carried out by regulated professionals. This was the first time that I took a closer look at controlled acts, what they were, and what they looked like in the community.

As I developed professional relationships with my DSW colleagues, I began to appreciate the complexity of the DSW role and to explore how I could best support them.  We were a team, each with our own responsibilities and expertise.  As a nurse, I focused on providing advice and guidance on best practices and on safety for the individuals we supported.  It was easy for our organization to train and support DSW staff in performing controlled acts.  We have a nurse on every shift.  We are right there to teach, monitor, support, and mentor on a daily basis.  DSWs performing controlled acts was a normal part of our operations and never caused the organization any stress.  This isn’t the case for many other organizations.

In 2007, the calls started coming in from surrounding agencies: “We have an individual with a new diagnosis…we need training and we do not have nursing staff…where do we start?” It quickly became very clear that agencies without internal nursing resources face a myriad challenges training their staff in controlled acts as well as managing the ongoing health challenges of clients who were aging.

So in 2009 we began to offer training and monitoring services to agencies in the Ottawa area.  Somewhere along the line we found ourselves training over 300 staff and inevitably, drawing the attention of the College of Nurses of Ontario.  Forced to re-examine our practices to ensure we were meeting the College’s standards, we embarked on a journey to create the perfect training program: one that balanced the needs of agencies, individuals, and provincial bodies.

First, we tried to train staff in-person in small groups and to perform all monitoring and supported individuals assessments ourselves.  But our nursing resources were quickly overwhelmed and most agencies did not have the means to hire a contract nurse from a nursing agency.  Those that could, were taught by a nurse who did their own research and developed their own training program.  Different nurses taught skills in different ways, and so when a nurse left the community, a new nurse had to start from scratch.  The result was costly and inconsistent.  It was clear: we needed to find a solution that was consistent and a program that was sustainable in an environment with scarce nursing resources.

We also faced a logistical roadblock.  It was not always possible to accommodate staff working nights and evening shifts.  Agencies were also paying an extraordinary amount of money to replace staff so that they could train offsite.  How then, we asked, do we get staff to training sessions? We decided to try a different teaching medium.  We moved our training onto webinars – this way we could reach many DSWs across the entire region at multiple times during the day.

We were almost there.  We still needed to find a way to ensure that it was appropriate for an agency’s unregulated workers to perform controlled acts but assessing the profile of each and every supported individual and the skills of each and every worker was infeasible.  We spent countless hours exploring possible solutions.  The answer had to be practical, affordable, and had to safeguard the health and well-being of those being supported.

Finally, after three years of research and program revisions we unveiled our comprehensive solution for agencies in the DS sector: Community Support Training Solutions (CSTS) is an end-to-end program that takes the guesswork out of controlled acts and makes training flexible and affordable.  We guide agencies through the nine program steps, providing resources and subject matter support along the way.  Once agencies are deemed suitable to perform Controlled Acts, we help them demystify regulatory compliance, establish policies, and implement a monitoring program.  And once this infrastructure is in place, agencies can begin Controlled Acts Training on a self-paced online learning management platform that can be accessed anywhere, anytime, and on any device.  While staff learn the theory online, our nursing team consult and address content questions, and agency managers can track their progress.  We supplement the theory training with a hands-on component through our mobile practice lab sessions, and our resources, templates, and guidance enable agencies to conduct individual assessments for those being supported, determine staff competency, and monitor controlled acts performed.

With CSTS, you do not have to start from scratch to find out what are the requirements, where do you start, what the regulations require of you.  We have done the research for you.  We have done the ground work, produced the manuals, created training materials and put the necessary checks and balances in place so you can breathe easy.  I hope you join us.  Together, we can create a standard of training across the province and bring the care we provide to individuals to a whole new level.

 Lauri Cox, RN

Director, Advocate, Nurse, and true believer that we can make a difference!

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