May 2017
VITAL SIGNS Spotlight on the Behavioural Supports Transition Unit (BSTU)
The Behavioural Supports Transi on Unit (BSTU) team works to enhance the lives of older adults living with demen a or age‐related cogni ve impairments and behavioural challenges.
Imagine how frustra ng it would be to no longer have the ability to express your thoughts, needs and desires. That’s how those living with Alzheimer’s and demen a feel daily. As their communica on abili es decline, frustra on mounts and inappropriate (or responsive) behaviours can increase. QHC’s Behavioural Supports Transi on Unit (BSTU), located at Belleville General Hospital, is a 20‐bed inpa ent program that specializes in enhancing the lives of older adults living with demen a or age‐related cogni ve impairments and behavioural challenges. “When our pa ents display responsive behaviours such as hi ng, yelling, throwing things or taking what’s not theirs, it’s because they’re distressed about something,” said Mary Storms, Pa ent Care Lead, BSTU. “Maybe they’re hungry or in pain, but they can’t communicate the problem. So providing care is about ge ng to know them really well and understanding what’s going on in their lives so we can help de‐escalate behaviours.” Although the BSTU is housed within Belleville General Hospital and QHC provides the care and manages the program, it is a regional service and is eligible to seniors currently in South Eastern Ontario hospitals, long‐term care homes, re rement homes and community se ngs. “All referrals must come through the South East Community Care Access Centre (SECCAC),” said Debbie Cornick, Manager of the BSTU. “It’s important for staff to know that even if there is a pa ent at QHC who you think would be Con nued on Page 7
Health Records drastically reduces number of incomplete charts “In all of QHC history, we’ve never had so few charts incomplete before,” said Peter Papadakos, Director of Decision Support, Privacy and Health Records. “The process changes that we’ve made following our Grassroots Transforma on FMEA event have helped incredibly with this.” As of May 23, only 70 charts remain incomplete, compared to 262 a year ago. That difference equates to about $200,000 in addi onal revenue for QHC this year (assuming the comple on of a typical chart fetches $1,000).
The Health Records team has been hard at work!
One of the biggest impacts on chart comple on has been Health Records staff taking charts to Quinte 4 and Quinte 5 inpa ent units and leaving them there for a brief period for physicians to complete. “Physicians appreciate the charts being made easily available to them,” said Sherry Mifsud, Manager of Health Records and Transcrip on. “They don’t have me to come down to Health Records but if the charts are on the unit, they can work on comple ng them when they have five or 10 minutes between pa ents. It’s been really successful and we plan to roll this out to the OR physicians as well.” Reducing the number of incomplete charts has allowed Health Records staff to spend more me reviewing charts that, due to deadlines, had previously been submi ed as “incomplete” to Canadian Ins tute for Health Informa on (CIHI). “Being able to review and resubmit these charts to CIHI allows us to accurately capture pa ents’ true health histories, ensuring we are ge ng the correct funding for treatments provided,” said Sherry. A few other process improvements have also contributed to speedier chart comple on – such as elimina ng the requirement of the most responsible physician to sign the face sheet of the chart; revising the readmission process; and having health records staff concurrently work on backlogged charts and newer charts. With plans to standardize the way in which physicians are no fied that they have incomplete charts, as well as plans to develop a process that allows charts to be signed out by mul ple physicians at once, Health Records will most certainly further reduce delays in chart comple on. “I’m really happy with the progress so far,” said Sherry. “We are going to con nue to make improvements and find efficiencies to make things easier for everyone.”
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Upcoming Grassroots Transformation Events June 19-22 — Emergency Department Physician Standard Work September 18-20 — Hospitalist Diagnostic Assessment October 16-19 — ICU Transfer Out Standard Work
To gown or not to gown? New gown guidelines at QHC In April, the Infec on Preven on and Control Commi ee made changes to how we use gowns at QHC. Visitors will no longer be required to wear gowns unless providing direct care or entering a room of a pa ent with Clostridium difficile. When providing direct care, visitors will wear the same gowns as staff members. Direct care refers to providing hands‐on care (e.g. bathing, washing, turning pa ent, changing clothes, con nence care, dressing changes, care of open wounds/lesions or toile ng). Visitor boards will now say: “It is preferred that you visit only one pa ent. If you must visit more than one pa ent, visit isolated persons last and clean hands upon entering and leaving rooms.”
Health care workers will not be required to wear a gown when entering a contact precau on room provided they are not having any contact with the pa ent or pa ent environment. Rou ne prac ces apply. A gown is required if there is risk of blood, body fluids, and secre ons or excre ons coming into contact with skin or clothing of health care worker. Why the Changes?
Be er posi on Quinte Health Care staff to ensure op mal use of personal protec ve equipment. Avoid over‐ or under‐use Support staff and pa ent safety Changes are informed by and consistent with PIDAC guidelines Changes are sensi ve to and respec ul of resources Excep onal care acknowledged — Impressed with the care her husband Jack received prior to his passing away at Prince Edward County Memorial Hospital (PECMH), Norma Brooks and her daughter Shelley Hurst donated funds to support the purchase of a Sleeper Chair (on which they’re si ng). They especially appreciated the pallia ve suite (Mary Catherine Sco Suite) for families to stay in while experiencing the end of life journey with loved ones. Standing (l to r) are: Patricia Evans, Vice President of the PECMH Auxiliary; Liz Jones, President of the PECMH Auxiliary; Lisa Mowbray, Site Lead, Manager Pa ent Services.
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A vital machine – The Belleville General Hospital Auxiliary funded the T Program using purchase of a vital signs machine for the Telemedicine proceeds from HELPP Lo ery cket sales. The vital signs machine will be used by Heather Leonard, Telemedicine Coordinator (le ), to take the vitals of pa ents and share the informa on with h physicians at other health care facili es. Instead of local pa ents having to t travel far distances for a brief follow up appointment (for example, to Kiingston Cancer Centre), they can come to QHC to have their vitals taken, saaving them me and the cost of travel. “Thanks to the Auxiliary for this piece of equipment – it benefits pa ents and the health care system as a whole,” said Catherine C Nicol, Director of Quality, Pa ent Safety and Interprofessional Prac ce (right).
Gra tude for great care – “I had an upper GI done this morning and wanted to commend Claire, for doing such a wonderful job. She's nurturing, conscien ous and made the procedure, though not that invasive, most pleasant. Too o en we're quick to complain... I just wanted to extend my gra tude, for her exemplary care.” Photo: Claire McKinney, Medical Radia on Technologist.
#ImagineItsYou
oceeds of our HELPP Lo ery to “Each year we donate $5,000 from the pro purchase medical equipment for BGH,” said Leah Johnson, Auxiliary President (centre). “Since its incep on in 1991, 1 we’ve raised $170,000!”
#WeAllProvideCare
#4MyTeam #WeAllProvideCare
#RespectEveryone Compassionate caring — Dr. Sylvain Duchaine; Sara Wetherall, RPN; Jennifer Stevens, RN; and Linda Latchford, RPN (all pictured) were praised recently by a pa ent who underwent a procedure in Trenton Memorial Hospital’s Same Day Surgery Department. The pa ent described the staff as lovely, deligh ul, competent and kind. She also gave praise to Dr. Peter Stone; Beth McIntosh, RN; and volunteer Dora Hockney. “All‐in‐all it was one of the nicest experiences I’ve had at any hospital,” said the pa ent.
#4MyTeam m Cheers to nurses ‐‐ To celebrate Nursing Week W (May 8‐14), Quinte 6 at BGH planned fun ac vi es all week. From pizzaa day and build your own ice cream sundae day, to making their own paper nu ursing caps, the team joined together to make things on the unit a li lee more fun all week. A special shout out to Dr. Trevor Bardell who w le a $200 credit at the BGH Tim Hortons to pay for nurses’ coffees durring Nursing Week!
#QHCValues
Service with a smile – As we con nue with our Grassroots Transforma on ini a ves, we become aware just how many people have a role to play in making these changes to be er our hospital – including Ted Eimers, Maintenance. “Ted has been a phenomenal support for the ICU rollout of our Kanban system in the pa ents’ rooms,” said Sarah Corkey, ICU Manager. “He has made himself available to support this important change in the ICU and he has done it with humour and pa ence. Ted plays a pivotal role in the ICU’s ability to roll out our improvement within the deadline we have set.” Showing spirit – On May 7th, some Sills 5 staff from BGH par cipated in the Bu erfly Run (in support of bereaved parents). “’Walk or run… no one gets le behind,’ was our team approach to the run,” said Kerry‐Lynn Wilkinson, Manager, Mental Health Program. “It was for a heart‐warming cause, a day of healing and a journey of recovery for many par cipants.”
Who inspires you? Anyone can share in celebra ng our teams – staff, pa ents, physicians and volunteers. Contact Carly Baxte er at ext. 2677, cbaxter@qhc.on.ca.
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PECMH staff and community provide input about site for new hospital
The site selec on community open house on May 15 had a great turnout of residents wan ng to have a say about where their new hospital will be built.
May was the month to have a say about where the new Prince Edward County Memorial Hospital (PECMH) will be built. County residents, community partners, staff and physicians all had the opportunity to provide input on which of the two poten al site op ons would be the best loca on for the new hospital. The two sites being considered are the exis ng hospital site with the addi on of donated land adjacent to the hospital, and the greenfield site by the H.J. McFarland Memorial Home. Through focus groups with community partners, staff/physician feedback and a community open house, the planning commi ee received excellent input. About 330 site selec on surveys were completed and the results will be taken into account when the planning commi ee makes a site recommenda on to the Ministry of Health and Long Term Care (MOHLTC). We are currently on Part ‘B’ of the Stage 1 proposal in the MOHLTC process for building a new hospital. This stage also includes an evalua on of the current site, a high‐level space plan and a cost es mate. While the capital planning process is lengthy – five stages in total – and will take a number of years before a shovel hits the ground, building a new hospital for the residents of Prince Edward County is QHC’s top redevelopment priority. In the end, the planning partners hope to create a campus that provides access to a wide range of primary care services in one loca on – family physicians, nurse prac oners, outpa ent clinics, an emergency room, inpa ent beds and community support services – crea ng a more efficient system of care that is responsive to the needs of pa ents and their families.
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Impacts of climate change on health Dr. Dick Zoutman gave audience members a lot to think about regarding the health implica ons of climate change during his May 4th presenta on at Belleville General Hospital. The QHC Chief of Staff was the latest presenter in the BGH Founda on’s “At the Cu ng Edge” speaker series. Dr. Zoutman gave an honest account of Canada’s contribu on to climate change (we are one of the top carbon dioxide‐emi ng countries per capita). He stated that global temperatures have already risen one degree since the industrial revolu on – two degrees is a certainty at the rate we’re going – and three or four degrees would be devasta ng for our planet. Climate change will lead to more flooding, drought and extreme weather, leading to more fires, crop failure, starva on and disease. While the tropical mosquitoes that carry infec ous diseases like dengue and the Zika virus currently can’t survive Ontario winters, that could change as global temperatures rise. Canada is already seeing an influx of West Nile and Lyme disease – with the Quinte region being especially hard hit by Lyme. Con nued on page 8 Con nued from Page 1 — Spotlight on BSTU
a good fit for the BSTU, the referral must s ll go through the South East CCAC. They are the gatekeepers of the referral process and bed assignment.” Prospec ve pa ents must have a diagnosis of age‐related cogni ve impairment and be medically stable to be considered for the unit. Other causes of responsive behaviours must be ruled out (delirium, stroke, brain tumour, etc.) and their needs must exceed the resources available in the pa ent’s current se ng (Alzheimer Society, CCAC, or community‐based Behavioural Support Services). With an average stay of 30‐60 days, the goal of care is to stabilize behaviours using medica on and/or other strategies and return the individuals back to their preferred des na ons (ie. long‐term care home, or with family). “Providing care can be a challenge at mes,” said Mary. “It’s hard to make them understand that you’re there to help them, not hurt them. But we have an awesome team of doctors, nurses, personal support workers, a physician assistant, a recrea onal therapist, etc., who all have the heart for it and genuinely want to help.” The team uses the Montessori method of providing meaningful, rewarding ac vity – such as gardening, cleaning, se ng tables, sor ng laundry, and se ng up games – to engage the pa ents and reduce anxiety. Jay Moxness, Recrea onal Therapist, also sets up daily group ac vi es like Bingo, trivia, music therapy and tea socials. “We find out what makes them happy and use those ac vi es to help with their care,” said Mary. “Ninety per cent of our pa ents love music and dancing, and many of them love dolls. When you see a pa ent cuddle a doll with a big smile on their face, it’s heart‐warming to see them respond that way. It makes it all worth it.”
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Race Car Pit Stop model leading to speedier treatment for stroke patients During a stroke, me is brain. It is impera ve that pa ents receive treatment as quickly as possible. Quinte Health Care’s Acute Stroke Team has recently been a rac ng provincial and na onal a en on for a unique aspect of their Code Stroke Protocol. Rather than immediately transferring the pa ent off of the EMS stretcher onto an Emergency Department stretcher, the pa ent remains on the EMS stretcher Dr. Andrew Samis (le ) and the Code Stroke team work quickly on a from arrival, through ini al stroke team pa ent who has arrived by EMS to the BGH Emergency Department. assessment, all the way to CT scan. This investment of only a few extra minutes of EMS me, shaves several very valuable minutes off the ‘door to needle’ me. The door to needle me is the me from pa ent arrival to the delivery of tPA, the clot‐bus ng medicine. The Acute Stroke Team’s target for door to needle me is less than 60 minutes. QHC’s Acute Stroke Team has dubbed this unique process the Race Car Pit Stop model because, upon arrival to the ED, the pa ent is descended upon by a pit crew of staff and physicians, each doing different jobs but working together. Concurrent ac vity of everyone on the stroke team allows for quick comple on of tasks. Dr. Al Jin, Regional Stroke Neurologist, loved the Race Car Pit Stop Model right from the beginning and encouraged Kingston General Hospital (KGH) to adopt the model. With this new model, and other work being done to shorten door to needle me, KGH managed a door to needle me of an incredible nine minutes! QHC’s quickest me to date is 14 minutes! "We developed the Race Car Pit Stop model of stroke care at QHC as a way to get pa ents the clot‐bus ng drug tPA more quickly,” said Dr. Andrew Samis, QHC Physician Stroke Champion. “We are humbled and honoured that KGH liked and adopted this model. It is exci ng for us at QHC to know that this model is helping KGH achieve incredibly fast tPA delivery mes." Pembroke Regional Hospital has also started using the Race Car Pit Stop model and has cut their ‘door to CT’ mes in half. Con nued from page 7 — Impacts of climate change on health
Rising temperatures will also lead to increased cardiac disease from heat stress, and polluted air will increase the incidence of respiratory disease. So is it all doom and gloom? Dr. Zoutman said people are applying new technology and innova on to help. “I’m hoping that we can apply our intellect as a race to change things.” What can we do as individuals? Lower our carbon footprint by driving less, ea ng less meat, advoca ng for renewable energy sources, not using pes cides and herbicides, and being informed.
QHC Vital Signs Newsle er, May 2017: Published by QHC Communica ons Department Editor: Carly Baxter (613) 969‐7400, ext. 2677, cbaxter@qhc.on.ca
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