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Petitjean research group. From left: Yushi Liang (3rd year undergraduate student), Caitlin Miron (PhD candidate), Dr. Anne Petitjean, and Isaiah Hasham (4th year undergraduate student).
Guanine quadruplex stabilization: A promising strategy for cancer therapeutics By Caitlin E. Miron NA: the library of genetic information that dictates the development and function of our bodies. This information is stored as a code of four elements: the nucleobases cytosine, guanine, adenine, and thymine. Although DNA is most frequently portrayed as a double-stranded helix, this code can only be read when regions of the double helix become temporarily single-stranded. Picture a necklace, where the chain is that single strand of DNA, and the
beads are the cellular machinery needed to translate sections of DNA into proteins that will participate in necessary cellular events. These beads move along the chain until they reach a knot. The “knots”, which are known as guanine quadruplexes, form in guanine-rich regions of single-stranded DNA – or RNA – through contacts similar to those that drive the formation of a double-stranded helix. Normally, specific proteins called helicases are tasked with unravelling these knots, but if there was a way to
stabilize that knot, to glue it into place, then it would act as a physical barrier, blocking the beads’ access to the region of DNA beyond it. If this region codes for a protein, stabilizing the knot would prevent the production of this protein and thereby silence its activity. The possibility that quadruplexes could be targeted for therapeutic applications was first raised in the 1980s, when researchers discovered that these knots could form in DNA telomeres. During cell division, DNA is packaged up into X-shaped struc-
tures called chromosomes and split between cells. Although some DNA at the chromosomal end can be lost each time this process occurs, critical information is not at risk because this region of DNA, called a telomere, does not code for anything. Once telomeres have shortened to a dangerous extent, the cell will no longer divide. In 85 per cent of cancer cells, an enzyme called telomerase lengthens telomeres, leading to “immortal” cancer cells that can divide continuously. Continued on page 5
Caitlin E. Miron is a fourth-year PhD candidate from the Petitjean group in the Department of Chemistry at Queen’s University. She was recently awarded the Mitacs 2017 Award for Outstanding Innovation (PhD). 2 HOSPITAL NEWS JANUARY 2018
Contents JANUARY 2018 Edition
IN THIS ISSUE:
A promising strategy for cancer therapeutics
2 ▲ Cover story: Taking action against workplace violence
▲ Professional Development and Education Supplement
13 ▲ Wellness Certificate Program helps hospital staff commit to self-care
COLUMNS Guest editorial .................4 In brief .............................7
Safe medication ............26 Hospital security ...........42 Nursing pulse ................43 From the CEO’s desk .... 44 Evidence matters ...........46
▲ Spirited and creative living
Continuing medical education and leadership development
▲ The key to a great learning experience
A doctor’s journey with
efore opioids destroyed Grant Matheson’s career, he was a pillar of his community. Respected physician, loving husband, devoted father, and trusted friend, Grant was a straight-laced kid who grew up to be a clean-living adult. No drinking, no smoking, and certainly no drugs. It took everyone by surprise, most of all himself, when he became addicted to narcotics in his 30s. His story hit local press when he was found guilty of professional misconduct related to his addiction, including over-prescribed painkillers to patients so he could buy them back – an infraction that caused his physician license to be suspended. Matheson’s memoir is a gritty account of his narcotic addiction and all that it cost him: various relationships, his career, and almost his life. The Golden Boy takes the reader from the very first day of Matheson’s drug addiction to that moment when he decided to rebuild his life through rehab and recovery. Grant says “I wrote this book to make healthcare workers aware of the dangers of self-prescribing and how that could lead them to possible substance-abuse. I also wanted to share my experience to put a spotlight on the fact that addiction is a H disease.” ■
An excerpt from Golden Boy You need a fortress around you to keep that abusive lover from calling you back. It’s easy to forget how bad it is. To romance the good times. Addiction is a lifelong disease. I would like to say that I won’t go back there, but that would be naïve. I can say that I work on maintaining my sobriety every single day. I know what it means to lose everything, and I don’t have any interest in doing that again. After my children, my sobriety is the most important thing in the world to me. And I have realized that abusing substances will destroy my life. With narcotics, it will do it quickly, and with alcohol, it will do it more slowly and insidiously. It is much like boarding an extravagant cruise on a sinking ship. But the gash in the hull depends totally on the substance and is totally out of my control. As I ponder the affliction that is now certainly my label, I can’t help but wonder how I got here. Many parts of medicine have tried to treat the addict but have failed. Even more have inadvertently been a catalyst to the condition, only to throw their hands up in despair when the patient fails to respond rationally. The problem is that addiction, in my opinion, is a disease of irrational thinking that is first precipitated by a crisis in a person’s life. It is then fuelled by an emotionally numbing agent. Once the cascade of mental unfitness has been fuelled by an accelerating agent, the point of no return can be swift and merciless. Continued on page 5
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Golden Boy Continued from page 4 No caregiver would do this intentionally: give someone destructive advice. It would be like advising someone who was cold to go home and sit by a warm fire, not realizing they had a gas leak in their house; the counsellor in this instance had no idea of the person’s separate crisis or imminent threat. If it was me giving the advice I would likely be defensive, and, frankly, arrogant; how could I have known all the circumstances? There would of course be no intent because the prescription was given without knowledge of the underlying situation. And the accepter of the prescription might not realize that they are in a fragile mental or situational state. I, myself, had no idea how impacted I was by the shame I felt for my brother’s death. Society has placed this condition in the wrong category for too long. No one intentionally causes this, it is a combination of circumstances. The more important thing is that we remove the negative label from the condition. Who would seek help for any medical condition or mental fragility, if it met with public scrutiny, bias, and job loss? I can say this from my own experience that this is a condition, much like a mental illness, that one tends to not admit publicly. Especially when it arises and is seen as a weakness or a relapse or a slip. People who struggle with other terminal illnesses are treated more graciously. There are no cakes for the addict who uses again, no flowers for the alcoholic who met a life crisis and got drunk. Let’s just all be less judgmental of each other and be part of the solution for this epidemic. Judging addicts is not only part of their disease, but is exactly how the disease wants you to look at them. Excerpted from The Golden Boy by Grant Matheson Copyright 2017, Grant Matheson. All rights reserved. Reprinted with permission from The Acorn Press www.hospitalnews.com
Guanine Quadruplex Stabilization Continued from page 2 Telomerase is not, however, active in most healthy cells. The presence of quadruplexes in human telomeres thus offered an exciting opportunity to selectively target cancer cells. If these knots could be stabilized, telomerase would be unable to access the telomere and the process that leads to cancer cell immortalization could be shut down. The search for chemical compounds that could stabilize quadruplexes was consequently well underway by the 2000s, when bioinformatics highlighted the prevalence of quadruplex-forming sequences at the start of oncogenes – sections of DNA which code for proteins that contribute to aspects of cancer development ranging from the formation of new blood vessels to cancer metastasis. The scope of guanine quadruplex research broadened as quadruplex stabilizers – acting as glues for the knots – were shown to prevent the processing of such oncogenes, leading to effects such as reduced cancer cell growth. This was the extent of my knowledge of the field of guanine quadruplex recognition when funding from NSERC, Mitacs Globalink, and Queen’s University allowed me to conduct two research internships at the European Institute of Chemistry and Biology in Bordeaux, France, thereby continuing a collaboration between my supervisor, Dr. Anne Petitjean, and Dr. Jean-Louis Mergny, one of the top experts in the field. The focus was on fundamental research: were any of the compounds synthesized in our lab for projects related to DNA recognition effective quadruplex binders? My research, considerably accelerated by the expertise of the Mergny group, led to the identification of a hit compound. We’d found a glue – a guanine quadruplex stabilizer – that was performing as well or better than any of the known standards in the field. Better yet, this was a glue that also showed little to no binding to the
Caitlin Miron was recently awarded the Mitacs 2017 Award for Outstanding Innovation (PhD). DNA double helix; an essential feature when attempting to selectively target an architecture present in much lower abundance than duplex DNA in cells. Through the NIH National Cancer Institute’s screening platform, we were recently able to show that this initial hit compound, along with several second-generation derivatives, did reduce cell growth in five human cancer cell lines.
Although these results are highly promising, questions remain to be answered at a fundamental level. What makes these compounds so effective? Do they, like other binders before them, prevent oncogenes from being accessed by cellular machinery? What features can be modified to improve biocompatibility? Will they be more potent in combination with other therapies? These are factors that must be considered as we move towards drug development and before we start a serious conversation about clinical trials. Ultimately, it is our hope that our novel family of quadruplex “glues” can be used as effective and perhaps broad-spectrum anticancer agents. Guanine quadruplex recognition shows exceptional promise for cancer therapeutics, and as research in the field progresses, we are learning that these knots may be involved in the development of other diseases as well. Quadruplexes, for instance, also play critical roles in regulating processes such as infection by HIV. Can we use quadruplex stabilizers to stop cancer in its tracks? Prevent infection by HIV? Guanine quadruplex recognition, as a field, is not yet there. The identification of these new quadruplex stabilizers, however, may represent an important step forward towards H that goal. ■
JANUARY 2018 HOSPITAL NEWS 5
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People with type 2 diabetes
underestimate their cardiovascular risk he International Diabetes Federation (IDF) recently presented the interim results of the first ever multi-country online survey on CVD risk awareness and knowledge among people living with type 2 diabetes, indicating low levels of awareness and limited dialogue between patients and healthcare professionals. The global survey – Taking Diabetes to Heart – developed in partnership with Novo Nordisk, runs until March 2018 and is open to all people with type 2 diabetes. Diabetes currently affects 425 million adults worldwide, with most cases being type 2 diabetes. Cardiovascular disease, which includes stroke, coronary heart disease and peripheral artery disease, is the leading cause of dis-
DIABETES CURRENTLY AFFECTS 425 MILLION ADULTS WORLDWIDE ability and death in people with type 2 diabetes. To date, 943 responses to the survey have been received from 32 countries and interim findings show that: • One in 3 respondents living with type 2 diabetes consider their risk of CVD to be low • 26 per cent of respondents had either never learned about CVD or received information on CVD several
years following their type 2 diabetes diagnosis • One in 6 respondents had never discussed their type 2 diabetes and CVD risk with a healthcare professional “The interim results of Taking Diabetes to Heart reiterate the importance of raising awareness of the association between type 2 diabetes and cardiovascular disease to promote prevention, timely diagnosis and appropriate treatment to help reduce the current burden that the two conditions represent,” says Dr Shaukat Sadikot, outgoing IDF President. “With the world facing an increase in the prevalence of type 2 diabetes, better understanding the link between these conditions is H needed more than ever.” ■
System changes increasing deceased donors S ince 2011, the number of deceased donors in Canada has increased steadily, with notable jumps in 2015 and 2016 (10% and 17% yearover-year increases, respectively). In 2016, there were 758 deceased donors in Canada. Each deceased donor can
provide up to eight organs for transplantation. Contributing to this increase is a rise in the number of organ donations from patients who have experienced circulatory death – meaning their hearts have permanently stopped beating – and neurological death – mean-
Quick facts • 2,835 transplant procedures were addition, there were 544 living performed in Canada in 2016, a organ donors. 32 per cent increase since 2007. • In 2016, there were 1,731 • The rate of deceased organ kidneys transplanted in Canada donation in Canada increased 42 and 3,421 Canadians still per cent since 2007 with notable waiting. jumps in 2015 and 2016, with 10 • Canada still has a shortage per cent and 17 per cent year-overof organs, with approximately year increases respectively. 4,500 patients still waiting for • In 2016, there were 758 deceased transplants. organ donors in Canada, 109 more • In 2016, 260 Canadians died than the 649 reported in 2015. In while waiting for a transplant. www.hospitalnews.com
ing their brain has permanently lost all function. “Donations through cardiac and neurological deaths have had an important impact on wait lists for organ transplants. In particular, we’re starting to see a decrease in the number of patients on wait lists for lung and liver transplants, which is a very good sign for patients and the healthcare system as a whole,” says Greg Webster, Director, Acute and Ambulatory Care Information Services, Canadian Institute for Health Information. Ontario, Quebec and British Columbia have the highest deceased donation rates in the country. In addition to established donation after circulatory determination of death (DCD) programs, these provinces have also implemented mandatory referral and the presence of in-hospital donation specialists, to ensure donation opporH tunities are explored. ■
benefits Canadians and the healthcare system ealth Canada is modernizing its approach to disclosing clinical information on drugs and medical devices to support advances in medical science and help improve patient care. Recently, Health Canada published draft regulations in Canada Gazette l that propose to make clinical information in drug and medical device submissions publicly available after the Department has completed its regulatory review process.
PROVIDING MORE DETAILED INFORMATION ABOUT DRUGS AND MEDICAL DEVICES ENABLES INDEPENDENT ANALYSIS THAT COULD HELP HEALTH PROFESSIONALS Health Canada uses clinical data when making regulatory decisions on drug and medical device submissions. These data provide comprehensive information on the safety and efficacy of these products. Increasing access to clinical data can have widespread benefits for patients and the health care system, for example: Providing more detailed information about drugs and medical devices enables independent analysis that could help health professionals make more informed decisions about their appropriate use; and Sharing these data could also help reduce inappropriate use of drugs and medical devices. In considering how best to make this information more broadly available, Health Canada sought public input on a discussion paper that was published online. It is also consulting expert stakeholders, including industry representatives, academic researchers and healthcare professionals on implementation of these proposed regulations. The draft regulations are available for public comment for a 75-day periH od, beginning December 9. ■ JANUARY 2018 HOSPITAL NEWS 7
From left, St. Jospeh’s Health Care London’s Director of Environmental Services Don Janzen was full of animation during his turn taking on the ‘Pie in the Face’ challenge beside Rikin Patel, systems consultant. This special event was part of the leader challenge, where leaders set goals for their teams to increase employee participation in Share the Spirit.
Spirited and creative giving By Courtney Morgan inging, dancing, dressing up, stair climbing and taking pies to the face were all highlights during this year’s Share the Spirit campaign at St. Joseph’s Health Care London (St. Joseph’s). Share the Spirit is St. Joseph’s annual employee and physician giving campaign in support of the health and well-being of the community, including those served by St. Joseph’s and the United Way Elgin Middlesex. Through almost a decade of fundraising, these two organizations have been able to advocate and care for those in our community who are vulnerable and without a voice. While a large part of the campaign is about giving back to the community, the other part is about staff engagement. The events held throughout the campaign provide an opportunity to play games, enjoy food, interact with one another and most importantly join in to share the spirit. Share the Spirit kicked off with a pizza party to get people excited and spread the message about why it’s important to give back. The spirit to give continued through the month at a special breakfast event and at the
United Way StairClimb, where participants dared to take on the stairs at One London Place – climbing to the top of London, Ontario’s tallest commercial building. “As the new Share the Spirit CoChair, I feel fortunate to be able to witness such enthusiasm and camaraderie,” remarks Laura Dockstader, Communication and Public Affairs Coordinator. “At the breakfast event, I was particularly impressed when some individuals chose to pay it forward by purchasing a breakfast ticket for someone who couldn’t afford a ticket – true moments of the St. Joseph’s mission in action.” Many leaders also set challenge goals for their teams. If the team was successful, leaders stepped up by either taking a pie to the face, singing karaoke, getting a spray tan, dressing in costume, dying their hair or other fun rewards for their team’s participation. “Staff and physicians took the events to the next level for the campaign this year,” says David Ross, Share the Spirit Co-Chair and St. Joseph’s Director of Finance. “I continue to be impressed that each year, the campaign is met with even more H energy and passion than the last.” ■
Courtney Morgan is a Communication Assistant at St. Joseph’s Health Care London. 8 HOSPITAL NEWS JANUARY 2018
Recognizing the value of psychological health and safety in healthcare organizations By Ed Mantler his week, 500,000 people in Canada will miss work because of a mental health illness or problem and many of whom will be from the healthcare sector. The workplace plays a major role in helping or hindering our psychological well-being. While protecting and promoting mental health in the workplace is important for all sectors, healthcare settings can be particularly challenging environments. In fact, healthcare workers are 1.5 times more likely to miss work due to illness or disability than people in all other sectors. They also face higher rates of burnout, compassion fatigue and sleep deprivation all of which can impact their psychological health and safety, as well as the safety of patients. “Healthcare is a unique, complicated and often unpredictable working environment,” says Sandy Coughlin, Director of Occupational Health and Safety at Providence Health Care in British Columbia. “We must ensure our staff and physicians have access to the resources they need to achieve and maintain good mental health in order to provide the highest quality of patient/resident/client care possible.” Matt Snyder, Chief Human Resources Officer of Peterborough Regional Health Centre agrees noting that, “The reality is that we have to be people-focused. We have to make sure that we take care of our people so that they can take care of the people whom they are there to serve.” In 2013, Canada became the first country in the world to launch a national standard to safeguard the mental health of employees. The National Standard of Canada for Psychological Health and Safety in the Workplace
(the Standard) is a set of voluntary guidelines, tools and resources intended to guide organizations in promoting mental health and preventing psychological harm at work. This year marks the fifth anniversary of the launch of the Standard. Progress has been made over this period; however, there is still a lot of work left to be done. While the Standard is applicable to any sector or workplace, it has had a unique role and momentum within the healthcare sector. Healthcare organizations have been some of the earliest adopters and champions of the Standard. HealthCareCAN, the national voice of healthcare organizations and hospitals in Canada, released a position statement strongly encouraging its members and all health system stakeholders to adopt the Standard. In 2014, the Mental Health Commission of Canada (MHCC) launched a threeyear Case Study Research Project to better understand how workplaces across Canada are implementing the Standard. Of the 41 organizations that participated in the study, 18 or 45 per cent – were from the healthcare sector, comprising the largest sector represented in the study. The Standard has also been downloaded over 40,000 times with approximately 30 per cent of the downloads from the healthcare sector. So, while there are unique challenges facing people working within the healthcare sector, there is also a clear appreciation and value for ensuring a psychological healthy and safe work environment. Building on this early momentum from healthcare organizations, in 2016, the By Health, For Health Collaborative (The Collaborative) was created in partnership with MHCC and HealthCareCAN. Continued on page 9 www.hospitalnews.com
Psychological health and safety Continued from page 8 The Collaborative is comprised of healthcare leaders from over 20 organizations from across Canada committed to advancing psychological health and safety. With a vision for healthcare workplaces to be leaders and role models in providing psychologically healthy and safe work environments for all Canadians, this Collaborative has developed a two-year action plan to realize this vision. Focus areas include mentoring and knowledge exchange, developing tools and resources, and system transformation. In June 2017, the Declaration of Commitment to Psychological Health and Safety in Healthcare (the Declaration) was the first initiative launched by the Collaborative. Signing the Declaration is a public commitment from health organizations to
HEALTHCARE WORKERS ARE 1.5 TIMES MORE LIKELY TO MISS WORK DUE TO ILLNESS OR DISABILITY THAN PEOPLE IN ALL OTHER SECTORS demonstrate that they value the psychological health and safety of their employees and will take action to improve their work environments. It is a public demonstration to current and prospective employees that psychological health and safety is recognized and emphasized within their workplace. “Health organizations have a responsibility to support the psychological health and safety of their employees,” says Katrina Philopoulos, Manager of Occupational Health, Safety & Well-
ness at Nova Scotia Health Authority. “By working together in the spirit of the Declaration, health organizations can demonstrate leadership and contribute to positive changes in organizational culture found in healthcare.” Over 35 healthcare organizations from across the country have already joined this movement by signing the Declaration. The Declaration is the first of many initiatives planned by the Collaborative to improve the psychological
health and safety of the healthcare sector. Upcoming initiatives include: developing tailored evaluation metrics for healthcare organizations, developing a toolkit of specific healthcare resources for creating a psychologically healthy workplace and, engaging with key influencers and accrediting bodies to embed and emphasize psychological health and safety within the system. Stay tuned for more information about this important work dedicated to improving the healthcare sector for all. Learn more about how your organization can sign the Declaration of Commitment to Psychological Health and Safety in Healthcare and take action to support your workers at: https://www.mentalhealthcommission.ca/English/workplaceH healthcare ■
Ed Mantler is Vice President, Programs and Priorities, Mental Health Commission of Canada.
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Kayleigh Faulkner (right), a clinical nurse specialist for the Trauma and Neurosurgery Intensive Care Unit, and Orla Smith, an associate scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, demonstrate “yoga at work”—one of the self-care techniques used in their project, ARISE, aimed at helping nurses address stress and build resilience.
Wellness Certificate Program helps hospital staff commit to self-care By Emily Holton new, one-year certificate program at St. Michael’s Hospital offers clinical and administrative staff a different kind of professional development: how to support one’s own wellness. “To me, wellness is not just about the absence of disease,” says Shivalee Paliwal, the performance and wellness consultant leading the program. “I’m talking about helping people reach their full potential for physical, mental and social well-being.” Paliwal believes that when staff’s wellness improves, so do organizational outcomes – it’s in everyone’s best interest to nurture wellness at work. Her goal is to equip staff with the tools to better navigate stress, improve their physical and mental health and have stronger social interactions. She began with weekly “chair yoga” and lunch-hour guided-meditation sessions in spare meeting rooms.
“I put the call out in our staff newsletter, hoping at least one or two people might show up,” says Paliwal. “It’s been so exciting to see such a great turnout every week, and a clear desire among staff to explore these topics more deeply.” In response, Paliwal has developed the I Am Wellness certificate program. It’s a series of 10 workshops offered to staff free of charge through St. Michael’s Human Resources and Corporate Health and Safety Services. Topics include breathing and posture, meditation and mindfulness, building resilience and cultivating gratitude. Participants can join as few or as many sessions as they wish, but those who participate in all 10 sessions will receive a certificate of completion. A homework component is central to each workshop. It asks participants to pick a daily, personal practice and stick to it for 30 days. Ex-
amples include five minutes of deep breathing, or a few pages of journal writing. “It’s about forming habits,” says Paliwal. “People vary largely in how long it takes them to stick to something, but 30 days is long enough to see impact and help them decide how they want to proceed afterwards.” A similar St. Michael’s initiative is evaluating a toolkit of wellness techniques and approaches designed specifically for nurses. The ARISE project offers in-hospital workshops, online sessions and a closed Facebook support group to see if they can enhance resiliency for up to 40 trauma and acute care nurses. The self-care topics are taught by St. Michael’s clinicians with special interest in supporting workplace wellness. “ARISE was built within St. Michael’s, with our people and for our nurses,” says Orla Smith, an asso-
ciate scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and the clinical leader manager for the Cardiovascular Intensive Care Unit. “Because the project is tailored to our nurses it understands and reflects the context of our mission, values and patients. It was designed for the reality of the bedside nurse and their unique needs related to health and wellness.” Like the I Am Wellness program, the ARISE program focuses on selfcare and stress-relief techniques such as yoga and mindfulness. “This concept of wellness is so often misunderstood,” says Paliwal. “Many believe it’s something for people with too much time on their hands, or a hobby to pursue after work. However I’ve seen how transformative these practices can be, no matter who you are or what your lifestyle may be. Everyone can H benefit.” ■
Emily Holton is a Senior Communications Advisor at St. Michael’s Hospital. 10 HOSPITAL NEWS JANUARY 2018
Striving to be the safest hospital
for patients and staff By Anne Kelly
t. Mary’s General Hospital’s vision is to be the safest and most effective hospital in Canada for patients and for staff. The Kitchener hospital has consistently been recognized by the Canadian Institute for Health Information as having one of the top scores in Canada for Hospital Standardized Mortality Ratio, a key measure of patient safety. St. Mary’s has also made great strides toward its goal of keeping staff safe with a comprehensive approach that engages staff and aligns with the Ministry of Labour’s “Safe at Work Ontario” strategy. The enforcement strategy included inspections of all acute care hospitals over three years and focused on the most serious hazards in healthcare workplaces: • Musculoskeletal disorders • Exposures to hazardous biological, chemical and physical agents • Slips, trips and falls • Worker contact with objects and/or being struck by objects • Workplace violence “We are proud of our culture of safety and our staff led-efforts have been essential,” says Sherri Ferguson, Vice President of Quality, People and Performance. “Our recent staff engagement survey indicated that the overwhelming majority of our staff feel safe at work and we want to continue to build on that success.” St. Mary’s use of Lean thinking for problem solving has been vital in addressing safety challenges and sustaining gains by drawing on ideas from front-line staff who implement them and track their effectiveness. Reducing blood and body fluid exposures and
Shown with violence prevention signage in St. Mary’s main lobby from left are Julie Emrich, Workplace Safety Coordinator, Mary Cupolo, Nuclear Medicine Technologist, and Lisa Borthwick, RPN in Emergency. muskoloskeletal injuries have been hospital-wide priorities over the past several years. Staff led-improvements using Lean resulted in: • A reduction in the number blood and body fluid exposures from 45 to 34 (April 1, 2016 to March 31, 2017) • A reduction in patient handling injuries from 30 to 18 (April 1, 2015 to March 31, 2017) Much work has also been done on violence prevention. St. Mary’s has made significant investments to enhance its security services and to provide mandatory training for all staff over three years to help them manage resistive behaviours by patients, visitors and others. In 2016 hospital leaders, staff and physicians participated in an extensive risk assessment for violence prevention, facilitated by our safety association. Progress on the assessment’s recommendations is reviewed monthly by St. Mary’s Joint Occupational Health and Safety Committee, which includes front-line staff. Staff also sit on the hospital’s Violence Prevention Task Force created in 2008. At its monthly meetings, the committee reviews employee incidents and security reports to identify root causes and help develop risk prevention and management strategies. For instance, in 2017 the committee designed a risk assessment tool for staff to identify potentially aggressive patients.
It facilitated distribution of highly visible signage throughout the hospital to highlight St. Mary’s zero tolerance approach to violence and harassment. The committee also oversaw a staff safety tagline contest in 2017 with submissions from more than 130 staff. In 2017 St. Mary’s has also strengthened its health and wellness program by adding specialists in ability management to help employees return to work safely and in employee wellness to better serve the physical, emotional and mental health needs of staff.
Soon to come is a new employee health and safety management system that aligns with Ministry of Labour Accreditation. Employee Mary Cupolo, a member of the Joint Occupational Health and Safety Committee says, “It is a testament to this organization that staff are front and cente in improving workplace safety. It means a lot to us that St. Mary’s strives not only to be the safest hospital for patients, but the safest for staff H as well.” ■
Anne Kelly is Manager of Communications at St. Mary’s General Hospital in Kitchener.
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Mindfulness in the healthcare setting
reducing stress at work By Katherine Mayer indfulness practice is quickly making its way into many healthcare settings, and with good reason. Healthcare workers face one of the highest risks of suffering from work related or occupational stress, leading to burnout, physical illness, and even depression.
HOSPITAL EMPLOYEES CAN PARTICIPATE IN RELAXATION SESSIONS AND LEARN VALUABLE MINDFULNESS TECHNIQUES Dave Gladun, Registered Practical Nurse and Contract Administrator with the Northern Supply Chain at Thunder Bay Regional Health Sciences Centre, has facilitated mindfulness and relaxation classes for staff over the past three years. His classes provide his colleagues with a valuable opportunity to gain useful stress management techniques that can be used at work and at home.
“Mindfulness is learning to be in the present moment, on purpose and not bringing judgment to whatever is occurring. The practice assists me in becoming less reactive or over reactive, but rather to respond in a more skillful manner,” says Dave Gladun, Registered Practical Nurse and Contract Administrator with the Northern Supply Chain at Thunder Bay Regional Health Sciences Centre. Gladun has been facilitating relaxation and mindfulness classes for hospital employees for the last three years. In his personal time, Gladun has taken a number of courses and immersion training related to Mindfulness Based Cognitive Therapy, and he generously shares his practice with our hospital’s employees to help prevent, control and reduce elevated stress levels, both at work and at home. Even though we all have the ability to be mindful, it takes daily practice and dedication for it to be readily available.
Gladun’s interest in becoming a Mindfulness and Meditation Facilitator comes from his yoga practices and education in nursing. “As my personal practice deepened and benefits were achieved and sustained, I realized that the teachings could benefit many others, including providing healthcare workers with another tool in their ‘wellness tool belt’ to complement Western medicine,” explains Gladun. Hospital employees can participate in relaxation sessions and learn valuable mindfulness techniques, such as a 3-minute breathing space, body scan, and gentle stretching. “The opportunity for staff to have 30 minutes of relative peace and stillness in an environment that is extremely busy, allows the body and mind to recuperate and build resilience. The seeds of peace and mindfulness that are planted during the sessions grow and mature in each participant’s moments to come, and are potentially shared with others that are encountered,” says Gladun. Krysta Logozzo Daniele, Project Lead in Information Services, attends the classes regularly. “These sessions help to reduce stress and tension, while resetting my mood and energy levels mid day. Overall I feel that this break allows me to think more clearly and thoughtfully, which is something that is essential for health centered organizations.” There is no doubt why mindfulness and meditation practices are becoming widely used in workplace settings, such as health care organizations. Gladun suggests that, “The Wellness Movement, which includes both Western and Eastern healing practices, is growing stronger and is becoming a true lifestyle by which individuals can achieve the richest life H possible.” ■
Katherine Mayer, Prevention and Screening Services, Thunder Bay Regional Health Sciences Centre. 12 HOSPITAL NEWS JANUARY 2018
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PROFESSIONAL DEVELOPMENT AND EDUCATION
Tackling the opioid crisis through physician education By Christina Flavell and Renice Jones hile mainstream news sources reporting on the nationâ€™s opioid crisis tend to focus on opioids that are illegally manufactured and sold, those prescribed legitimately for pain can also influence the misuse of opioids and result in addiction. Management of opioids to treat chronic pain can present significant patient safety concerns and is an increasing medical-legal difficulty for Canadian doctors. Canada ranks only second to the United States in the per capita consumption of prescription opioids. In May, the National Pain Centre at McMaster University published the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. This set out recommendations for Canadi-
an doctors in the prescribing of opioid medication. However, this remains a complex area for physicians as many of them have difficulty in managing the conversation surrounding opioid usage. Canadian healthcare professionals, researchers and educators are making efforts to tackle this skill gap through educational programs that help physicians navigate the complexities of opioid prescribing and reduce the risk of misuse and addiction. One example of this type of program is the University of Torontoâ€™s â€œSafer Opioid Prescribing, A Multimodal Program for Chronic Pain and Opioidsâ€?. The program consists of three webinars and an in-person skill-development
Schulich School of Business injects healthy dose of real-world expertise into its MBA Healthcare Specialization Canadaâ€™s growing healthcare industry expected to account for $4.3-trillion by 2030 Three things in Canadian life are certain: Death, taxes and a future of rapid healthcare sector expansion due to one of the fastest-aging populations in the Western world. The healthcare industry currently accounts for over $219-billion (or $6,000 for every Canadian), with private and public spending in this industry projected to reach $4.3-trillion by 2030. This is in contrast to other sectors that may experience slower growth or even decline. Such accelerating growth will create unprecedented opportunities for advancement for those currently working in the healthcare industry or those just entering the industry, as long as they have the right managerial credentials, said Joseph Mapa, Executive Director of the MBA Health Industry Management Program at Schulich School of Business at Torontoâ€™s York University. â€œThis is an ideal time for health industry practitioners and professionals to invest further in their human capital as we prepare for tremendous future challenges and opportunities,â€? said Mapa, who is also CEO of Sinai Health Foundation and past and founding President and CEO of Sinai Health System, formed after the amalgamation of Mount Sinai Hospital, Bridgepoint Active Healthcare, Lunenfeld Tanenbaum Research Institute and Circle of Care, a home care organization. â€œThe healthcare industry has never been so in need of highly specialized business leaders to drive innovation, creative thinking and change as the healthcare landscape evolves to meet the challenges of demographic and systemic changes,â€? said Mapa. Thatâ€™s why so many part-time and full-time MBA students have enrolled in Schulichâ€™s Health Industry Management Program (HIMP) since its launch in 2004, he said. Mapa works closely with Program Director Amin Mawani, Associate Professor and Graduate Diploma Coordinator, in helping to shape the strategic direction of the HIMP program. Mapa has also served as an Executive-in-Residence, adjunct professor, mentor and executive advisor to the program and Schulichâ€™s Career Development Centre. The Health Industry Management Program (HIMP) builds on Schulichâ€™s established strength in management fundamentals, delivering an industry-focused curriculum, intellectual content and career-based development. The goal of HIMP is to enable students to leverage their learnings in pursuing exciting career opportunities and growth in this dynamic sector. 'UDZQIURPPDQ\GLVFLSOLQHV6FKXOLFKÂśV+,03IDFXOW\DUHH[SHUWVLQWKHLUÂżHOGVDQGSOD\OHDGLQJUROHV in the private and hospital sectors as CEOs, entrepreneurs and consultants; in the public sector as SROLF\ DGYLVRUV DQG HFRQRPLVWV DQG LQ WKH QRWIRU SURÂżW VHFWRU DV FRQVXOWDQWV ERDUG PHPEHUV DQG administrators. Graduates of Schulichâ€™s MBA HIMP work in a variety of progressive roles such as program managers, directors, analysts, planners and consultants in the government, private and public healthcare sectors. Core HIMP courses include: Business of Healthcare; Strategy in Healthcare; Economics of Healthcare; and Entrepreuneurship and Innovation in Healthcare.
14 HOSPITAL NEWS JANUARY 2018
workshop. It was originally developed in 2012-2013 by faculty at the Universityâ€™s Department of Family and Community Medicine to address the educational gaps in chronic pain and opioid prescribing. Specifically, faculty recognized the need to develop a program that was evidence-based, free of industry conflicts of interest and accessible to busy physicians, especially those in rural and remote communities that have been hardest hit by the opioid crisis and typically have poorer access to high quality education. More than 600 physicians from across the country have participated in the program to date and it was among the first to be compliant with the 2017 Guidelines. Since the programâ€™s inception, the webinars have been available to all physicians in Canada and the workshop has been held in Ontario. However, through a newly announced partnership between the University of Toronto and Saegis, a new subsidiary of the Canadian Medical Protective Association (CMPA), the workshop component of the program is being expanded. Starting in 2018 workshops will also be offered in Quebec, Saskatchewan and Alberta. It is expected that other provinces will follow in 2018 and beyond. Saegis was launched in August 2017 to offer new programs that extend beyond the CMPAâ€™s current offerings, including in-depth continuing pro-
fessional development programs that address the specific educational needs of physicians and healthcare professionals. Because increasing access to high quality medical education has been identified as a key strategy in addressing Canadaâ€™s opioid crisis, Saegis considered an opioid program to be a high priority and found the University of Toronto, with its high quality and well-regarded Safer Opioid Prescribing program, to be the ideal partner. â€œWe have a common objective of supporting physicians with the best possible tools for managing opioid prescribing, and the U of T program is highly innovative and effective, with blended learning to maximize competency building.â€? says Dr. Tom Lloyd, Director, Saegis Safety Institute. â€œWe wanted to give more physicians access to the program because supporting them in providing care to patients is an important step in effectively addressing opioid prescribing challenges.â€? â€œWe are facing a national crisis and need to collaborate widely to expand access to evidence-based interventions. Partnering with Saegis to deliver prescriber education workshops across Canada will do just this,â€? adds Dr. Abhimanyu Sud, Academic Director, Safer Opioid Prescribing. Physicians interested in registering for the webinars and workshops or learning more about the program can visit the University of Torontoâ€™s webH site or the Saegis website. â–
Christina Flavell is a Communications Specialist, Saegis and Renice Jones is Manager, Communications, University of Toronto. www.hospitalnews.com
PROFESSIONAL DEVELOPMENT AND EDUCATION
Reimagine Your Career in the Dynamic Healthcare Sector The Schulich Health Industry Management Program (HIMP) is an industry-focused MBA specialization at Canada’s top-ranked business school. The program focuses on the public and private healthcare sector, as well as innovation and entrepreneurship, delivering real-world applications and a solid base of understanding of this highly complex industry. Schulich’s Health Industry program provides the robust training, networking opportunities and career development that will deliver on the healthcare sector’s burgeoning need for highly-specialized management practitioners. To learn more, contact: Amin Mawani, Program Director: email@example.com Joseph Mapa, Executive Director: firstname.lastname@example.org
schulich.yorku.ca /mba /himp
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PROFESSIONAL DEVELOPMENT AND EDUCATION
Training perioperative nurses in their future work environment By Diane Wild he operating room is a fastpaced and highly technical environment, and Fraser Health, like healthcare organizations across the country, is facing the challenge of hiring trained surgical nurses. To support current registered nurses and licensed practical nurses in obtaining this specialty training, the health authority in British Columbia has begun to offer an in-house program based on the Association of Perioperative Registered Nurses (AORN) Periop 101â„˘, in addition to off-site programs at the B.C. Institute of Technology and Grand Prairie Regional College. The Periop 101 program was developed by expert surgical nurses and is used by more than 2,500 facilities across Canada and the United States.
In November, Royal Columbian Hospital in New Westminster and Eagle Ridge Hospital in Port Moody became the first Fraser Health sites to implement the new in-house training. â€œI like how Periop 101 combines theory with hands-on training right in the OR theatres that we will call home one day,â€? says Diana Thorogood, who is part of the first cohort of students. â€œItâ€™s great that we have the opportunity to learn and develop skills from our future colleagues.â€? The 10-month training combines a standardized, evidence-based online curriculum with hands-on skills labs, operating room experiences and clinical practicums to prepare nurses to work in the operating room. Students will take approximately six months to complete the 27 modules, immediately
The current and first cohort of nurses enrolled in the program. Front row from left to right: Sat Sandhu, Sara Boychuk Back row from left to right: Melissa Mitchell, Diana Thorogood, Dara Konjevic, Amanda Sawatzky
THE BALANCE BETWEEN IN-CLASS COURSE WORK AND HANDS-ON PRECEPTORSHIP HAS PROVIDED A STRUCTURE TO SOLIDIFY OUR KNOWLEDGE IN A MORE MEANINGFUL WAY ITâ€™S EXCITING TIMES IN EDUCATION as Medix College merges with Westervelt College in London, Kitchener and Brantford moving forward with the 132 year old Westervelt College brand representing more than 50,000 successful graduates. At Westervelt College, our mission is to not only provide you with quality training but to nurture our studentsâ€™ dreams with pride and dedication by educating, empowering and enriching their lives through career training. Whether you are just starting your career or looking for a new career, the programs at Westervelt College will ensure you are well prepared! With a variety of programs in healthcare, business, law and IT, programs are industry-tested and offer hands-on training. Focused training allows students faster access to being career ready. Program Advisory Committees and dedicated faculty ensure students receive skills training for todayâ€™s employment world. :HVWHUYHOW&ROOHJHLVRQHRIWKHROGHVWFROOHJHVLQ&DQDGDKDYLQJĂ€UVW opened our doors in 1885 in London, Ontario. Through the years, a lot has changed and evolved, but our dedication to our students and our communities remains the same. At Westervelt College, we offer assistance every step of your educational journey. From career counseling to developing D Ă€QDQFLDO SDFNDJH IURP SHUVRQDOL]HG LQVWUXFWLRQ WR RQHRQRQH JUDGXate employment services, our staff and instructors are committed to your success. As we like to state â€œBe a Westervelt Graduate, so you do not compete with one!â€?
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followed by about four months of orientation in the work environment. â€œIt has been a steep learning curve due to the specialty nature of the job, but we are 100 per cent supported along the way,â€? says student Sara Boychuk. â€œThe staff have been so gracious in accepting us as their own and providing hands on mentorship. The balance between in-class course work and hands-on preceptorship has provided a structure to solidify our knowledge in a more meaningful way and I feel will set us up for success in the workplace.â€? Jie Xu and Maria Ingram were operating room nurses at Royal Columbian Hospital prior to taking on clinical nurse educator roles for Periop 101. They began by reviewing the AORN Periop 101 course curriculum to ob-
tain their administrator certificates, then developed lesson plans for each day within the core curriculum. They also completed the AORN Preceptor Certificate Program and created handbooks for preceptors. â€œIt is a different environment behind the elusive double doors of the operating room,â€? says Ingram. â€œIt has been a pleasure to watch the studentsâ€™ progress. They have accomplished so much in such a short period of time and should be very proud of themselves.â€? The second phase of the implementation is planned for April 2018 at a total of four sites: Royal Columbian, Eagle Ridge and Surrey Memorial Hospitals, and the Jim Pattison Outpatient H Care and Surgery Centre in Surrey. â–
Diane Wild is a Senior Communications Consultant at Fraser Health. www.hospitalnews.com
PROFESSIONAL DEVELOPMENT AND EDUCATION
Competence by Design Initiative
upgrades Canadian specialty medical education By Kenneth A. Harris eraclitus once said, “There is nothing permanent except change.” This quote rings especially true for specialty medical education in Canada in 2018. The Royal College of Physicians and Surgeons of Canada (Royal College), in collaboration with medical schools and other key stakeholders across the country, have officially begun implementing Competence by Design (CBD) initiative – the first systemic change to apprentice-style physician learning in over a century. CBD introduces a new approach to specialty medical training in which residents are evaluated on their abilities rather than time spent on an activity. Our current training system assumes that time spent on an activity determines a physician’s expertise,
and while this time-based learning approach has been successful, there is growing evidence that suggests that the current method can be upgraded. That’s why, for the past 10+ years, over 47,000+ Fellows and faculty at Canada’s 17 teaching hospitals have worked together to develop CBD based on input and sound principles of education. The new approach to training is cutting-edge, and reflects the need for 21st century learning so that residents are prepared to work in a variety of hospital settings upon graduation. Think of it like a hockey coach with their team – to ensure players are prepared for games, the coach includes many small observations and actionable feedback. This is the essence of CBD. CBD is an outcome-based approach that considers what abilities
Nursing Footcare by Ruth Ruttan, RN, CDE Are you looking for something new? Embrace the opportunity to become a successful Nurse Entrepreneur! Revive and enhance your nursing career by becoming a part of this high demand and growing field. Nursing Footcare is a nurturing and “wholistic” service which allows individuals to live healthier, independent lives by improving their comfort and ambulation. Amputation rates are reduced with appropriate Footcare Education and support! Whether a nurse chooses the path of entrepreneurship or to enhance their professional competencies, the knowledge gained in this field is both practical and empowering. Ruth Ruttan & Assoc. have been leaders in Nursing Footcare Education since 1997. She teaches nationally and her graduates are in great demand. Student’s quest for excellence is supported through continuing education and an Annual Conference. As a leader in the industry, Ruth stays abreast with developments and standards. Ruth is a well accomplished Registered Nurse, Educator, Author, Public Speaker, Conference MC, Clinical Auditor and Footcare Nurse . We look forward to working with you!
physicians need at each stage of their career, then organizes these abilities into specific teaching and learning outcomes for each stage of training. Holistic in nature, CBD ensures that physicians are not only evaluated on basic knowledge and clinical skills, but on competencies including patient safety, interprofessional teamwork, quality improvement, and wellness. By building in competencies that focus on bedside manners, adaptability and resiliency within medical training, we are emphasizing learning and evaluation of transferrable skills that are a ‘must have’ for doctors. CBD will also expand the learning environment to include both community and regional hospitals – not just large traditional training hospitals – to ensure residents are evaluated on relevant competencies for all settings.
CBD is designed to be ‘learner driven,’ allowing residents to play an active role in their learning and really focus on the skills and abilities they need to progress. The focus of CBD is on frequent, low stakes observations in the clinical setting leading to a continuous improvement cycle, while not unduly lengthening the process of providing care. At the same time, the competency-based approach allows educators to more easily assess what stage a learner is at, resulting in more meaningful, direct feedback for the learner. This approach aims to eliminate any knowledge gaps, and ensures graduates can perform the activities that are necessary at a particular stage of development. This will improve overall patient safety, as abilities and skills are directly assessed, rather than assumed.
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18 HOSPITAL NEWS JANUARY 2018
CBD is being implemented through a phased approach in which ongoing collaboration with specialty committees, universities and other stakeholders is critical to continuous improvement of the program. Recognizing hospitals as essential partners in the education process, the Royal College is seeking input as part of key stakeholder collaborations. This dialogue will ensure emphasis on the role of clinical care as an important resource for both teaching and learning. Beyond ongoing collaboration, the Royal College is preparing to implement CBD by conducting pre-launch activities such as extending the Royal College Resident ePortfolio, and creating faculty support resources, assessment tools and specialty-specific milestones. Ultimately, the initiative helps ensure specialty physicians are prepared to meet evolving patient needs in a variety of settings. Healthcare delivery continues to endure rapid change, and our specialty medical training must adequately prepare physicians for the demands on, and expectations of, the
healthcare system. Doctors are now having to also navigate massive technological and societal change, and it is crucial that our medical training emphasize and evaluate the competencies necessary to navigate this change. CBD is vital to ensuring we are being proactive in creating doctors ready for the future of healthcare.
CBD is truly an investment in Fellowship, and in the quality of what stands behind designation. The program aims to instill a continuous quality improvement approach that encourages continued learning, which is why all doctors – both residents and those currently practicing – will participate in CBD. The healthcare sys-
tem has evolved, and it’s time that our specialty medical training does as well. Together, we can continue to produce excellent physicians in the wake of rapid change, and provide an even higher level of care for patients seen in Canada`s healthcare institutions. Questions about CBD? Contact us H at email@example.com ■
Kenneth A. Harris, MD, FRCSC is Executive Director, Royal College of Physicians and Surgeons of Canada
Leading and Inﬂuencing Change in CPD February 26-March 2, 2018 & October 22-26, 2018 This advanced certiﬁcate program in health professions education is designed for those interested in promoting excellence, innovation and change in continuing education to improve health care outcomes. Throughout the two week intensive program, participants will develop skills and learn the tools necessary to lead CPD initiatives in today’s complex health care environment. Individuals engaged in continuing health education, knowledge translation, patient safety, quality improvement, performance improvement initiatives or health policy are encouraged to apply.
Upon completion of the program, participants will be able to: •
identify and discuss opportunities and challenges to continuing health education providers;
apply innovation principles and change process to implement new initiatives and overcome barriers to change;
foster collaboration with a diversity of stakeholders in continuing health education to enable success;
lead and promote innovation in continuing health education for healthcare professionals.
Review complete program details and application information at
JANUARY 2018 HOSPITAL NEWS 19
PROFESSIONAL DEVELOPMENT AND EDUCATION
The key to a great learning experience By Elise Copps
EXPAND YOUR NURSING CAREER New Nephrology for Nurses program
This program prepares nurses to deliver kidney care to affected patients across all stages of the kidney care journey, from early detection through dialysis, palliative care and transplant. You will develop the knowledge required to promote and deliver competent, safe and ethical care to those at risk for developing or affected by renal disease and/or insufficiency. The curriculum has been designed and developed in accordance with the Canadian Nurses Association (CNA) nephrology nursing competencies and standards of practice established by the Canadian Association of Nephrology Nurses and Technologists (CANNT).
hen Nick Millar, a clinical manager at Hamilton Health Sciences, introduced the idea to his team, he got a few sets of raised eyebrows. “It’s was a bit unconventional,” he admits. “But people got really into it since we started.”
tion from some colleagues and landed on a concept. A senior’s care escape room. If you haven’t heard about the escape room craze, here’s a quick explainer: teams are “locked” in a room filled with a series of activities and challenges that will lead to a key out.
MILLAR WANTED TO DELIVER THIS IMPORTANT TEACHING IN A WAY THAT WOULD EXCITE AND ENGAGE HIS STAFF
He wanted to improve his team’s knowledge and understanding of how to care for older adults, especially those with dementia or delirium. The units he manages at Juravinski Hospital and Cancer Centre have seen a rise in the number of seniors they’re caring for over the last several years. Millar wanted to deliver this important teaching in a way that would excite and engage his staff. He drew inspira-
There are clues along the way, but participants have to think creatively and work together to find them. Millar enlisted one of his registered practical nurses, Helena Richards, to assist him in developing the escape room challenge. She created a series of stations focused on different topics related to seniors care, including nutrition, medication management and safe patient handling. Continued on page 22
20 HOSPITAL NEWS JANUARY 2018
PROFESSIONAL DEVELOPMENT AND EDUCATION
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JANUARY 2018 HOSPITAL NEWS 21
PROFESSIONAL DEVELOPMENT AND EDUCATION
Helping Leaders Manage Unprofessional Behaviour Saegis, a new subsidiary of the Canadian Medical Protective Association, has developed a comprehensive program for leaders to assist them in recognizing and addressing unprofessional behaviour within their healthcare institutions. In August 2017, the Canadian Medical Protective Association (CMPA) announced the launch of Saegis, a new subsidiary offering specialized safety programs and services for physicians, healthcare professionals and institutions, as well as practice management solutions for team-based practices and clinics across Canada. Saegis saw a need among hospital and healthcare team leaders for help dealing with unprofessional behaviour. Leaders had voiced concerns that they lacked the necessary knowledge and skills to handle difficult team members. With these concerns in mind, Saegis developed a customized program for institutional leaders called Strategies for Managing Unprofessional Behaviour, which was very successfully piloted in a Canadian hospital during November 2017. The program is now being rolled out nationally. It is offered on-site at a hospital or institution to minimize time the away for participants and fit with busy hospital schedules. It is carefully designed to include the development of personal and institutional improvement plans to ensure the program has a lasting impact.
Hospital and healthcare leaders interested in learning more can CALL 1-833-435-9979 or EMAIL firstname.lastname@example.org
22 HOSPITAL NEWS JANUARY 2018
Staff at Hamilton Health Sciences participate in a senior care escape room, so they developed an escape room to excite and engage staff.
Great learning experience Continued from page 20
THERE ARE CLUES ALONG THE WAY, BUT PARTICIPANTS HAVE TO THINK CREATIVELY AND WORK TOGETHER TO FIND THEM “It was really fun to put it together,” says Richards. “Participants had to demonstrate that they understood the concepts in order to move forward in the room.” To add another layer of learning, teams earned extra bonus points for including as many different professionals groups as possible on their five person roster. This encouraged knowledge sharing between professions and
helped participants come away with a better perspective of what their colleagues go through when caring for seniors. Millar was pleased to see how many teams registered to participate, and has received great feedback so far. He’s hopeful that this teaching style will help staff to retain what they’ve learned and share their excitement for H improving senior’s care. ■
Elise Copps works in communications at Hamilton Health Sciences Centre. www.hospitalnews.com
Hospital and healthcare team leaders We understand that unprofessional behaviour within healthcare teams affects morale, productivity and patient safety. Saegis can help you navigate the challenges with our customized program.
Strategies for Managing Unprofessional Behaviour Delivered on-site at your hospital or institution
• Learn to deal with this complex challenge in a constructive way • Learn strategies to prevent issues from escalating or even occurring • Develop personal and institutional improvement plans to ensure the program has a lasting impact
Designed with a flexible schedule to minimize time away
Strategies for Managing Unprofessional Behaviour is a comprehensive program for leaders to assist them in recognizing and addressing unprofessional behaviour within their healthcare institutions.
Excellent program! All people in leadership roles should do this. Department Head, Obstetrics & Gynaecology, ON
Saegis is a wholly owned subsidiary of the CMPA that offers professional development, safety programs and practice management solutions to physicians, healthcare professionals and teams, hospitals and clinics. To find out more about this program and others we have developed for healthcare institutions, contact us at
JANUARY 2018 HOSPITAL NEWS 23
Nursing students at York University presented their assignments for the Change Day Ontario Challenge where they had to identify a healthcare issue they are passionate about, then develop and implement a change initiative and create a social media strategy.
students and staff to drive change By Claire Mallette tive to this top-down approach is for healthcare providers to work together to improve patient care, with the support and participation of the leadership team. An example of this type of change occurred this fall with, Change Day Ontario: Make a Difference in Patient Care. Change Day is a grassroots movement that is being adopted around the world to improve quality compassionate care. In Ontario, the initiative was launched by Associate Medical Services (AMS) and Health Quality Ontario. Change Day was
ithin the stressors of todayâ€™s rapidly changing technological healthcare environments, many healthcare providers are finding it difficult to incorporate quality compassionate care into their practice. While there is an overwhelming recognition that healthcare delivery needs to change, strategies to do this are often addressed through top-down initiatives. These strategies are often initiated by leaders within the organization, who sponsor a change initiative to be rolled out to staff. An alterna-
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Lead and manage in a fast-changing, multidisciplinary environment.
Gain useful tools, techniques, and checklists to take back and apply immediately.
Manage complexity and promote organizational success.
Build their professional healthcare network.
based on the belief that one person or a group of people can improve healthcare through taking actions big or small to collectively improve the healthcare system. Individual acts of change, regardless of the size, can add up to the significant improvements for Ontarians, the professions and the healthcare system overall. Frontline healthcare providers often have ideas of how things should change to improve patient care and/ or the work environment. However, they can feel powerless in actually implementing these initiatives. It is im-
portant for them to realize their own power as change agents in making a difference. The Change Day Ontario initiative was designed to empower people within the healthcare system to make these type of positive changes through making pledges and taking actions, big or small, to improve care. At York Universityâ€™s School of Nursing, myself and fellow faculty members, Mavoy Bertram and Brenda Orazietti, took up the Change Day initiative as part of two senior-level undergraduate nursing courses. Five hundred senior undergraduate nursing
NURSING OPPORTUNITIES In the Canadian Armed Forces CANADIAN FORCES HEALTH SERVICES IS NOW HIRING Are you thinking about a career change? Does working both at home on Canadian soil as well as overseas on military operations interest you? Nurses in the Canadian Armed Forces have a unique opportunity to deliver team-based collaborative care with the added distinction of serving their country with honour. CANADIAN FORCES HEALTH SERVICES IS CURRENTLY SEEKING SPECIALTY TRAINED LICENSED REGISTERED NURSES IN THE FOLLOWING AREAS OF PRACTICE: â€˘ Critical Care; â€˘ Peri-operative; and â€˘ Mental Health.
SOME OF THE MANY BENEFITS OF EMPLOYMENT INCLUDE: â€˘ Annual Salary Range: $54,000 to $104,600; â€˘ Paid Annual Leave (20 to 25 days/year); â€˘ Generous government pension; â€˘ Excellent maternal and parental leave beneďŹ ts; â€˘ Comprehensive medical and dental coverage; and â€˘ SigniďŹ cant professional development opportunities.
To learn more about how you can join the team of health care professionals that provides full spectrum, high quality health services to Canada's ďŹ ghting forces wherever they serve, please contact HealthSvcsRecruiting-RecrutementSvcsdesante@forces.gc.ca or 1-800-856-8488.
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24 HOSPITAL NEWS JANUARY 2018
students were given the assignment to take up the Change Day Ontario Challenge by identifying a healthcare issue that they are passionate about, then develop and implement a change initiative and create a social media strategy. The goal of the assignment was to impress upon the students the power they have to be change agents and create change within the healthcare system. The students were energized! They realized their own power in making a difference as change agents and used their knowledge to create overwhelm-
ingly powerful strategies. Their initiatives included, for example: a social media strategy highlighting inequities that indigenous families face in accessing prenatal and labour and delivery services in remote areas of Northern Ontario; a “Homeless not Hopeless” initiative, with a pledge to decrease the stigma surrounding homeless youth; influencing the nursing practice issue of patients’ loss of autonomy when admitted to hospital; and an initiative entitled, “Expression of Depression: Accessing Mental Health Services for Depression”. The students’ initiatives,
alongside over 6,000 Change Day pledges across Ontario, demonstrate the importance of providing opportunities to enable change by unleashing the creativity and imaginations of those who want to make a difference. This type of change can occur anywhere. Anyone in your healthcare organization can become that change agent who has an idea of how to create a new way of delivering and/or improving upon quality compassionate care. All that is needed is an idea, some courage, and taking the risk to “just do it” one person or group at a
time. At the same time, leaders within the organization should ask themselves, how can I inspire the people I work with to generate and implement their change strategies? How do I enable the way and then get out of the way so their imaginations and creativity can be unleashed and their initiatives enacted? Just imagine what your initiatives could be. Be bold, be brave, and just do it! For more information on Change Day Ontario go to http://www.changeH dayontario.ca/■
PHYSICIAN OPPORTUNITIES In the Canadian Armed Forces Are you considering taking the next step in your professional career? Does the notion of providing health care in unique and challenging environments appeal to you? Do you have a keen sense of adventure? Physicians and Medical Specialists within the Canadian Armed Forces play a vital role in providing high quality health care to Canada’s uniformed men and women wherever they serve. Take your clinical practice to the next level. Consider a rewarding career opportunity within the Canadian Forces Health Services. CANADIAN FORCES HEALTH SERVICES IS CURRENTLY HIRING: • Family physicians; • Anesthesiologists; • Orthopedic Surgeons; • General Surgeons; • Radiologists; • Internal Medicine Specialists; and • Psychiatrists.
SOME OF THE MANY BENEFITS OF EMPLOYMENT INCLUDE: • Annual Salary Range: $157,000 to $276,500; • Signing bonus of up to $225,000; • Generous government pension; • No professional related overhead costs; • Comprehensive medical and dental coverage; • For family physicians who have served 3 to 5 years, the opportunity to apply for fully subsidized training in the following areas: - Aviation Medicine; - Sports Medicine; - Specialty Training in Orthopedic Surgery, - Dive Medicine; - Submarine Medicine; General Surgery, Anesthesiology, - Public Health; Radiology, Psychiatry, Internal Medicine and Physical Medicine & Rehabilitation. - Occupational Health;
To learn more about how you can join the team of health care professionals that provides full spectrum, high quality health services to Canada's ﬁghting forces wherever they serve, please contact HealthSvcsRecruiting-RecrutementSvcsdesante@forces.gc.ca or 1-800-856-8488.
JANUARY 2018 HOSPITAL NEWS 25
PROFESSIONAL DEVELOPMENT AND EDUCATION
What do we need in medication incident reporting for effective shared learning? By Jim Kong and Certina Ho n order to learn from breakdowns in the healthcare system that lead to potential harm in patients, incident reporting needs to be implemented with a blame-free, non-judgemental, and non-biased manner. Incident reporting is a retrospective process that captures data for analysis and shared learning, allowing healthcare practitioners to investigate the root causes of incidents for future prevention and patient safety advancement. In recent years, mandatory incident reporting programs for community pharmacies have gradually been implemented across different provinces in Canada. With pharmacy regulatory authorities aligning processes and objectives to enhance patient medication safety, a standardized
MANDATORY MEDICATION INCIDENT REPORTING PROGRAMS IN COMMUNITY PHARMACIES ACROSS CANADA PRESENT A GREAT OPPORTUNITY FOR SHARED LEARNING ON HOW TO ADDRESS SYSTEM-BASED ERRORS AND IMPROVING PATIENT SAFETY NATIONALLY
core data set for incident reporting is the foundation for a cohesive, robust national incident data repository where all healthcare practitioners can contribute, share, and facilitate continuous quality improvement in their practice settings. Medication incident is defined as â€œany preventable event that may cause
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26 HOSPITAL NEWS JANUARY 2018
or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer; medication incidents may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labelling/packaging/nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and useâ€?. Although the mechanism of reporting medication incidents and the associated application programming interfaces for the purpose of reporting may differ among reporters and reporting organizations, ISMP Canada has led the development and maintenance of the core data set for community pharmacies through the use of its community pharmacy incident reporting program originally adapted from the Canadian Medication Incident Reporting and Prevention System (CMIRPS) Core Data Set for Individual Practitioner Reporting which is aligned with the WHO conceptual framework for the International Classification for Patient Safety (ICPS) for incident type â€œMedication/IV Fluidâ€?. This core data set represents a universal set of incident reporting data categories that can be effectively utilized by any reporter or analyst to review, reflect, and learn from medication incidents that occurred in community pharma-
cies. Such harmonization of reporting characteristics not only facilitates the collection of incident data towards the national incident data repository, but also allows more comprehensive quantitative and qualitative incident analyses from which healthcare practitioners can learn from their mistakes. The seven mandatory categories of the core data set are designed to capture a cohesive narrative for reported medication incidents. The optional categories, if incorporated, are designed to further capture complexities that may be relevant to the incident narrative. Finally, by excluding any identifying information of the parties involved in the incident, as well as information regarding the healthcare professional, or relationship between the individual reporting the incident and the patient involved in the incident, the core data set eliminates the â€œblame and shameâ€? potential of incident reporting that may deter potential reporters.
MANDATORY DATA FIELDS IN THE CORE DATA SET FOR COMMUNITY PHARMACY INCIDENT REPORTING Mandatory medication incident reporting programs in community pharmacies across Canada present a great opportunity for shared learning on how to address system-based errors and improving patient safety nationally. Adopting the core data set for community pharmacies is the first step for contributing to the national incident data repository that offers a collaborative information-sharing platform where multi-disciplinary healthcare practitioners can gain a better understanding of medication incidents, as well as develop effective and feasible H strategies to prevent patient harm. â–
Jim Kong is a Program Development Manager at the Institute for Safe Medication Practices Canada (ISMP Canada); Certina Ho is a Project Lead at ISMP Canada. www.hospitalnews.com
PROFESSIONAL DEVELOPMENT AND EDUCATION
Your workplace is changing. Are you?
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JANUARY 2018 HOSPITAL NEWS 27
PROFESSIONAL DEVELOPMENT AND EDUCATION
Continuing medical education and leadership development â€“ better for you, better for your teams By Lindee David t Joule, not a day goes by that we donâ€™t feel grateful for the opportunity to work in healthcare with physicians who can see a brighter future. If youâ€™re one of those doctors who knows we can do better, whose ideas could really change the world, you also know the challenges of implementing change and scaling new ideas. No physician expects things to be easy. The members of this profession are nothing short of resilient. This being said, physician burnout is still a great concern. We know that system level issues play a significant part in physicians feeling disengaged with the passion that once inspired them but it could also be work-related stress
and an inability to recognize quick wins also diminishes professional satisfaction and contributes to burnout. A September issue of CMAJ included a story on physician burnout which suggests that physicians are facing a constant challenge â€“ with the system, with other professions they feel no longer respect them, within the profession, and with staying on top of changes in the profession. The stressors seem endless. Without the skills to advocate for what you need, to improve interpersonal relationships, to influence change to the benefit of your patients while also staying on top of medical developments, one cannot possibly feel they are at their best â€“ for their
#1 source for physician leadership courses in Canada Whether youâ€™re looking for non-clinical continuing professional development to help \RXEXLOGVNLOOVOLNHFRPPXQLFDWLRQLQĆŽXHQFH and negotiation, or for comprehensive leadership development, weâ€™ve got you covered.
patients, their colleagues or their families. For 35 years, Jouleâ€™s Physician Leadership Institute has provided physicians and their health teams with continuing medical education (CPD) and leadership development. These courses are designed to fill the gaps in medical education, help physicians stay on top of new developments and, to help them build leadership skills. What does this have to do with physician burnout? It does not matter how confident you are about your clinical training. If you manage staff or work on a team, thereâ€™s a good chance that your medical training didnâ€™t prepare you for personnel management or interpersonal negotiation. Gaps such as these create workplace stress. Joule has accredited CPD courses to help build skills and confidence and reduce stress and anxiety. Bombarded by changes in the health system â€“ medical assistance in dying (MAiD) for example? Changing expectations of your patients, evolving policies, and wrestling with your own personal ethics can be draining. At Joule we donâ€™t want you to feel impacted by change but rather, empowered by it. Thatâ€™s why Joule created
the MAiD curriculum â€“ so you could navigate these changes more easily. And then, there is the matter of leadership. Tired of being impacted by change and want to lead it? Or maybe youâ€™ve been nominated for an unexpected leadership position or are in one, and have a strong desire to make a difference. Despite what you might read on social media, leaders are rarely born. Whether you want to get your head around change management, conflict management, or developments in patient-centered care, Physician Leadership Institute courses will reduce any anxiety you have of taking on a leadership position while helping you build greater professional satisfaction. The sense of achievement you will get from building these skills and earning a certificate are well documented amongst course alumni. There is an added benefit of leadership training. Did you know that being a strong leader reduces the stress and improves professional satisfaction of those you lead? Did you know you have that power? At a time when everything might feel like a challenge, isnâ€™t it nice to know that there is something you can do to reduce that stress, H for you and your team? â–
Lindee David is Chief Executive Officer, Joule. 28 HOSPITAL NEWS JANUARY 2018
Helping you accomplish your goals in 2018 Leadership begins with Self-awareness Self-awareness is about knowing your strengths and UHFRJQL]LQJ\RXUZHDNQHVVHV/HDGPRUHHÆªHFWLYHO\ WKLV\HDUE\PDNLQJ\RXUGHYHORSPHQWDSULRULW\ 7KLVFRXUVHLVRÆªHUHGRQOLQH-DQXDU\
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PROFESSIONAL DEVELOPMENT AND EDUCATION
Education grants program an investment in staff and patient care By Emily Dawson aising children. Being a good spouse. Meeting professional responsibilities. Running a home. Paying a mortgage. Caring for aging parents. When working adults consider full or part time studies they often face many daunting challenges. To help Providence Healthcare employees take the big step, it established an Education Grants program in 2006. Since its inception, hundreds of people have taken on the challenge and a total of $831,936 has been awarded to date. Here are the stories of two grant recipients. After working at Providence since 2004, Human Resources senior director Aileen Edwards felt she hit a career ceiling when she reached her 50s. So she applied to the Master of Arts in Leadership at Royal Roads University
in Victoria, British Columbia, and was accepted. Providenceâ€™s Education Grants program covered about 80 per cent of the cost of her tuition and books; Aileen paid for her flights to Victoria and accommodation expenses. â€œThe grant was extremely helpful,â€? says Aileen, explaining her decision to apply for a Masterâ€™s degree was easier to make knowing the organization would support her. Obtaining her graduate degree took collaboration, strength and determination. She and her husband, who works full time, reorganized their responsibilities at home to create time for her to study. Leading up to her classes, Aileen had worried she might be the oldest in her class, which turned out to be the case, â€œbut not by much,â€? to her relief. During the program her
mother died â€“ a deeply difficult time for Aileen and her family â€“ but she resolved to continue her studies believing this is what her mother would have wanted. Having graduated, she reflects attaining her goal has had a positive impact personally and professionally. At home, â€œMy children say Iâ€™m their hero,â€? she says humbly. At Providence, Aileen applies her education to improve patient care. Her Masterâ€™s thesis, for example, examined how nurse practice consultants can enhance communication among the front line nurses at Providence; several of her reportâ€™s recommendations have been implemented. For Providence, its investment in Aileen and other employees through the Education Grants program pays off, too.
The program helps the organization achieve its strategic direction BEST Community of Experts, one of three strategic directions featured in Providenceâ€™s BEST Together Strategic Plan 2015-2020. There are two primary strategic aims of the Best Community of Experts: ensuring staff has the confidence and resources to create better care and relationships; and, for staff to feel enriched and empowered to make decisions that create a better Providence. Innovation and education specialist Drema MacDonald oversees the Education Grants program. Since its inception in 2006, the amount of funding has increased to $110,000 annually for the past three years. Applications are due in September each year and stipulate an individual must have completed the course or con-
a leader in health continuing professional education &EVDBUJPOUIBU"EWBODFT1BUJFOU'JSTU$BSF BOE#VJMET&YDFMMFODF 'JOEPVUNPSFBCPVUPVSJOUFSEJDJQMJOBSZBOE FWJEFODFCBTFEDPVSTFTBOEDFSUJGJDBUFQSPHSBNTJO t t t t
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30 HOSPITAL NEWS JANUARY 2018
ference prior to the deadline in order to be eligible. The maximum amount granted per employee per year is $5,000. Last year, Providence reimbursed close to 100 per cent of the individual grant applications. However, just applying for a grant does not guarantee funding, explains Drema. An Education Grant Committee reviews the award applications; courses or conferences must be applicable to the individual’s work at Providence to be eligible for funding. The number of applicants and total amount of funding requested also influences the amount distributed each year. Those awarded a grant are recognized at Providence’s Innovation and Education Award Day ceremony held annually in November. There are many inspiring stories throughout Providence of staff returning to school while working and managing other responsibilities. Midway through an undergraduate program is Adolfo Rodriguez, a registered practical nurse (RPN) and a res-
Aileen Edwards, senior director human resources at Providence Healthcare
ident care supervisor in the Cardinal Ambrozic Houses of Providence. The 37-year-old husband and father of two children, ages 6 and 12, has returned
to school full time to obtain a degree in nursing while working full time. Adolfo has successfully completed the one-year RPN Bridge to B.Sc.N.
program at George Brown College and is in the first of five semesters of Trent’s B.Sc.N. program offered at the George Brown site. “A degree offers more opportunities,” says Adolfo. “I’m glad I’m doing it,” he explains, adding he had contemplated going back to school for a long time. He has applied for funding from the Education Grants program for the bridge program he completed; Adolfo will apply for the program again when he completes his B.Sc.N. Although difficult, returning to school as a working adult has benefits. “I’ve been able to apply leadership skills I learned through the program to my role at Providence, while applying what I have learned at work to my studies,“ reflects Adolfo. Providence Healthcare is part of a new network that includes St. Joseph’s Health Centre and St. Michael’s Hospital. For more information about the Education Grants program contact Drema MacDonald at DMacDonH email@example.com ■
Emily Dawson is a Senior Communications Advisor, Providence Healthcare.
Learn about Quality Management Systems from a different perspective! IQMH elevates the knowledge and competence of medical diagnostic professionals by providing training and education tools. Our interactive training series, webcasts, workshops and publications will help you develop your knowledge of quality management systems.
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Looking for training at your place? Contact us at email@example.com to arrange a personal training session for your group. JANUARY 2018 HOSPITAL NEWS 31
PROFESSIONAL DEVELOPMENT AND EDUCATION
Video game improves doctors’ recognition and triage of severe trauma patients laying an adventure video game featuring a fictitious, young emergency physician treating severe trauma patients was better than textbased learning at priming real doctors to quickly recognize the patients who needed higher levels of care, according to a new trial led by the University of Pittsburgh School of Medicine. The results, published recently by The BMJ, held even though doctors assigned to the game enjoyed it less than those assigned to traditional, textbased education. This indicates that if
game enjoyment can be improved, the already favorable results might be enhanced. “Physicians must make decisions quickly and with incomplete information. Each year in the U.S., 30,000 preventable deaths occur after injury, in part because patients with severe injuries who initially present to non-trauma centres are not promptly transferred to a hospital that can provide appropriate care,” says lead author Deepika Mohan, M.D., M.P.H., assistant professor in Pitt’s departments of Critical Care Medicine and
Surgery. “An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still out-performing their peers in recognizing severe trauma.” Mohan created the game Night Shift with Schell Games, an educational and entertainment game development company. The game is designed to tap into the part of the brain that uses pattern recognition and previous experience to make snap decisions using subconscious mental shortcuts – a process called heuristics.
the US who did not work at hospitals with trauma specialization. Half were assigned to play the game and half were asked to spend at least an hour reading the educational materials. Participants then responded to questionnaires and completed a simulation that tested how often they “under-triaged,” or failed to send severe trauma patients to hospitals with the resources necessary to handle them. Physicians who played the game under-triaged 53 per cent of the time, compared with 64 per cent for those
AN HOUR OF PLAYING THE VIDEO GAME RECALIBRATED PHYSICIANS’ BRAINS TO SUCH A DEGREE THAT, SIX MONTHS LATER, THEY WERE STILL OUT-PERFORMING THEIR PEERS IN RECOGNIZING SEVERE TRAUMA
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Learning for the future: education that evolves with our health care system Continuing Education at The Michener Institute of Education at UHN has a long history of being here for you – busy professionals who are transforming our health care system. For almost 60 years, lifelong learning has been at the heart of our innovative program design and education solutions that prepare health care providers to take their careers to the next level. As part of University Health Network, our collective purpose is that above all else, patients come first. To fulfill this purpose, we are committed to learning for the future by helping you maintain skills, enhance your practice and reach your professional development goals with over 100 specialty courses and comprehensive graduate certificate programs. While some of Michener’s Continuing Education programs are targeted to specific learner groups like medical laboratory technologists or radiological technologists, many other courses and workshops meet the learning needs of several health professions. Having options for online or hybrid learning means that we can offer you flexible and interactive learning solutions to help you take the next step in your career from the comfort of your home – anywhere in Canada or even the world. Continuing Education programs at The Michener Institute of Education at UHN include: 4 Graduate and Accelerated Certificates in Diabetes Educator, Leadership, Quality Management, Intraoperative Neurophysiological Monitoring, Clinical Research, Clinical Management, Clinical Educator, Plain Language and Imaging Informatics 4 Specialty and Enhanced Practice Programs in Medical Laboratory Sciences, Primary and Critical Care, Radiation Sciences and Imaging, Chiropody, Infection Control and Epidemiology. 4 Workshops and seminars such as Advanced Cardiac Life Support and Pediatric Advanced Life Support. Interested in preparing yourself for the future of health care? Email us at firstname.lastname@example.org or visit michener.ca/hospitalnews to view our online brochure and registration details.
Physicians in non-trauma centers typically see only about one severe trauma per 1,000 patients. As a result, their heuristic abilities can become skewed toward obvious injuries such as gunshot wounds, and miss equally severe traumas such as internal injuries from falls. On average, 70 per cent of severely injured patients who present to non-trauma centres are under-triaged and not transferred to trauma centres as recommended by clinical practice. Both the game and the text-based learning are intended to help physicians improve their decision making regarding severe traumas. The game, however, sought to do this through narrative engagement, or the use of stories to promote behavior change, which has shown promise in recalibrating heuristics. Mohan’s team recruited 368 emergency medicine physicians from across
who read the educational materials. Six months later, Mohan reassessed the physicians and found that the effect of the game persisted, with those who played the game under-triaging 57 per cent of the time, compared to 74 per cent for those who had read the educational materials. “There are many reasons beyond the doctor’s heuristics as to why a severe trauma patient wouldn’t be transferred to a trauma centre, ranging from not having an ambulance available to a lack of proper diagnostic tools,” says Mohan. “So, it is important to emphasize that recalibrating heuristics won’t completely solve the under-triage problem and that the problem isn’t entirely due to physicians’ diagnostic skills. But it’s heartening to know we’re on track to develop a game that shows promise at improving on current H educational training.” ■
M I C H E N E R.C A/H O S P I TA L N E W S
32 HOSPITAL NEWS JANUARY 2018
PROFESSIONAL DEVELOPMENT AND EDUCATION
M I C H E N E R I N S T I T U T E CO N T I N U I N G E D U C AT I O N
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JANUARY 2018 HOSPITAL NEWS 33
Students put young researchers in t By Alexis Dobranowski UPCOMING PROGRAM DATES
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34 HOSPITAL NEWS JANUARY 2018
n enthusiastic group of elementary school students took time out of their summer holidays to visit Sunnybrook for a day of learning – and teaching – for the annual Tell it to a Fifth Grader Research Contest. As part of the D+H Sunnybrook Research Institute Summer Student Research Day, university summer students were invited to submit a simple summary of their work in a way the public – even kids – would understand. More than 45 projects were submitted. Eleven youngsters took part in judging the finalists, who presented complicated research about Alzheimer’s Disease, risk assessment for ACL injury, and cochlear implant technology using plain language and kid-approved analogies. “A person becomes deaf when the ear stops working because of little nerve cells dying, like how a TV would stop working if I cut its power wire or if the wire got frayed or broken,” says Dilakshan Srikanthan, a student at Universi-
ty of Toronto, to start off his presentation about a camera that helps surgeons take pictures inside the ear in preparation for cochlear implant surgery. The young students didn’t let the summer researchers off easy. Hands shot up when words needed clarification or something didn’t quite make sense to the 5th graders. The event aims to help teach the undergraduate scientists how to breakdown their research in ways the public can understand. Katie Bozek, a fourth-year undergraduate student from the University of Toronto, took home the first-place ribbon (and a cash prize) for her presentation about exploring how swine flu bugs stay in pig barns and can spread. “The contest was an excellent idea to showcase real scientific research to young students. It also provided an opportunity for up-and-coming scientists like myself to highlight the importance of making science accessible for everyone,” she says. In addition to the presentations, the young students also visited two
Alexis Dobranowski works in communications at Sunnybrook Health Sciences Centre. www.hospitalnews.com
cell-sorting labs and tried their own hands at pipetting. “I give the day a 10 out of 10,” says Charlotte Jez, age 10. “Every fifth grader should get to meet a scientist or researcher.”
year doing really incredible research, publishing papers and presenting at international conferences. We thought it’d be great to ask these students to practice sharing that work in a way the general public can understand.”
THE EVENT AIMS TO HELP TEACH THE UNDERGRADUATE SCIENTISTS HOW TO BREAKDOWN THEIR RESEARCH IN WAYS THE PUBLIC CAN UNDERSTAND
Left: University student Emma Griese fields questions from a keen group of 5th Graders during Sunnybrook’s annual Tell it to a 5th Grader Research Contest. Middle: University summer student researchers presented their research projects in plain language to 5th graders and their siblings for the annual Tell it to a 5th Grader Research Contest. Right: Judges got to try pipetting at the annual Tell it to a 5th Grader Research Contest, where elementary school students judge plain language summaries presented by summer researchers.
BRAIN HEALTH: MOOD, METABOLISM, & COGNITION Special Seminar To Be Held What is the role of the brain in managing weight loss, diabetes, sleep, depression, and oral health? ěȃǉɰƺȈǉȶɽȈˎƺƃȢȢʰӸƹƃɰǉǁɰȈʯӸȃɁʍɨƺɁʍɨɰǉӗӠ9ɨƃȈȶǉƃȢɽȃӖÃɁɁǁӗÃǉɽƃƹɁȢȈɰȴӗ ƃȶǁ:ɁǼȶȈɽȈɁȶӠʥȈȢȢɥɨɁʤȈǁǉȃǉƃȢɽȃӸƺƃɨǉɥɨɁǹǉɰɰȈɁȶƃȢɰʥȈɽȃȈȶǹɁɨȴƃɽȈɁȶƃƹɁʍɽ keeping the brain in optimal condition. ěȃǉɰǉȴȈȶƃɨʥȈȢȢƹǉɥɨǉɰǉȶɽǉǁǹɁʍɨ ɽȈȴǉɰȈȶȢƹǉɨɽƃĀɨɁʤȈȶƺǉӖ Thursday, April 26, 2018 Radisson Hotel, љњїѕӸќћɽȃʤǉȶʍǉӗ Edmonton, Alberta;
The initiative is part of Sunnybrook’s ongoing effort to involve the community in all aspects of the health-care setting and bring research to the public. “At Sunnybrook, we like to find new ways to engage the community and show them how research relates to everyday life, so it’s important that our researchers can explain their amazing, complex work to the public,” says Craig DuHamel, VP Communications. “We have about 150 summer students at Sunnybrook each
Congratulations to Katie and the other finalists: Dilakshan Srikanthan, Emma Griese, Michael Rosen, Lee Yu (Tina) Wu, Megan Lam. And a big thank you to the 5th graders (and their siblings): Abby, Bosco, Charlotte, Hayden, Jillian, Jordyn, Lila, Mary, Nyla, Sacha and Taya. For information about Sunnybrook’s undergraduate summer student proH gram, visit sunnybrook.ca/research ■
Friday, April 27, 2018 Executive Royal Inn, їѝїѝӸїјɨǁ ČɽɨǉǉɽӗÇKӗ:ƃȢǼƃɨʰӗȢƹǉɨɽƃӢ
Thursday, May 10, 2018 Radisson Hotel, љњїѕӸќћɽȃʤǉȶʍǉӗ Edmonton, Alberta. ěȃǉɰǉȴȈȶƃɨɽȈȴǉɰʥȈȢȢƹǉѝӖјѕӝÃӝ ɽɁјӖјѕĀӝÃӝ
AɨӝĀƃʥȢƃȟʥȈȢȢɰɥǉƃȟɁȶɥɨӝїћƃȶǁїќӝAɨӝŚȃȈɽǉʥȈȢȢɰɥǉƃȟɁȶÃƃʰўƃȶǁіѕӝ ěȃǉƺɁʍɨɰǉʥȈȢȢǉʯƃȴȈȶǉʥȃʰƹɨƃȈȶǁȈɰɁɨǁǉɨɰƃɨǉȴɁʍȶɽȈȶǼƃȶǁʥȈȢȢƺɁʤǉɨ ȃɁʥǁȈǹǹǉɨǉȶɽǹɁɁǁɰƃǹǹǉƺɽɽȃȈȶȟȈȶǼӝɽʥȈȢȢɨǉʤȈǉʥɽȃɁɰǉǹɁɁǁɰɽȃƃɽƺƃȶƹǉ ӠɰȈȢǉȶɽӠƹɨƃȈȶȟȈȢȢǉɨɰӝ ěȃǉɰǉȴȈȶƃɨȈɰɰɥɁȶɰɁɨǉǁƹʰɽȃǉ9ȈɁȴǉǁ:ɁɨɥɁɨƃɽȈɁȶӗÇɁɨɽȃȴǉɨȈƺƃӡɰ ȢƃɨǼǉɰɽɥɨɁʤȈǁǉɨɁǹȢȈʤǉɰǉȴȈȶƃɨɰǹɁɨȃǉƃȢɽȃɥɨɁǹǉɰɰȈɁȶƃȢɰӝ9ȈɁȴǉǁǁɁǉɰȶɁɽ ƃƺƺǉɥɽƃȶʰǼȈǹɽɰɁɨǼɨƃȶɽɰӝ ěɁɁƹɽƃȈȶȴɁɨǉȈȶǹɁɨȴƃɽȈɁȶӗɥȢǉƃɰǉƺɁȶɽƃƺɽӖ Biomed General, 3545-32 Avenue NE, Box #622, Calgary, Alberta T1Y 6M6
Wednesday, May 9, 2018 Executive Royal Inn, їѝїѝӸїјɨǁ ČɽɨǉǉɽӗÇKӗ:ƃȢǼƃɨʰӗȢƹǉɨɽƃӢ
Visit Biomed's Web site at www.biomedglobal.com Telephone: 1-877-246-6336 (toll-free) or (925) 602-6140 E-mail: firstname.lastname@example.org
JANUARY 2018 HOSPITAL NEWS 35
PROFESSIONAL DEVELOPMENT AND EDUCATION
Mood, Metabolism, & Cognition A Seminar for Health Professionals TUITION $109.00 (CANADIAN) Conference registration is from 7:45 AM to 8:15 AM. The conference will begin at 8:30 AM. A lunch break (on your own) will take place from approximately 11:30 AM to 12:20 PM. The course will adjourn at 30DWZKLFKWLPHFRXUVHFRPSOHWLRQFHUWLÂżFDWHVDUHGLVWULEXWHG
Registration: 7:45 AM â€“ 8:30 AM Morning Lecture: 8:30 AM â€“ 10:00 AM z Mounting Brain Disorders in America: Cognitive Decline, Alzheimerâ€™s Disease, Anxiety and Depression. z The Vulnerable Brain: What the Brain Needs to Be Healthy. z The Brainâ€™s â€œGatekeeperâ€?: The Blood-Brain Barrier. What Causes a â€œLeaky Brainâ€? or an Âł,QĂ€DPHG%UDLQÂ´":KDWDUHWKH&RQVHTXHQFHV" z Diabetes and the Brain: The Final Frontier. Parallel Lives of Insulin in the Body vs. Brain. How Sugar Affects Thinking. Effect of Diabetes on the Blood-Brain Barrier. Diabetes and 'HSUHVVLRQ'RXEOH7URXEOH5HSXUSRVLQJ'LDEHWHV'UXJVIRU'HPHQWLD" Mid-Morning Lecture: 10:00 AM â€“ 11:30 AM z The Obese Brain. 2EHVLW\DQG&RJQLWLYH'HFOLQH&KLFNHQRUWKH(JJ"&RXOG7ULPPLQJ<RXU :DLVWOLQH'HOD\$O]KHLPHUÂśV'LVHDVH"2EHVLW\DQG'HSUHVVLRQ:KDWÂśVWKH/LQN" z Scourge of the â€œWestern Dietâ€?: 'RHV:KDW:H(DW5HDOO\$IIHFW+RZ:H7KLQN"$UH:KHDW &DUEVDQG6XJDU5HDOO\WKHÂł6LOHQW%UDLQ.LOOHUVÂ´"+RZD3RRU4XDOLW\'LHW&DQ'LVUXSW $SSHWLWH&RQWURODQG3URPRWH2YHUHDWLQJ)RRGDQG0RRG:KDW)RRGVDUHÂł$GGLFWLYHÂ´DQG:K\" z Sleep and Brain. 6OHHSDVDÂł3RZHU&OHDQVHÂ´IRUWKH%UDLQ"Âł6RFLDO-HW/DJÂ´DQG%UDLQ+HDOWK z Leaky Gut Ă…Ă† Leaky Brain? Neurodegenerative and Neuropsychiatric Consequences of 3RRU*XW+HDOWK*XW0LFUREHVDVWKH%UDLQÂśV3HDFHPDNHU"7UXVW<RXU*XW7KH3RZHURID Healthy Gut and Gut Microbes to Heal and Protect the Brain. Microbiome Reprogramming: Probiotics, Prebiotics, Symbiotic, and Others.
Lunch: 11:30 AM â€“ 12:20 PM Afternoon Lecture: 12:20 PM â€“ 2:00 PM z Oral Health and the Brain. Periodontal Disease and Depression. Periodontal Disease and &RJQLWLYH'HFOLQH:KDW)DFWRUV([SODLQ7KLV/LQN"7R[LF0RXWKWR7R[LF%UDLQ z Periodontal Therapy to Prevent or Delay Alzheimerâ€™s Disease. z Periodontal Disease and Brain Health. 7KH5ROHRI&KURQLF%DFWHULDO,QIHFWLRQDQG,QĂ€DPPD tion on Brain Health and Overall Metabolic Health. z What to Eat to Defend and Fortify â€œthe Castle.â€? The â€œWhole Foods Dietâ€?: A Feast for the Mind. Âł6XSHU)RRGVÂ´IRUWKH%UDLQ" z Supplements and the Brain: +D]DUGRU3DQDFHD":KDWWKH6FLHQFH6D\V)DVWLQJIRU,PSURYHG %UDLQ+HDOWK" Mid-Afternoon Lecture: 2:00 PM â€“ 3:20 PM z Nutritional Psychiatry. &DQ:H(DWWR%HDWWKH%OXHV"Âł3V\FKRELRWLFVÂ´IRUWKH3XUVXLWRI+DSSLQHVV" 0HQWDO+HDOWK7KLQNLQJIURPWKH*XW"*OXWHQ3V\FKRVLV" z Change Your Lifestyle to Transform Your Brain: Physical Activity, Social Engagement, Mental Exercises and Stress-Reduction Techniques. z Return to the Life of Our Ancestors: 2XU0RGHUQÂł3DOHR'HÂżFLW'LVRUGHUÂ´<RXU%UDLQ2Q 1DWXUH1DWXUHÂśV,QĂ€XHQFHRQ%UDLQ+HDOWKDQG9LWDOLW\ Evaluation, Questions, and Answers: 3:20 PM â€“ 3:30 PM
Biomedâ€™s Website: www.biomedglobal.com
MEETING TIMES & LOCATIONS CALGARY, AB CALGARY, AB
Thu., April 26, 2018 8:30 AM to 3:30 PM Radisson Hotel 4520 76th Avenue Edmonton, AB
Fri., April 27, 2018 8:30 AM to 3:30 PM Executive Royal Inn 2828 23rd Street NE Calgary, AB
Thu., May 10, 2018 8:30 AM to 3:30 PM Radisson Hotel 4520 76th Avenue Edmonton, AB
Wed., May 9, 2018 8:30 AM to 3:30 PM Executive Royal Inn 2828 23rd Street NE Calgary, AB
Dr. Laura Pawlak (Ph.D., M.S., R.D.) (emerita) is a full-time lecturer for INR. Dr. Pawlak undertook her graduate studies in biochemistry at the University of Illinois, where she received her masters and GRFWRUDOGHJUHHV$XWKRURIVFLHQWLÂżFSXEOLFDWLRQVDQGPDQ\DFDGHPLFERRNVVKHFRQGXFWHGKHU postdoctoral research in biochemistry at the University of California San Francisco Medical Center. Dr. Beverly White (Ph.D., R.D.) is a full-time instructor for INR (Institute for Natural Resources), presenting seminars nationally and internationally. For over 30 years, she has also served as a clinical dietetic consultant. Dr. White obtained her doctorate in nutrition from Oregon State University. She holds a bachelorâ€™s degree in dietetics from the University of California, Davis. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.
FEE: CHEQUES: $109.00 (CANADIAN) per person with pre-registration or $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar. ACCREDITATION INFORMATION NURSES (RNs, RPNs, & LPNs)
7KLVSURJUDPLVGHVLJQHGWRSURYLGHQXUVHVZLWKWKHODWHVWVFLHQWLÂżFDQGFOLQLFDOLQIRUPDWLRQDQG to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Institute for Natural Resources (INR) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
ACCREDITATION INFORMATION (cont'd) PHARMACISTS & PHARMACY TECHNICIANS
$OEHUWDOLFHQVHG SKDUPDFLVWV VXFFHVVIXOO\ ÂżQLVKLQJ WKLV FRXUVH ZLOO UHFHLYH FRXUVH FRPSOHWLRQ FHUWLÂżFDWHV %LRPHG LV DQ DFFUHGLWHG SURYLGHU WKURXJK WKH$PHULFDQ &RXQcil on Pharmaceutical Education. The ACPE universal activity numbers (UAN) are 0212-9999-18-001-L01-P and 0212-9999-18-001-L01-T. This is a knowledge-based CPE activity.
Biomed, under Provider Number BI001, is a Continuing Professional Education (CPE) Provider Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDâ€™s) and dietetic technicians, registered (DTRâ€™s) will receive 6 hours worth of continuing professional education units (CPEUâ€™s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics. This course has Activity Number 130181 and Suggested Learning Codes: 2000, 3000, 5190, 5300.
This activity is co-provided with INR. Social Workers completing this program will receive course FRPSOHWLRQFHUWLÂżFDWHV$SSOLFDWLRQIRUDSSURYDORIWKLVFRXUVHKDVEHHQPDGHWRWKH$6:%IRU hours of credit. This program is approved by the National Association of Social Workers (Provider #886502971-2474) for 6 Social Work continuing education contact hours.
Biomed General is approved by the Canadian Psychological Association to offer continuing education for psychologists. Biomed General maintains responsibility for the program.
Please check course date:
Please return form to: Biomed General 3545-32 Avenue NE, Box #622 Calgary, AB T1Y 6M6 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 ÂŠ FAX: (925) 687-0860
(This registration form may be copied.)
Thu., April 26, 2018 (Edmonton, AB) Fri., April 27, 2018 (Calgary, AB)
Wed., May 9, 2018 (Calgary, AB) Thu., May 10, 2018 (Edmonton, AB)
Please print: Name: Profession: Home Address: Professional License #: City: State: Zip: Lic. Exp. Date: Home Phone: ( ) Work Phone: ( ) Employer: E-Mail: QHHGHGIRUFRQÂżUPDWLRQ UHFHLSW
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36 HOSPITAL NEWS JANUARY 2018
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Please register early and arrive before the scheduled start time. Space is limited. Attendees requiring special accommodation must advise Biomed in writing at least 50 days in advance and provide proof of disability. Registrations are subject to cancellation after the scheduled start time. A transfer at no cost can be made from one seminar location to another if space is available. Registrants cancelling up to 72 hours before a seminar will receive a tuition refund less a $35.00 (CANADIAN) administrative fee or, if requested, a full-value voucher, good for one year, for a future seminar. Other cancellation requests will only be honored with a voucher. Cancellation or voucher requests must be made in writing. If a seminar cannot be held for reasons beyond the control of the sponsor (e.g., acts of God), the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year, for a future seminar. A $35.00 (CANADIAN) service charge applies to each returned cheque. A $15.00 fee ZLOOEHFKDUJHGIRUWKHLVVXDQFHRIDGXSOLFDWHFHUWLÂżFDWH)HHVDUH subject change without notice. The rate of exchange used will be the one prevailing at the time of the transaction.
High NSQIP score boosts frontline workers’ morale By Alineh Haidery eeping employee morale high in any company is a challenge. Add in the complex structures of hospitals and surgery and it can be even more difficult. When your job consists of life and death, employee morale can be elusive to maintain or control. However, whether your day-to-day job is at a desk or performing surgeries in the OR, most people are motivated by positive results. This holds true in the hospital setting in particular, when excellence and hard work can save lives. When William Osler Health System’s (Osler) Etobicoke General Hospital and Brampton Civic Hospital ranked in the top 10 per cent of hospitals in North America for measuring care delivered through its surgery program, the team involved with the initiatives that contributed to the ranking had a noticeable boost in morale. The ranking, recognized by the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) for delivering safe, quality surgical care, ranked Etobicoke General Hospital and Brampton Civic Hospital in the top 10 per cent of 680 participating hospitals across North America. Leading the team is Dr. Rardi van Heest, NSQIP Surgical Lead at Osler. Dr. van Heest believes that this ranking not only benefits Osler’s patients but also the staff’s morale: “With a multidisciplinary team of physicians and staff, we are proud to have developed an extensive and exhaustive process that guides patient safety and reduces risk to enable quality surgical care. This recognition is a tremendous achievement for the surgical team, and validation for its cohesive, coordinated approach as we continue working together to meet the growing healthcare needs of the community.” Contributing to the high ranking is an initiative Dr. van Heest refers to as
Surgeons work on a patient at Osler.
THIS TANGIBLE MEASURE OF SUCCESS KEEPS THE TEAM MOTIVATED AND ENGAGED WITH THE WORK THEY ARE DOING ON A DAILY BASIS “patient care bundles” – implemented as part of the General Surgery care program. The patient care bundles include various processes implemented prior to surgery, during surgery and as part of post-operative care. The bundles are also customized by frontline workers (physicians, nurses, pharmacy team members) and are tailored for the procedure or surgery on a case-by-case basis. This gives the frontline workers autonomy and further motivates them to take an interest in the program and its outcomes. The care bundles include appropriately timed antibiotics, warming the patient, special skin cleansing before and during the surgery, a discharge sheet for patients post-op with infor-
mation on their surgery and medications as well as a 30-day post-op follow-up call from a team member to check-in on the patient’s progress. During the follow-up calls, team members also solicit feedback from the patients on their experiences with the program. Based on this feedback, team members can implement changes as needed to the bundles to make them even more effective for better patient outcomes in the future. In the General Surgery department, the patient care bundle initiative decreased post-op infections and reduced emergency department visits by 50 per cent. As part of the program, the multidisciplinary team – comprised of nurses, physicians and pharmacy team
members – are provided with monthly data updates from NSQIP that allows them to track their success month over month. This tangible measure of success keeps the team motivated and engaged with the work they are doing on a daily basis. The success of the bundles is a result of the team members working together and staying committed to the initiative. This multidisciplinary team can see the results month after month with the data provided by NSQIP and it continues to motivate them to look for ways to increase positive patient outcomes. It also keeps the frontline employees engaged in their work as they can directly see the results of their combined efforts. Osler’s surgical team continues to work on improving the program as it evolves. In addition to using the data from NSQIP, the team is always looking for other ways to observe their practices and partners in multiple settings to ensure they are continually improving and using the best possible practices. While the program is currently implemented at Etobicoke General Hospital and Brampton Civic Hospital primarily in the General Surgery discipline, Osler is looking to expand it to other departments including Gynaecology, Urology and more. Dr. van Heest hopes that by using the program in various surgical departments, they will have even more opportunities to adapt it by incorporating a wider range of patient and employee input. Dr. van Heest heads up the team at Etobicoke General and she also has a working group at Brampton Civic Hospital. She regularly shares the findings of this initiative through speaking engagements and conferences in the hopes that other hospitals may benefit from implementing H similar programs. ■
Alineh Haidery is Manager Public Relations, William Osler Health System. www.hospitalnews.com
JANUARY 2018 HOSPITAL NEWS 37
Taking action against
By Henrietta Van hulle
was a frontline nurse for 17 years. The work was challenging and rewarding, and it was a career I absolutely loved. During that time, however, I was hit, pinched, scratched and verbally abused on several occasions. The events were not what I would call frequent, nor did they ever result in serious injury. I consider myself among the lucky. Like many healthcare professionals, I’ve come to learn that this is not the case for everyone. Throughout Canada’s healthcare sector, violent incidents and acts of aggression are escalating in both frequency and severity. An employee is threatened and struck with a phone. A nurse removing a BiPAP mask is kicked. An employee is bitten while administering medication. Oftentimes, healthcare workers describe violent events like these as daily
38 HOSPITAL NEWS JANUARY 2018
occurrences, some so serious in nature that they result in a range of physical or psychological issues, from chronic mental stress to anxiety, depression or post-traumatic stress disorder. The rise in incidents can be attributed to an aging population, increasing rates of dementia, a lack of access to mental health resources, and overcrowding and wait times in healthcare organizations, just to name a few. Workplace violence is one of the most pressing issues affecting health care workers today. The affected population is significant. Healthcare and social services represent a large portion – approximately 13 per cent – of Canada’s total labour market. In 2015, healthcare received 19 per cent of total national injury claims, more than any other industry in Canada. In Ontario alone, violent-related incidents made up 10 per cent of all lost-time injury claims in hospitals in 2015, costing these institutions over $23 million
that same year. In one health region in Saskatchewan, violent incidents almost doubled from 224 in the first two quarters of 2015-16 up to 416 over the same period just one year later. In New Brunswick, 66 per cent of nurses reported experiencing physical or verbal abuse during a one-year period. As alarming as these figures are, the reality is likely even more shocking as incidents of violence and acts of aggression have been found to be severely underreported. Research indicates that this is associated with the normalization of violence for healthcare workers, and is attributed to the belief that violence and aggression is “simply part of the job”. Efforts toward reversing this notion is another important task that many jurisdictions are actively working on. For healthcare organizations across the country, acknowledging that there is a problem is the first step. The next is taking action to affect real change. By
taking a proactive approach to tackling violence in the healthcare sector, we can create safer environments for healthcare workers while simultaneously improving patient care. Provinces and healthcare organizations across the country are stepping up to start the conversation, develop and implement solutions, and work toward eliminating this critical hazard. In response, the Public Services Health & Safety Association (PSHSA) launched www.workplace-violence.ca, an interactive framework providing workplaces with a consistent, scalable and consensus-based approach to building a comprehensive workplace violence prevention program for healthcare. Included are five Violence, Aggression and Responsive Behaviours (VARB) toolkits which were developed in collaboration with the Ontario Ministry of Labour, Ontario Ministry of Health & Long Term Care, labour unions, healthcare leadwww.hospitalnews.com
ers, patient advocate representatives, safety experts, employer and professional associations and other key stakeholders. The use of the PSHSA VARB toolkits are one of 23 recommendations put forward by Ontario’s Workplace Violence Prevention in Health Care Leadership Table Report. More resources and changes are expected as other recommendations are rolled out in the near future. “The Violence Leadership Table was a good first start”, says Linda Haslam-Stroud, President of the Ontario Nurses Association. “It is critical that we continue to build on this work, using the practical tools available to assess risk and prevent workplace violence. I applaud the hospital CEOs who have committed to using these tools and urge others to join them.” Hospitals across the province are being advised to integrate the interactive tools into their workplace violence prevention programs. The tools found in each of the five toolkits provide a simple step-by-step implementation process that allows for customization to meet the unique needs of every workplace. “[Workplace violence in health care] is a complex issue that requires individualized approaches tailored to each unique workplace”, explains Anthony Dale, CEO of the Ontario Hospital Association. “As hospitals continue to work through the recommendations put forth by the Leadership Table, it is important to create solutions that reflect their individual missions, the services they provide and that best suit the needs of their staff and community.” An organization with an existing workplace violence prevention program is able to use the VARB tools to evaluate or enhance current program components. • The Workplace Violence Risk Assessment Toolkit: This toolkit is designed to support healthcare organizations in identifying workplace-specific hazards, establishing their risk rating, identifying controls and implementing an action plan. • Individual Client Risk Assessment: This toolkit is designed to help
THE RISE IN INCIDENTS CAN BE ATTRIBUTED TO AN AGING POPULATION, INCREASING RATES OF DEMENTIA, A LACK OF ACCESS TO MENTAL HEALTH RESOURCES, AND OVERCROWDING AND WAIT TIMES IN HEALTHCARE ORGANIZATIONS, JUST TO NAME A FEW healthcare organizations identify behaviours and triggers associated with increased risk of violence so that prevention measures for staff and the client may be taken. • Communicating the Risk of Violence: This toolkit is designed to support healthcare organizations in developing a proactive flagging-alert program to communicate violence-related risks to healthcare teams. This toolkit provides practical tools and information that will help organizations to establish a sustainable flagging-alert program focused on providing quality preventative care. • Security: This toolkit is designed to assist healthcare organizations, with or without designated security personnel, to establish an effective security program. This toolkit provides sample tools and resources to increase awareness and understanding of security program functions, program elements, training requirements, allowing organizations to identify security program gaps and develop a comprehensive and customized action plan. • Personal Safety Response System (PSRS): This toolkit is designed to help healthcare organizations establish an effective PSRS that can effectively summon immediate assistance for impending workplace violence situations or incidents in progress. The tool kit provides practical information regarding legislative requirements, key definitions, devices, procedures, training and implementation considerations. Through the utilization of these tools, incidents of violence and aggression can be reduced and sustain-
able outcomes achieved. Thus far, 59 hospitals and healthcare organizations are actively using the tools. Carrie Fletcher, Senior Director of Health Information Management and Enterprise Project Management Office at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario says the PSHSA toolkits are practical and usable. “The toolkits provide a step-by-step process that an organization can use to implement a practice they don’t already have in place, or improve upon a process they do have. At CAMH, we plan to use them for Quality Improvement to enhance our current workplace violence prevention program.” In my experience, building and enhancing strong, positive relationships and partnerships across the health care system enables excellence in prevention; this is why many players are taking a collaborative approach to addressing the widespread issue of workplace violence. While PSHSA’s VARB toolkits were built for Ontario, two additional provinces are currently trialing to evaluate effectiveness in their jurisdictions, teaming up to make better use of respective resources and capitalize on promising practices. Saskatchewan is also working to address workplace violence in healthcare through their Provincial Violence Prevention Strategy, a collaborative plan which brings together partners from across the province to reduce healthcare’s injury rates through a variety of targeted actions. The group identified PSHSA’s VARB toolkits as a best and promising practice out of Ontario. The Saskatchewan Association for Safety Workplaces in Health (SASWH) is in the process of validating the PSH-
SA tool kit for use in Saskatchewan in three locations. “To date feedback and evaluations have been very positive,” says Sandra Cripps, Chief Executive Officer at SASWH. “SASWH as well as all provincial partners are impressed with the work accomplished by PSHSA in this area, and are most appreciative to access and use these invaluable resources.” Likewise, Alberta Health Services is evaluating the Individual Client Risk Assessment toolkit for use in Alberta. “Alberta Health Services recently conducted a provincial pilot related to Violence/Aggression Alerts, designed to identify patients who may have a higher propensity of violence or aggression based on their history and observed behaviors,” explains Lindsey Simpson, Acting Director of the Centre of Expertise, Workplace Health & Safety at Alberta Health Services. “The goal of this pilot was to establish a formal mechanism of communication of risk between staff, and from one point of care to the next, to enable the provision of safer, quality care, through more informed conversations and effective care planning. One of the most challenging aspects of this initiative was determining which tool to use to support our staff in the decision-making; ideally one that was intuitive and validated. The screening tool developed by PSHSA was critical to our success, and we look forward to partnering with them in the future.” As a whole, the Canadian healthcare system is making major strides in addressing the issue of workplace violence. We must continue to remember that our healthcare system’s greatest asset are those committed, skilled and compassionate individuals that dedicate their careers to the duty of care. Ongoing initiative and collaboration will be required to keep them safe at work and doing what they do best. Together, we can attain a future where it isn’t “lucky” for healthcare workers not to experience violent incidents, and shift the culture so that workers come to expect protection from workplace H violence as the norm in healthcare. ■
Henrietta Van hulle is the Executive Director of Health & Community Services at Public Services Health & Safety Association, and holds a Masters of Health Services Management. www.pshsa.ca www.hospitalnews.com
JANUARY 2018 HOSPITAL NEWS 39
Always looking at the big picture By Michelle Lee Ho s vice president, Our People, corporate services and chief human resources officer at Southlake Regional Health Centre in Newmarket, Ontario, Sandra Smith is always focused on human resources’ (HR) role in shaping and impacting the culture of the organization. “The ability to make a difference inspires me – developing and impacting others and watching them succeed and grow is very rewarding,” says Smith. Southlake is comprised of more than 3,000 staff, nearly 600 physicians and almost 1,000 volunteers, the basis of what Smith refers to as “Our People.” Having worked in HR for 18 years, Smith began her healthcare journey as a nurse, then became involved with union leadership and out of that role evolved to a career in HR. From her experience working on the floor, Smith knows what is important to staff. She says her time and experience delivering care to patients and families taught her the business of the hospital. This understanding differentiates her approach to supporting her people. At Southlake, Smith oversees: human resources; occupational health, safety and wellness; organizational development; diversity; volunteers; corporate communications; patient relations; privacy; patient access; central communications; emergency preparedness; food services; transport, power plant; biomed; environmental; and facilities. She is also the executive liaison for the 224-bed long-term care facility, Southlake Village. The best part about her role at Southlake is her ability to make connections with her people and to be able to impact their work lives. Smith and her teams create policies and practices that make the hospital a better place to work, practice and volunteer.
By Amber Daugherty
he health of employees has never been so important – with rising rates of stress, the constant connectivity that many staff members have to their work, and enhanced conversations about mental health, it is essential for employers to ensure they’re supporting and promoting health and wellness. To do this, hospitals across the province have resources in place, including Employee Assistance Programs and educational information for staff members – and now St. Joseph’s Health Centre Toronto is going one step further by launching a health-based app as part of their wellness strategy.
Sandra J. Smith, VP Our People, Corporate Services & Chief Human Resources Officer at Southlake Regional Health Centre. Smith credits her team with coming up with collaborative approaches and creative programs that are fiscally responsible. She has also done tremendous work to build HR as a strategic business partner. Smith believes in a taking a system lens approach when looking at Leadership Development and the Talent Development Framework. This approach enables Southlake to create the climate to have the right leaders in place to work towards achieving the organization’s strategic goals and to support the development of leaders for the greater system. Three overarching goals shape Southlake’s workforce: the first is to develop high-performing individuals and teams; secondly, to drive employee engagement by creating a workplace where people can practice, work or volunteer to their full potential; and thirdly, to align our engaged workforce to deliver exceptional organizational performance. To support Southlake’s leaders, Smith continues to come together with members of a consortium of hospitals in the GTA to create a foundation for system-level leadership impact. Talent Development tools were
mapped to both the Ontario Hospital Association (OHA) Leadership Competency Model and the LEADS in a Caring Environment Framework. A common tool set was created for Talent Development to: promote consistency and language across hospitals; assess and identify leadership potential; and increase pan-hospital sharing. Southlake documented an increase in organizational leadership bench strength, based on the talent management approach and leadership development programs. Applying a broader lens for talent management/succession planning, Southlake has contributed to the system in supporting leaders who have moved to other healthcare roles. Southlake has also added to the richness of other organizations and committees, while encouraging the growth of leaders through promoting profession-based community leadership activities. Smith’s advice – find a great mentor to help you develop as a professional, continue to network to keep up-todate with your profession, and be sure to take the time to also be a mentor and give back, with the big picture alH ways in mind. ■
Michelle Lee Hoy is a Strategic Communications Consultant at Southlake Regional Health Centre. 40 HOSPITAL NEWS JANUARY 2018
Wellness app promotes healthy competition
IT IS ESSENTIAL FOR EMPLOYERS TO ENSURE THEY’RE SUPPORTING AND PROMOTING HEALTH AND WELLNESS
Sprout is a networking platform similar to Facebook and Twitter that allows users to connect – with a special twist – it’s entirely focused on health and wellness. Once a user registers, they’re encouraged to complete a health risk assessment; based on data including the amount of vegetables they eat, how frequently they exercise and the stress they experience, Sprout gives users a health index number – between one to 100 – to indicate generally how healthy they are. Users can also see personal potential risk factors – for example, if someone in their immediate family has diabetes, they may be at increased risk for the disease. “We wanted to partner with Sprout and invest in launching a wellness app because it’s important to us as an organization that we are taking care of our people, so that together, our teams can provide the best possible care to www.hospitalnews.com
the patients and families we serve in our community,” says Mitch Birken, Senior Director, Human Resource Consulting. “Sprout complements our wellness program – it’s a space where we can share activities and events and for staff to celebrate one another’s accomplishments.” The app provides unique opportunities, including promotion of health-related challenges where users can track their status in real-time. Users can also keep track of their daily activity and earn points for being active – walking 45 minutes, for example, will earn someone over 150 points. Accumulating points gets users up to bronze, silver and gold levels, and helps populate leaderboards – at the organization, on the unit level, and so on. Virona Ibrahim, wellness coordinator at St. Joe’s, said she was really ex-
cited when she started using the app because of the potential it holds. “We’ve traditionally advertised health challenges on units, which has been effective, but this will allow more active participation from our staff members,” she says. “There’s a healthy competition involved as well – when you see that your colleague is winning the stair-climbing challenge, for example, you might be more motivated to join in and catch up.” “It also provides a go-to area where staff members can access health resources – they can opt into different groups like meditation, stress, healthy eating and can share information and education that they might find interesting. We’re really excited because we think this will be a great fit for our teams, and help encourage happier, H healthier lifestyles,” she adds. ■
Sprout is a networking platform similar to Facebook and Twitter that allows users to connect – with a special twist – it’s entirely focused on health and wellness.
Amber Daugherty is a Communications Associate, St. Joseph’s Health Centre Toronto.
Reducing the opportunity for
violence in healthcare By Sam Asselstine wo things are required in order for a crime to be committed. First you need a perpetrator. There are many theories on why people perpetuate criminal activity. Some will argue the strain theory defined as “society putting pressure on individuals to achieve socially accepted goals though they lack the means, this leads to strain which may lead the individuals to commit crimes.” Other theories speak towards genetics, early childhood trauma and varying psychological explanations as to why crime occurs. An individual does not become a perpetrator until they have taken advantage of an opportunity to follow through and commit the crime. Whatever our views are on why people commit crime the fact remains that crime occurs everywhere and hospitals are not immune to criminal activity. In fact, criminal activity in healthcare has been reported at alarming rates across North America for years. So, in keeping with the idea that criminal activity requires an equation, being (Perpetrator)+(Opportunity) = Crime, the question is not how can we stop it, but rather how can we reduce the likely hood of it occurring in the first place? Hospitals are designed to accommodate sick people as well as the well-meaning folks charged with the responsibility to care for them. Peo-
ple use hospitals, and we can’t control that. However we can reduce the opportunity of crime thereby limiting the perpetrators ability to commit it. Since violence in healthcare seems to be the predominant discussion taking place today, lets focus our attention in that direction. Here are some tips for my favourite people in the world – our nurses, on how to put their safety first while working in close proximity to the patients.
SCENE SURVEY As a former first aid and CPR Instructor, I will never preach to the choir about the importance of first aid. There is one guiding principle learned in first aid and CPR that people routinely forget and it’s called the scene survey. Nurses, take your time. Before engaging in a non-urgent situation, look around, look at the patient, consider by-standers. As you’re donning your non-latex gloves engage with the patient to briefly evaluate their level of crisis. If something gives you that feeling that something isn’t right – disengage, call another nurse or security for back-up and then enter again with support.
ALTERNATIVE SCHEDULING Shake things up. My colleagues in other high-risk public service areas tell me that certain people will ex-
BEFORE ENGAGING IN A NON-URGENT SITUATION, LOOK AROUND, LOOK AT THE PATIENT, CONSIDER BYSTANDERS amine patterns of behavior if given enough time. Rotating nursing staff through a variety of different patients over an eight–hour period will disrupt this from happening. This is why security posts often rotate every couple of hours, a new set of eyes, a different perspective creates less complacent behaviour. Operationally, this could present challenges, but it’s a security principle that can be employed by anyone.
LOWER THE BED Patient beds are often placed at a convenient height for clinicians to work, assess and care for the patient. This being said it’s also convenient for a patient to strike and kick from that location. In placing the bed at a lower height, the patient may not be able to strike your throat or face. This does not mean you won’t be assaulted, but you are substituting your head, face and neck, for other regions of the body that may be able to sustain less serious injury.
NON -VERBAL INDICATORS OF CRISIS All too often people give themselves away with their non-verbal indicators of crisis. Due to the busy nature of nursing, sometimes sight is lost on the obvious cues. Pacing, clenched fists, staring, target glance, gross extremity movement – not an inclusive list but a good start. If a patient’s hands are not visible, ask to see them. If the patient refuses, disengage immediately and assemble your back up plan to safely engage the patient.
ROOM DESIGN The number of weapons available within arms-reach within a typical emergency department set-up is incredible. Perhaps it’s not realistic, but reconsidering the traditional design of a patient room may contribute to fewer incidents involving weapons. In placing medical devices and items out of arms-length fewer opportunities will exist. Ask your security director/manager about principles of CPTED – 42 they would be happy to talk to you about it! Nurses will always be required to work in very close proximity to patients, and most of these patients will accept and appreciate the care they receive while in hospital. However as violence continues to rear its head in our hospitals, it’s time to start thinking differently about our approach to violence, and through root cause analysis it starts with reducing the H opportunity ■
Sam Asselstine is the Manager of Security, Safety and Parking at The Royal Ottawa Mental Health Centre, and is Chapter Chair of IAHSS Ottawa/ Carleton. 42 HOSPITAL NEWS JANUARY 2018
Nursing standards and supervised injection services By Tim Hannigan arlier this year, Health Canada approved a number of supervised injection services (SIS) in Ontario. While these services were expected to open over the summer of 2017, there has been significant delay in many cases. To date, only a small number of sites that offer these services have commenced operation. These sites provide intravenous drug users with access to sterile needles, a hygienic environment, and the opportunity to administer pre-obtained drugs under the supervision of a health professional, in most cases RNs. Registered nurses and nurse practitioners employed in emergency departments across the province already understand that overdoses have become a far-too-common medical emergency, and these sites have been created as part of a proactive strategy designed to save lives. RNs and NPs may engage in supervision at an SIS through their employment with a public health agency, for example, or outside of their regular employment, in a volunteer capacity. Given these services are relatively new, it is important for those who are providing them to keep in mind their professional obligations.
CRIMINAL LIABILITY One of the first questions people often ask in regards to SIS is whether or not it is legal, given clients are injecting drugs which are illegal to obtain and possess in Canada. It is not illegal for an SIS to operate, provided it has been granted an exemption by the minister of health under Section 56 of the Controlled Drugs and Substances Act (CDSA).
THESE SITES PROVIDE INTRAVENOUS DRUG USERS WITH ACCESS TO STERILE NEEDLES, A HYGIENIC ENVIRONMENT, AND THE OPPORTUNITY TO ADMINISTER PRE-OBTAINED DRUGS UNDER THE SUPERVISION OF A HEALTH PROFESSIONAL
Section 56 of the CDSA allows the health minister to exempt the application of the Act where it is necessary for a medical or scientific purpose, or in the public interest. Section 56.1 makes specific reference to supervised consumption sites, and sets out the requirements for an application for an exemption, considering the intended public health benefits and information, if any, in regards to community support, resources available, the ad-
ministrative structure to support the site, the need for the site, as well as the impact of the site on crime rates. The minister may give notice of the application to provide members of the public with the opportunity to provide comments. For an RN or NP engaged in supervising clients at an SIS that has received an exemption by the health minister, it is not illegal to provide that supervision.
COLLEGE OF NURSES OF ONTARIO (CNO) Whether a nurse is providing supervision at an SIS as an employee or as a volunteer, it is important to understand your nursing practice is always governed by the College of Nurses of Ontario (CNO), and you are always required to meet the standards of CNO. Continued on page 45
Tim Hannigan is a lawyer at Ryder Wright Blair and Holmes in Toronto, and has been representing members of RNAO’s legal assistance program (LAP®) for more than 15 years. This article was originally published in the November/December 2017 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO). www.hospitalnews.com
JANUARY 2018 HOSPITAL NEWS 43
FROM THE CEO’S DESK
Remembering our purpose to improve the patient experience By Arden Krystal any years ago, when I was a young nurse in British Columbia working on a cancer ward, I learned my first lessons about commitment and serving with purpose. It wasn’t a fellow nurse or a doctor who I remember most, though I have worked with so many dedicated colleagues over the years who share this trait. No, it was a housekeeper as they were called back then, and she was probably completely unaware of the impact she had on developing and reinforcing the value system of this particular young nurse. This employee, who I saw cleaning every day, was one of the hardest working people on our ward. It wasn’t an easy job – our patients had leukemia and lymphoma and were all in private rooms. Because they were immunosuppressed, our standards were high. We demanded a lot of all our staff. I noticed that this one housekeeper always went above and beyond in everything she did. So I asked her what made her work so much harder than her colleagues did. Her response was simple. She said she cleaned with passion because she knew her patients’ lives depended on the quality of her work. It wasn’t just a “job.” She understood that regardless of the role we play in the health system, we all contribute in some way to our patients’ experiences. She felt important. Fast-forward several years and several role changes later and here I am in Ontario in my new role as president and CEO of Southlake Regional Health Centre. My belief in serving with purpose is as strong as it’s ever been, but I have seen how challenging it can be for our staff to hold true to that value when they feel stressed in our busy and complicated work environments. Catchphrases and initiatives such as “Patients First” and “Patient-Centred Care” are laudable in their intent to create the safest, highest quality ex-
Arden Krystal is president and CEO, Southlake Regional Health Centre. periences and outcomes for patients. In my experience, these taglines can carry with them some unintended consequences – subtle perhaps, but present nonetheless. For when we say someone or something is first, that means someone else is second. It infers
a sense of competition for highest value. The reality is, we provide the best patient experiences, high-quality and great outcomes by employing great people. Everyone needs to know they are critical to this aim. They are not second, in fact they are the lynchpin.
I have been asked by many, much like my former colleagues who have recently relocated, to compare and offer insights about the differences in our provincial healthcare models. While there are pros and cons to each, I can honestly say that committed people can achieve great things in a less than perfect model, but the reverse – a great model without commitment, will never succeed. Managing increasing volumes of patients and keeping patients safe when services are not growing at the same rate is challenging. This issue exists in every province, despite their structures. Although we do need to make strategic investments in capital, technology and research to continue to make improvements, the most important resource we need to keep cultivating is our people. Perhaps it’s my humble roots talking, but I believe that in addition to providing our staff and physicians with the tools they need to do their best work, we need to ensure they have ways to extract the value of the simple things, and conduct themselves in a way like that housekeeper, that brings deep satisfaction to both them and their patients. Serving with purpose never goes unnoticed. It’s not just “nice to do” and it doesn’t go out of style. Each act reminds staff why they chose a career in healthcare and that their key role is to make a difference in the lives of patients and families. At Southlake, my goal is to improve both the staff experience and the patient experience in an integrated way. Patient satisfaction surveys at hospitals across Canada tell us the simplest things matter most to patients and families; and this is where we sometimes fall short. Communicating, listening and treating others with respect consistently ranks the lowest. The irony is that these are the very things staff want from their leaders and organizations. Continued on page 45
Arden Krystal is president and CEO, Southlake Regional Health Centre 44 HOSPITAL NEWS JANUARY 2018
FROM THE CEO’S DESK
Continued from page 44 The solution is simple, but it’s not easy. It will require focus, leadership and behaviour change. Tackling this “soft” stuff is hard for some people, much harder than completing the most intricate technical procedures. But we have to get on it. Emphasis on the patient experience and patient engagement is evident in Accreditation Canada’s most recent standards and reflects a worldwide movement. I, for one, want Southlake to be on the front of that wave. As we build our new five-year strategic plan, we will be getting started by engaging our community for their feedback on what matters most to them. I suspect that in addition to diagnosing their health problems, providing cures, easing their pain and supporting them with end-of-life care, they will tell us to make sure we get the simple things right. Yes, healthcare is complicated. We need to keep racking our brains to solve those complicated problems. We H can’t let the simple things slide. ■
Nursing pulse Continued from page 43 As with any aspect of nursing practice, events occurring in the course of providing supervision at an SIS could give rise to an investigation by the college if there are allegations that a nurse’s practice fell below the standards of the profession.*
PROFESSIONAL LIABILITY CNO requires all RNs and NPs practising in Ontario to have professional liability protection (PLP). It is important to understand the coverage you have, and the scope of coverage, particularly if you are participating in an SIS as a volunteer
or otherwise outside of your regular employment. If you are a member of the Registered Nurses’ Association of Ontario (RNAO), the professional association that has been representing registered nurses, nurse practitioners, and nursing students in Ontario since 1925, PLP is an automatic benefit of membership, and covers you for all services provided within the scope of nursing practice. The coverage applies 24 hours a day, seven days a week, whether or not you are working directly for your employer. For anyone not covered by RNAO’s PLP, particularly those who are
relying on liability coverage from an employer, review your written policy in order to determine if the coverage continues if you are engaged in nursing activities outside of the workplace. *For legal matters related to CNO, it is highly advisable that nurses become members of RNAO and sign up for its Legal Assistance Program (LAP®), which is not included with the cost of membership. For more information on the differences between LAP® and professional liability protection (PLP), which is included in RNAO membership, visit RNAO.ca/ H LAP ■
JANUARY 2018 HOSPITAL NEWS 45
Weeding through the evidence on
medical cannabis By Dr. Janice Mann e call this column Evidence Matters. The reason is pretty simple. Evidence really does matter when making an important health decision. Often, when those in healthcare need to make decisions but have questions about a drug, medical device, test, or procedure, they turn to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs and medical devices. On August 24, 2016, Health Canada announced the Access to Cannabis for Medical Purposes Regulations, which allow Canadians access to a reasonable amount of cannabis prescribed by healthcare practitioners for medical purposes. Conditions treated with
cannabis include nausea and vomiting, loss of appetite, and pain. Patients, clinicians, and others in the Canadian healthcare system have been asking for evidence on the medical use of cannabis to help guide treatment decisions. Below are just a few of the questions that have been posed to CADTH – and the answers we were able to find.
DOES CANNABIS WORK TO TREAT CHRONIC PAIN? For one evidence review on this topic we were asked to look specifically at nabilone – a synthetic version of cannabis – to see if it works to treat chronic pain. There wasn’t a lot of evidence to help answer this question and
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PPC•CPP February 3-7, 2018
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www.cshp.pharmacy 46 HOSPITAL NEWS JANUARY 2018
there were some limitations to it – but the evidence we did find shows some positive benefits and limited harms when nabilone is used to treat chronic pain. As is often the case though, more research is needed to be able to definitively answer this question. For a second review of the evidence on this topic, we were asked to look specifically at a cannabis-based spray to see if it works and if it’s safe to treat neuropathic pain or other types of chronic pain. It’s a combination of two products, delta-9-tetrahydrocannabinol and cannabidiol (THC:CBD) marketed under the name Sativex®, and is taken by spraying it under the tongue or inside the cheek. Five systematic reviews were found, and they show that the spray may lead to favourable outcomes for patients in the short term, including reduced pain, and is well tolerated when compared with a placebo (no active medication). However, whether treatment of pain with the cannabis-based spray is beneficial and safe over the long term is uncertain. And there was no evidence comparing the spray to other pain treatments, so it’s not clear how well it works compared to other medications. One evidence-based guideline does recommend TCH:CBD spray as a third-line option for the treatment of neuropathic pain when other treatments are not adequate.
DOES CANNABIS WORK TO TREAT OTHER CONDITIONS, LIKE POST-TRAUMATIC STRESS DISORDER (PTSD)? CADTH has been asked to look at the evidence to answer this question a number of times since 2009. Our most recent review looked at how well both cannabis and synthetic versions work to treat PTSD and whether there were any clinical practice guidelines to guide their use. One systematic review
was found that included six individual studies. The included studies weren’t considered high-quality but they did find evidence to support the effectiveness of smoked marijuana, oral THC, and nabilone in reducing some symptoms of PTSD. Side effects were covered in only one of the studies on nabilone and were reported to be mild to moderate. No guidelines offering recommendations on the use of cannabis to treat PTSD were found.
IS CANNABIS SAFE TO USE WITH OTHER MEDICATIONS? DOES CANNABIS INTERACT WITH OTHER MEDICATIONS, DRUGS, OR ALCOHOL? This is an important question but unfortunately there isn’t a lot of evidence to help with an answer. In our review of the evidence, one systematic review shows that nabilone may decrease the need for other medications such as opioids, NSAIDs, tricyclic antidepressants, dexamethasone, and ondansetron when used together, but it may make the effect of diazepam (a drug that depresses the central nervous system) stronger when taken together with codeine and alcohol. This isn’t much evidence and whether it’s high quality evidence isn’t clear, so it isn’t a lot to go on to guide decisions. But this is an area we’re likely to see more evidence on in the near future as medical use of cannabis increases. www.hospitalnews.com
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Q January 17, 2018 Community-Acquired Pneumonia: A Webinar on the Economic Impact and Post-Discharge Pathway Live Webinar by Alexandru Dobrescu Website: www.conferenceboard.ca Q February 19-23, 2018 Complia Health 2018 CARE Conference Marriott Orlando World Center, Orlando Florida Website: www.compliahealth.com
CAN CANNABIS HELP IN THE TREATMENT OF ADDICTIONS?
Although cannabis may itself be addictive, it may also have anti-addictive properties that could help to treat addiction. In one CADTH review of the evidence, we looked to see if cannabis works to help treat addiction in residential transition or addiction programs. And despite our search efforts, we did not find any evidence to help answer this question. The role of cannabis in treating addiction remains uncertain. These are just a few of the evidence reviews that CADTH has been asked to do on topics related to medical cannabis. You can find all of our related evidence at www. cadth.ca/cannabis. But CADTH is
just one organization of many working to answer your questions about the medical use of cannabis. The Canadian Centre on Substance Use and Addiction (CCSA) has a focus on marijuana research including the Clearing the Smoke on Cannabis series. Health Canada also has many resources on the medical use of cannabis, and these and other resources can be accessed directly or through the additional resources section of our cannabis evidence bundle. If you’d like to learn more about CADTH and our evidence reviews on this and other topics, please visit: www.cadth.ca, follow us on Twitter at @CADTH_ACMTS, or speak to the CADTH Liaison Officer in your H region. ■
Dr. Janice Mann is a knowledge mobilization officer at CADTH.
CAMP MANITOU Nurses
children’s summer camp near Parry Sound Room and Board, great salary June 23 – August 16 (4 month contract available) If you love the outdoors and love children contact this will be the summer of a lifetime! contact Dave at 416-322-5888 or Mark at email@example.com firstname.lastname@example.org www.manitoucamp.com www.hospitalnews.com
Q March 18-23, 2018 Wound Care Institute Clinical Stream Hilton Niagara Falls/Fallsview Hotel & Suites, Niagara Falls Website: www.rnao.ca Q March 21-23, 2018 Wound Care Institute Program Planning Stream Hilton Hotel, Niagara Falls Website: www.rnao.ca Q March 27-28, 2018 Healthy Canada Conference 2018: Personalized Health and Wellness Sheraton Centre, Toronto Website: www.conferenceboard.ca Q April 11-12, 2018 Canada’s MedTech Conference presented by MEDEC The International Centre, Toronto, ON Website: www.medec.org Q April 17-18, 2018 3rd Annual Workplace Mental Health Accommodation Toronto, Ontario Website: www.canadianinstitute.com Q April 22-24, 2018 HPCO Hospice Palliative Care Ontario Sheraton Parkway Toronto North Hotel & Suites, Richmond Hill Website: www.conference.hpco.ca Q April 24-25, 2018 2nd Canadian Healthcare Infastructure West Vancouver, BC Website: www.canadianinstitute.com Q May 25-27, 2018 LABCON 2018 (hosted by CSMLS) Windsor, Ontario (Caesars Windsor) Website: labcon.csmls.org Q May 27-30, 2018 eHealth Conference & Tradeshow Vancouver, British Columbia Website: www.e-healthconference.com To see even more healthcare industry events, please visit our website www.hospitalnews.com/events
JANUARY 2018 HOSPITAL NEWS 47
DID YOU KNOW? 34%
of NURSES reported physical assault from a patient over the past year in their workplace. (Statistics Canada Health Reports Volume 20)
Violence in the workplace cannot be tolerated Safe workers mean better care. Letâ€™s work together to reduce violence in healthcare.
workplace-violence.ca 48 HOSPITAL NEWS JANUARY 2018
Published on Dec 20, 2017