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Inside: From the CEO’s Desk / Evidence Matters / Trends in Transformation / Nursing Pulse / Careers

May 2017 Edition


2017 Nursing Heroes A salute to nurses Page 13 BENEFITS THAT WORK FULL-TIME FOR THOSE WHO DON’T



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Nine years in the making:

McMaster Children’s celebrates new OR By Calyn Pettit


ust five days after a surgery to remove a cancerous tumour in her chest, fouryear-old Maliya Lafayette was on her feet, dressed in a pretty spring outfit and anxious to head home to her three siblings and, of course, her Barbies. But before her departure from McMaster Children’s Hospital (MCH), she had one request: to revisit the operating room (OR).

“For some patients, it means less pain, a, faster recovery, and the ability to go home sooner,” says Dr. Helene Flageole, chief of pediatric surgery at MCH. Features of the new spaces include: • Special green lighting in the ORs that allows surgeons to view screens without glare, while maintaining enough light for other team members to work in the room.

IT’S THE FIRST TIME THE SURGICAL DEPARTMENT HAS SEEN A MAJOR RENOVATION SINCE THE 1970’S, BEFORE THE SITE WAS A DESIGNATED CHILDREN’S HOSPITAL Her words were music to the ears of her surgical team who, on the same day, were celebrating the grand opening of a brand new OR, same day surgery (SDS) and post anesthesia care unit (PACU). It’s the first time the surgical department has seen a major renovation since the 1970’s, before the site was a designated children’s hospital. The new spaces – while still providing some surgical care for adult patients – were specifically designed with kids in mind. Maliya was one of the first patients to benefit from the new, state-of-the-art technology and kidfriendly environment. In fact, the success of her procedure was made possible in part by technological enhancements that allowed her surgical team to remove a greater proportion of her tumour using a less invasive technique.

• An OR dedicated to C-sections, with a built-in neonatal resuscitation area. • Television screens in the OR, SDS and PACU areas that provide positive distraction for kids before and after their procedure. • Two new procedure rooms that can be converted in to operating rooms. • Brighter, more open spaces with kid-friendly designs. • Enhanced privacy between adult and pediatric areas. The redevelopment project was nine years in the making and required a multi-phased approach to ensure that the team could maintain “status quo” with minimal impact to patients. A major redevelopment like this is a time intensive, all-hands-on-deck process. But Maliya is a testament to what makes it all worthwhile: a happier, less stressful visit to the operating room and a faster H recovery. ■

Calyn Pettit works in public relations & communications at Hamilton Health Sciences. (Top) Just five days after a surgery to remove a cancerous tumour in her chest, four-year-old Maliya was ready to head home from McMaster Children’s Hospital, thanks to state-of-the-art new surgical technology that made for a less invasive procedure and a quicker recovery. (Bottom) The new surgical department at McMaster Children’s Hospital features state-of-the-art technology in a kid-friendly environment designed to make the operating room experience less stressful for young patients and their families. 2 HOSPITAL NEWS MAY 2017

Contents May 2017 Edition


Nine years in the making McMaster Children’s new operating room


▲ Cover story: 2017 Nursing Heroes


▲ Surgical safety a shared responsibility


▲ New technology manages deadly heart condition

Columns Guest editorial ................. 4


In brief ............................. 6 Nursing pulse ................ 37 Evidence matters ...........38 From the CEO’s desk .....40 Trends in transformation .............. 41

▲ Personalized bereavement care


Pain relief for spinal tumours


▲ GPS for early lung cancer detection


Waiting for emergency care –

how long is too long?

New study sheds light on an old problem By Alan Katz and Jennifer Enns


mergency departments in Canada are very busy places. Every year, Canadians make about 16 million visits to emergency rooms and more than one million Canadians are admitted to hospital through emergency departments. Given how complex it is to assess, treat and admit this large and variable population to hospital, it likely comes as no surprise that nearly all emergency department patients spend some of their time in hospital, waiting. Emergency department wait times are a matter of concern for many Canadians. We wonder if we, or our loved ones, will have to wait in pain or discomfort for hours before being seen. Or if a life-threatening condition could get worse while we wait. Several research studies have explored the factors that contribute to wait times. A few studies have shown that emergency departments can become overwhelmed by the sheer number of patients arriving for care. Emergency medicine clinicians and leaders often point to hospital overcrowding as the main culprit for longer waits because patients who are waiting to be admitted to hospital occupy stretchers that would otherwise be available to new patients. These observations highlight important opportunities for improving wait times. But one aspect of emergency care that has not been well studied is the time it takes to assess patients’ conditions once they


have been seen by a practitioner in the emergency department. How long patient assessment takes depends partly on how sick the patient is, but can also be influenced by other factors, such as the need for blood tests, x-rays or consultation with other healthcare specialists. So how long do we wait for care? A recent study led by Dr. Malcolm Doupe at the Manitoba Centre for Health Policy provides a detailed picture of the many factors affecting Winnipeg’s emergency department wait times – and also studies the patient assessment period for the first time. The study team used the relatively new Emergency Department Information System (EDIS) to track patients as they move through emergency from their initial assessment (triage) to treatment, and then to hospital admission or discharge back to the community. They found that Winnipeg emergency departments are functioning moderately well in most instances, even though they are often at more than 100 per cent capacity during daytime hours. Across all types of emergency department, half of the patients had a visit time of 5.1 hours or less, and half stayed longer than 5.1 hours. With a national wait time average of 4.4 hours for emergency departments, there’s clearly plenty of room for improvement. Continued on page 7



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Monthly Focus: Health Care Transformation/eHealth/Mobile Health/Medical Imaging: Programs and initiatives that are transforming care and contributing to an effective, accountable and sustainable system. Innovations in electronic/digital process in healthcare, including mHealth (health applications on mobile devices). A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.

Monthly Focus: Cardiovascular Care/Respirology/Diabetes/ Complementary Health: Developments in the prevention and treatment of vascular disease, including cardiac surgery. Advances in treatment for various respiratory disorders, including asthma and allergies. Prevention, treatment and longterm management of diabetes Examination of complementary treatment approaches to various illnesses.

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New palliative program expands care options for

vulnerable patients

By Alica Hall


he true test of a health system is how well it supports people when they are most vulnerable. More than half of patients in Ontario facing a life-threatening illness will spend five days or longer in a hospital during their last month of life. While some people prefer to stay at home, others feel safer in the hospital environment and these preferences can change over time. Whatever their choice, every patient should have access to the care they need in their local community. “People mistakenly believe that palliative care is just about death, but it’s actually focused on helping people live comfortably and enhancing their quality of life,” says Maria Rugg, a Clinical Nurse Specialist at St. Joseph’s Health Centre. “Ensuring people remain connected to their social network is an important part of that.” Patients with life-threatening illnesses have unique needs and palliative care addresses the physical, psychological, spiritual and emotional changes that affect people at this stage of life. Research shows that early access to palliative care offers important benefits for patients; it can be started as soon as someone is diagnosed with a life-threatening illness. “There have been 12 deaths in my life over the past five years and I was present for five of those deaths which took place in family homes, hospitals and in-hospice,” says Eileen Laffey, a Patient-Family Advisor at St. Joseph’s Health Centre in Toronto. “The best situations were ones where people were empowered and had a say in their endof-life planning.” St. Joe’s has offered palliative services for many years and last month we expanded our services to better serve patients and families. Eileen joined our team as a Patient Family Advisor in 2014, bringing her personal experiences as a caregiver, social worker and background in bereavement counselling, to support the development of a new care model. The collaboration between our team of interprofessional clinical experts and patient family

advisors ensures the specific needs of this vulnerable patient population were integrated into every element of care delivery. As part of this service expansion, palliative patients from across the Health Centre are being brought together into a single area so our specialized care teams can support them. “Bringing people together in one area gives us the ability to better coordinate care,” says Melissa Morey-Hollis, Clinical Director, Medicine and Senior’s Care Program. “We know that it can be challenging for families to navigate the health system and understand their choices – our teams are trained to help.” A recent report from Health Quality Ontario highlights that nearly twothirds of older adults in Ontario say they have had discussions with family, friends or healthcare professionals about healthcare plans in the event they become ill and cannot make decisions for themselves. Planning at this stage of life is critical; patients and families often have questions about how to get the most out of life, how to make healthcare decisions and how to manage symptoms and plan for what lies

ahead. These can be challenging conversations, but our interprofessional team works closely with caregivers at every stage of the process. “Supporting someone who is terminally-ill is an emotionally exhausting

roller-coaster ride,” says Eileen. “Staff need to have time to spend with patients and families, it’s not the type of thing you can rush; compassionate care is key and that looks different for every H person.” ■

Alica Hall is a Communications Specialist at St. Joseph’s Health Centre.



Inflammatory bowel diseases on the rise in very young Canadian children


anada has amongst the highest rates of paediatric inflammatory bowel disease (IBD) in the world, and the number of children under five years old being diagnosed increased by 7.2 per cent every year between 1999 to 2010, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES), Children’s Hospital of Eastern Ontario (CHEO) Research Institute and the Canadian Gastro-Intestinal Epidemiology Consortium. “The number of children under five being diagnosed with IBD is alarming because it was almost unheard of 20 years ago, and it is now much more common,” says Dr. Eric Benchimol, lead author of the study, scientist at ICES and a pediatric gastroenterologist at the Children’s Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, in Ottawa.

IBD primarily includes Crohn’s disease and ulcerative colitis, which are lifelong conditions that cause inflammation in the digestive tract, leading to chronic diarrhea, blood in the

stool, abdominal pains and weight loss. The study published in the American Journal of Gastroenterology, identified children under 16 years of age diagnosed with IBD from 1999 to

2010 from five Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) , and found that cases among children five and younger have increased 7.2 per cent per year from 1999 and 2010. Researchers say a change in the bacterial composition of the gut may be to blame for the increase in IBD cases but they don’t know what is causing the change. They suspect a combination of environmental risk factors could be to blame, such as early life exposure to antibiotics, diet, or lower levels of Vitamin D in Canadians. “What our research tells us is that we need to focus future research on identification of triggers in young children with IBD, understand the biology behind changes resulting in the disease, and intervene to prevent the occurrence of IBD in this vulnerable age group,” adds Benchimol. Continued on page 7

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Expanding pharmacy services Cost of could save healthcare system billions


hanges to pharmacy legislation and standards have occurred in the provinces and territories over recent years, creating the opportunity for community pharmacists to take on an expanded role in service delivery. A new report by The Conference Board of Canada estimates that Canada-wide implementation of just three pharmacy services could yield cumulative cost savings between $2.5 billion and $25.7 billion over the next 20 years, depending on the level of uptake of these services in the population. “Pharmacists are an integral part of the healthcare delivered to many Canadians,” says Louis Thériault, Vice-Presi-

dent, Industry Strategy and Public Policy, The Conference Board of Canada. “They could play an even greater role in ensuring the sustainability of the health care system, if we can further capitalize on their expertise as medication experts and expand the services they provide.” The report, The Value of Expanded Pharmacy Services in Canada, assesses the health and economic impact of three services that are currently delivered within a community pharmacy setting in some provinces, and which have the potential to be implemented across Canada: smoking cessation, advanced medication review and management for cardiovascular disease, and pneumococcal vaccination.

Inflammatory bowel diseases Continued from page 6 The researchers found that the incidence of IBD has stabilized in children over the age of five, but in children under five it continues to rise rapidly. The researchers estimate that approximately 600 to 650 children are diagnosed with IBD every year in Canada. The study findings indicate that

the number of children under 16 years old living with IBD in Canada rose from 29 per 100,000 in 1999 to 46 per 100,000 in 2008, an increase of almost 60 per cent. å Almost 3,000 children under the age of 16 years old are currently living H with IBD in Canada. ■

The largest economic benefits of expanding the selected community pharmacy services would result from scaling-up advanced medication review and management for cardiovascular disease (CVD), with cumulative savings valued between $1.9 billion to $19.3 billion in healthcare system efficiencies and increased labour productivity by 2035. Providing smoking cessation services could result in savings of $563 million to $5.6 billion and administering pneumococcal vaccination for individuals aged 65 and up could generate savings between $206 million and $761 million. In addition to measuring the health and economic gains that could result from expanding these services, an important issue of concern for governments is whether there would be a return on investment with the wide-scale implementation of any one or more community pharmacy practice models. A large return on investment is also expected for all three community pharmacy services. The analysis shows that by 2035, for every dollar spent, the direct return could reach up to $2.30 for advanced medication review and management for CVD intervention, $9.10 for smoking cessation, and $72.00 for pneumococH cal vaccination. ■

Waiting for emergency care

Continued from page 4 It was a better news story for urgent care. The study corroborated many findings from previous studies and found that wait times were very short (median wait time of six minutes) for those who needed care immediately. For less urgent conditions, wait times varied and depended on how many higher urgency patients were receiving care, and how many other lower urgency patients were waiting. But the study’s striking finding was the importance of the diagnostic testing process in determining wait times – a new piece of evidence that will help us find solutions.

Diagnostic tests are an essential part of an emergency doctor’s work, but when tests and scans were ordered, wait times for other patients began to climb significantly. For example, Winnipeg’s emergency departments had periods of time where up to 45 per cent of treatment areas were occupied by patients waiting for x-rays or other tests. During these peak periods, wait times for patients with moderate to less urgent conditions could increase from 15 minutes to as much as five hours. These findings indicate that new strategies to shorten wait times should be considered. Could processes within

the emergency department be streamlined to reduce the time it takes to get tests done? Are diagnostic tests quickly available at all hours and at all emergency departments? Are community-based providers sending patients to emergency departments to access diagnostic tests that would best be done in doctors’ offices? Bringing about improvements to wait times in emergency departments will require collaboration and new approaches between leaders and experts in emergency medicine. But there’s no reason we can’t get there. Patients deH serve no less. ■

Alan Katz is an expert advisor with and Director of the Manitoba Centre for Health Policy. He is a practicing Family Physician and the Research Manitoba/Heart and Stroke Chair in Primary Prevention Research. Jennifer Enns is a postdoctoral research fellow at the Manitoba Centre for Health Policy. She has expertise in population health, health equity, and knowledge translation.



ue to rising healthcare costs and an aging population, the number of hospitalized cases and the total cost of treating pneumonia is expected to rise dramatically by 2025, according to a new Conference Board of Canada report. The Economic Burden of Pneumonia in Canada: A Status Quo Forecast estimates the total number of pneumonia cases requiring hospitalization will nearly double to 49,424 in 2025, up from 24,761 in 2010. Meanwhile, the annual total direct healthcare cost of treating the disease will reach over $530 million by 2025. “As the Canadian population continues to grow and age, additional preventative measures, such as vaccines, would provide value by reducing the number of cases over time and improve how disease is managed in hospitals as well as in the community,” says Louis Thériault, Vice-President, Industry Strategy and Public Policy, The Conference Board of Canada. The largest cost driver for treating pneumonia is the need for hospitalization and the potential complications or illness following hospital discharge. While the average cost per case of pneumonia is forecast to increase for all age groups examined, the highest cost is found among those aged 65 to 69 and is expected to reach $12,619 by 2025. Overall, the total direct health care cost of pneumonia will increase from $216.2 million in 2010 to $532.2 million in 2025. Age heightens an individual’s risk of contracting pneumonia. With the number of Canadians over age 65 set to sharply increase, population growth and demographics alone will be responsible for 58 per cent of the overall cost increase by 2025. The incidence rates of the disease are expected to rise most significantly among those aged 75 and older—at nearly 20 per cent over the forecast period. To ease the inevitable economic burden the increasing number of cases will create, public health policies have included recommendations to vaccinate children, seniors, and other vulnerable and high-risk populations against common H causes of pneumonia. ■ MAY 2017 HOSPITAL NEWS 7


Innovative new device manages deadly heart condition By Jane Kitchen ardiac patient Jamie Dornan has survived sudden cardiac arrest. Twice. The first time, she collapsed unexpectedly at her college, and was revived by a defibrillator wielded by a paramedic. The second time, thanks to the Central East Regional Cardiac Care Centre, a defibrillator implanted near her rib cage saved her life. Dornan, 18, is susceptible to an irregular heartbeat, or arrhythmia. Specifically, she experiences episodes of ventricular fibrillation (VFib), where her heart beats so quickly it quivers and doesn’t pump. There is then no blood moving from the ventricle and the heart stops functioning. This leads to sudden cardiac arrest (SCA), and an individual at this stage only has


minutes until death. Also known as the “silent killer,” as there are few to no warning signs, 85 to 95 per cent of those who have an SCA die before they get to hospital. After Dornan’s first episode of SCA, she was referred to the Central East Regional Cardiac Care Centre, located at the Centenary site of Scarborough and Rouge Hospital (SRH). The Centre offers the only comprehensive cardiac arrhythmia program in the Central East Local Health Integration Network (Central East LHIN). After an initial assessment, she was referred to cardiologist Dr. Amir Janmohamed as a potential candidate for an implantable cardioverter-defibrillator (ICD), designed to shock an irregular heartbeat back into a normal rhythm.

Dornan was familiar with ICDs as a member of her family has the traditional transvenous ICD, implanted in the upper left chest wall under the collarbone, with electrical leads that are imbedded in the heart muscle. As she is just starting out as a model, Dornan was afraid that this type of ICD would spell the end of her career before it had even really begun. But Dr. Janmohamed suggested a solution that would save her life as well as her potential livelihood: a subcutaneous ICD (S-ICD™) system. “Jamie was a model candidate for an S-ICD™, excuse the pun,” says Dr. Janmohamed. “First of all, it is less visible, which is ideal for her career choice. Second, as she is very young, she needs a device with a long livelihood. Most importantly, she didn’t need the pace-

maker function of a transvenous ICD, but a defibrillator that will deliver a shock only in the case of SCA. This device fit all those criteria and was the best choice.” The S-ICD™ has only been approved for use in Canada in the last two years, and is not yet widely in use across Ontario or even Canada. As a cardiac electrophysiologist specializing in electrical issues in the heart, Dr. Janmohamed is the only cardiologist in the Central East LHIN who does these implants and has completed several. But in Dornan’s case, his team met Dornan’s specific concerns and minimized her scarring: Dr. Janmohamed inserted the device using only two incisions rather than three, and he called upon Dr. Mansour Bendago,

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FOCUS Cardiac patient Jamie Dornan with her cardiologist Dr. Amir Janmohamed.

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he told her that the device shocked her heart back into a functioning rhythm within 16 seconds of entering VFib. “Jamie would have died without the S-ICD™,” says Dr. Janmohamed. “In the big arena that she was in, it would have been highly unlikely that an external defibrillator, like the kind you see in public arenas and community centres, would have reached her in time. People with cardiac conditions can develop severe social anxiety, as they can be afraid to go anywhere or do anything in case something like this happens. This device takes away that worry.” Dornan has been through a lot since that day last October when she first collapsed. While she was depressed when she first got out of the hospital with the realization of how completely her life had changed, she is now adjusting to her new reality: she has a cardiac condition that requires constant monitoring. But, her device has already proven that it can and will save her life. “I couldn’t ask for a better outcome,” H she says. ■

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a plastic surgeon with SRH, to suture her implant incision. “I’m so glad I went through with getting the defibrillator implanted,” says Dornan. “It is barely visible; you can’t tell it’s there even when I’m wearing a tank top. I’m grateful to Dr. Janmohamed for suggesting this and for Dr. Bendago for rearranging his whole schedule to close me after the device was inserted. I am healing very well and the scar is already fading. If I had to say one thing to anyone, whether you’re my age or older, go through with it. It’s worth it.” Dornan knows exactly how much it’s worth – her life. Six weeks after the implantation, the device did its job, as it delivered “therapy,” or a shock, to her. “I was at a concert and started seeing black, so I got down on my hands and knees,” says Dornan. ”I woke up, laying on the floor, with a crowd staring at me. My friend said I was down for a minute and that my chest was trembling. The device saved my life.” When Dornan checked in with Dr. Janmohamed after the cardiac event,

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GPS for early lung cancer detection could increase

five-year survival rate By Melicent Lavers-Sailly


arly detection for lung cancer is an ongoing challenge. Like most cancers, lung cancer survival rates are directly tied to the stage at which it is found. According to the Canadian Cancer Society, early-stage lung cancer patients have a 50 per cent five-year survival rate. However, as stages advance, that may drop to single digits. Unfortunately, nearly half of lung cancer cases are diagnosed at an advanced stage. Based on 2016 data, the lung cancer five-year net survival is approximately 14 per cent for males and 20 per cent for females.

Lung cancer is a serious health concern that affects millions of Canadians, and continues to be the leading cause of death in Canada. Each day, 78 Canadians are diagnosed with lung cancer; 57 of those will die from it. In addition, lung cancer represents 14 per cent of all new cancer cases and 26 per cent of all cancer deaths in 2016. Overall, lung cancer kills more than colorectal, pancreas and prostate cancer combined.

There are a number of reasons why early stage detection is such a challenge; the first being that patients often mistake symptoms such as coughing, shortness of breath, fatigue and hoarseness with other conditions. As such, they don’t seek medical attention until they have worsened, at which point the cancer may already be at Stage 3 or 4. In other cases, lung cancer is found by accident when the patient is being investigated for something else. The nature of the disease itself is another factor. Lung cancer tends to begin in the periphery of the lungs, an extremely difficult area to reach in order to conduct an accurate biopsy. Another challenge is the screening procedures. There has been no definitive screening test that is generally available to all patients; and the conventional test procedures used can be invasive, inaccurate, and present higher risks to patients. However, there is now GPS-based technology that is resolving many of those challenges and bringing new hope to lung cancer patients. Let us first consider the conventional options. Procedures such as TTNA (transthoracic needle aspiration), a needle biopsy conducted through the thorax, carries a 42 per cent risk of pneumothorax (lung collapse); a 17 per cent risk of requiring a chest tube insertion; and a 10 per cent risk of hemoptysis (spitting up of blood) and hemorrhaging. A thoracotomy (surgical removal of lung tissue) brings with it a higher risk of morbidity and mortality and cannot be used on compromised patients. In addition, many of these surgeries prove to be unnecessary as many lesions are benign (20 to 45 per cent). Periodic CT scanning, while not as invasive, is often used in cases where a highly compromised patient may not be

Known as ENB (electromagnetic navigation bronchoscopy), the technology uses GPS-based technology to accurately and safely navigate a bronchoscope into difficult to reach areas of the lung. able to tolerate TTNA or surgery. Understandably, there is a higher degree of probability that the cancer will grow. With traditional bronchoscopy – the process of inserting a lighted tube through the nose or mouth to evaluate lungs and collect tissue samples – it is especially challenging to reach deep into the lungs where most lesions are found. The failure rate stands at 65 per cent, which often means additional invasive procedures are needed. Yet there is another option for early detection of peripheral lung cancer that reduces the need to conduct more invasive procedures, while resolving the accuracy challenges in bronchoscopy. Known as ENB (electromagnetic navigation bronchoscopy), the technology uses GPS-based technology to accurately and safely navigate a bronchoscope into difficult to reach areas of the lung. ENB technologies, such as Medtronic superDimension™ Navigation System,

offer an opportunity to aid in earlier diagnosis, with low complication rates, and high diagnostic yield. In simple terms, a CT scan image is imported into the LungGPS™ Technology to create a 3D bronchial map that connects the trachea to the intended targets in the safest and most efficient way possible. During navigation, the map is matched to the patient’s anatomy to provide interactive pathway guidance to the target. ENB can play a key role in helping physicians diagnosing earlier, with far less complexity and risk. Lung tissue collection is also optimized to deliver more accurate results, which translates into faster, more effective treatment. The technology also helps doctors from having to engage in multiple procedures to gain the same outcomes. Considering these advantages, the benefits for the patient and the H healthcare system are clear. ■

Melicent Lavers-Sailly is the PR & Corporate Communications Manager, Medtronic Canada. 10 HOSPITAL NEWS MAY 2017

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Enhanced recovery after lung cancer surgery By Anne Kelly


ithin an hour after having a cancerous lobe of her lung removed, Michele Way was walking around the recovery room at St. Mary’s General Hospital in Kitchener. She went home the next day and within a couple of weeks was walking 70 minutes a day. The 56-year-old Waterloo woman credits her quick recovery with an innovative model being used for minimally invasive lung cancer surgery at St. Mary’s. Called Enhanced Recovery

Dr. Paul Chiasson, a thoracic surgeon at St. Mary’s says the ERAS approach for lung cancer surgery “requires a paradigm shift in attitude for patients and staff. Patients feel empowered to help themselves get better. There is a marked reduction in post-operative complications and hospital stays are shorter, saving healthcare dollars. Patient satisfaction is greatly improved with a quicker return to home and work,” he says.

ENHANCED RECOVERY AFTER SURGERY CHANGES HOW PATIENTS PREPARE FOR SURGERY, HOW THEY ARE SUPPORTED IN HOSPITAL AND AT HOME, AND HOW PAIN AND FLUIDS ARE MANAGED DURING SURGERY. After Surgery (ERAS), it changes how patients prepare for surgery, how they are supported in hospital and at home, and how pain and fluids are managed during surgery. “I have no doubt I was 100 per cent better recovering at home,” says Michele, a non-smoker. “St. Mary’s provided the tools and resources I needed to work for my own wellness.”

Some centres in Canada are using components of ERAS with lung cancer patients, adds Matthew Dubuc, a Nurse Practitioner and Registered Nurse First Assistant at St. Mary’s. “To our knowledge we are the only centre in Canada to fully implement ERAS for video assisted lung cancer surgery,” he says, ERAS patients must comply with a pre-surgery regimen of

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Dr. Paul Chiasson, thoracic surgeon, with patient Michele Way. exercise, healthy eating, pain medication and smoking cessation. During surgery, local anesthetic nerve blocks are used rather than an epidural, allowing patients to be mobile and comfortable soon after surgery. They are given fewer narcotics, resulting in less post-operative drowsiness, nausea and dizziness. Fewer intravenous fluids reduce the chance of post-surgery injury to the lungs. Within an hour after surgery, patients are fed and walking with a family member who continues to walk with them every hour until bedtime. Those who have a small wedge of their lung removed are discharged the same day, versus two-to-three days. Patients having a lobe of lung removed go home the next day, versus four-to-five days. St. Mary’s is a Level One Centre for Thoracic Surgery, completing a minimum of 120 lung cancer surgeries per year. It implemented the ERAS model in August of 2016 after visiting a Virginia hospital which was using it for lung cancer patients. The model relies on another St. Mary’s innovation, the Integrated

Comprehensive Care Program (ICC), to provide a home visit from a nurse prior to surgery who ensures patients have done the required preparations. ICC arranges an in-home nursing visit a day after discharge (and again if necessary). ICC care coordinators are available by phone 24/7 to answer questions for up to 60 days after surgery. Clinical Nurse Educator Christa Saunders says the support and encouragement patients receive prior to their surgery helps motivate them. “These patients are determined by the time they arrive for surgery that they are not going to spend several days in hospital,” she says. Patients visit their surgeons for follow-up one month later. “Their recovery is accelerated remarkably,” says Dr. Chiasson. “After two weeks, they are generally at a level we would have previously seen at four or five weeks post-operatively.” He says St. Mary’s is now considering how the ERAS model could be used with other types of surgery. “I think it H is the way of the future.” ■

Anne Kelly is Manager of Communications at St. Mary’s General Hospital in Kitchener.


A Salute to

Nursing Heroes commitment | dedication | excellence | compassion


MAKING A WORLD OF DIFFERENCE Thank you to our nurses! At North York General Hospital, our teams are making a world of difference. Caring, skilled and dedicated, our nurses play an outstanding role in achieving a new standard of excellence in integrated patient- and family- centred care. On behalf of the people we serve across our diverse communities, we appreciate and recognize everything you do each day to provide the best and safest patient care.

You are truly making a world of difference! Find out more about our amazing nursing team by visiting our website.






we salute you W

ithout a doubt our May Nursing Hero issue is our favourite. In the months leading up to the Nursing Hero deadline I receive emails highlighting stories of heroism in nursing. From a gesture as small as holding a patient’s hand to saving a patient’s life – they are all heroic.


It is a challenging time for our healthcare system as demographic changes are increasing the demands on hospitals and staff. Many stories about healthcare in the media are negative – it’s not often a patient who receives exemplary care is deemed newsworthy, so we don’t often hear about the heroic feats our healthcare professionals perform every day.

IF YOUR NAME IS ON THE LIST AND YOU WANT TO READ YOUR NOMINATION PLEASE EMAIL ME AT EDITOR@HOSPITALNEWS.COM Over the past 12 years our annual Nursing Hero Contest has seen its fair share of heroes. These pages share their stories, their acts of heroism. From patients who say this nurse changed their life to colleagues who live in awe of their hero. There is no shortage of inspiration in the pages that follow. This year we received 115 nominations for 113 nursing heroes – every single one of them appears on our nominee list because we want them to be recognized (pg.24). We want every one of our nominees to know they are a hero. If your name is on the list and you want to read your nomination please email me at and I will gladly forward it to you.


It’s important that we share the positive stories too, not only as a way to thank you but to acknowledge the integral role that nurses play not only in patient care but in improving the system as a whole. This year’s winners have not only had a tremendous impact on patients – they have had a tremendous impact on the way other nurses (and often the system) provides care to patients. They have given a voice to some of the most vulnerable patient populations, and in our eyes, that makes them a hero. To our 2017 winners, finalists, honourable mentions and every single nominee – we say congratulations and H thank you. ■


Neil McBride

Staff Nurse, Paediatric Critical Care Unit (PCCU) London Health Sciences Centre (LHSC)


Cash Prize

nd prize

Patricia Woods

Trauma Therapy Program, Women’s College Hospital


Cash Prize

rd prize

Jessica Bridgeman Kristie Jones Editor, Hospital News

Harm Reduction Coordinator Interior Health, B.C.


Cash Prize



Neil McBride

Staff Nurse, Paediatric Critical Care Unit (PCCU) London Health Sciences Centre (LHSC)


eil McBride has worked in the PCCU for more than 20 years as a staff nurse, a Paediatric and Neonatal Transport Team member, a dedicated member of several committees, and the innovator and champion of many creative and visionary initiatives within LHSC. He has been a passionate advocate for children, families, and staff since before his LHSC journey. He is a conscientious activist, an enthusiastic preceptor of staff and students, a creative and trusted colleague, and an outstanding nursing leader. We would like to introduce you to Neil McBride, whose legacy can be summed up in 16 HOSPITAL NEWS MAY 2017

NEIL ALWAYS PROMOTES A MESSAGE OF HOPE AND MEANING IN THE FACE OF LOSS AND HEARTACHE. three simple but meaningful words; hope, believe, inspire.

Hope At the bedside of children who are suffering from life threatening illnesses, Neil provides exceptional care to his patients and their families. He is a dedicated and passionate advocate for them at their most vulnerable moments. Neil is the nurse that families

request to be with them for their final precious hours with their children. He has the ability to build strong and trusting relationships very quickly through his authentic, calm, gentle, and caring presence. The number of letters and cards from families that include special appreciation for Neil is unprecedented. He has been asked to provide eulogies for children, to serve as a pall bearer, to serve as Co-MC with a former patient

at a Family Centered Care Conference and the list goes on. Even amidst heartache and adversity, Neil is a leader that instills hope for others. Following the death of his infant grandson, Owen, in the PCCU, Neil and his family supported the PCCU Memory Box Program initiative: a program that provides a hand-made memory box and end of life memories for families. A cart, donated to the unit by the family in memory of Owen, holds supplies for creating lasting end-oflife memories for other bereaved families. He has presented at conferences on creating memories at end-of-life, and shared his story as a grand-parent


speaker at the Children’s Hospital Memorial. He always promotes a message of hope and meaning in the face of loss and heartache. His wisdom borne from the pain of lived experience extends to the bedsides of the patients and families that he cares for as well and they treasure it. Neil is respected by his peers for leading or growing change initiatives. During the ‘90s, Neil and two colleagues started the Humour Team, with a goal of bringing laughter, cheer, and hope to patients, families and staff. A humour cart was designed to bring entertaining experiences to patients and families at the bedside. An entire day was dedicated to humour initiatives at the hospital in the late ‘90s; a novel idea at the time that was covered by all local media. A Humour Night, an annual comedy show, was held for many years. Staff were invited to share creative and entertaining acts, created by staff for staff. This unique experience was a much welcomed opportunity for fellowship, stress relief, and fun! Neil even managed to share these initiatives with other community organizations through outreach education about humour. Neil is always the mastermind behind creative cards or jokes in the unit, when appropriate, bringing much needed levity to a very stressful environment. He was an instrumental part of the PCCU Earth Angel program and his ingenious ideas made him the most popular angel of all! Over the years, he created props for conferences that brought meaning and energy to each unique event. Whether a spectacular train that reached six feet tall and stretching the entire width of an amphitheater to bring The Polar

NEIL NEVER FAILS TO BRING MAGIC AND MYSTERY TO LEARNING. DRESSED AS A TRAIN CONDUCTOR, CAPTAIN HOOK, OR A CHAUFFEUR, HE IS A CONFERENCE MASTER OF CEREMONIES THAT IS FOREVER REMEMBERED BY THOSE WHO ATTEND! Express theme alive at a Palliative Care Conference, or a pirate ship built to share the story of Peter Pan for a Family Centered Care Conference, he never fails to bring magic and mystery to learning. Dressed as a train conductor, Captain Hook, or a chauffeur, he is a conference Master of Ceremonies that is forever remembered by those who attend!

Believe Neil achieves results that improve the organization in a way that benefits everyone. He is a passionate advocate for workplace safety. He was a leader in the transition of the transport team to a dedicated RN/RRT model. He along with a colleague thoroughly researched all aspects of occupational health and safety and advocated for appropriate training and attire for the team members. These initiatives created the foundational safety concepts for the team that still exist today. For this work, Neil and his colleague were awarded the Scott Dumaresq Memorial LHSC Award for Safety in 2005. Recently, Neil initiated a PCCU Safety Checklist in order to meet Ministry standards, after identifying gaps that had the potential to jeopardize



patient safety. Every nurse now completes the checklist at the beginning of their shift to ensure appropriate patient identification, the delivery of accurate treatments and medications, and the presence of appropriate equipment to provide excellent care. He spear-headed a collaborative effort by staff, management, and physicians to explore ideas to improve patient safety in the face of budget constraints. The overwhelming buy-in created a unanimous effort; unprecedented in the unit to date. Neil never gives up, always believing that we can do better together.

Inspire Neil motivates people towards a vision; at home, in the hospital and within the community. Before the new millennium, Neil and his family took the opportunity to learn about significant events of past decades. With patches illustrated by his children depicting these events, they created a beautiful memory quilt which hangs outside of the PCCU to educate, comfort, and inspire those who come through the doors. Neil inspires confidence and enthusiasm. When given the choice, students and new staff members almost exclusively request Neil as their mentor because he leads and teaches by example, in a universally inclusive, non-judgmental, supportive, and engaging manner. As one nursing graduate noted, “I recently started in the PCCU and Neil

was my preceptor. Not only is Neil an exceptional teacher, he is a fantastic nurse who is passionate about excellent patient care. I am consistently amazed by how much wisdom and experience Neil is able to share with all members of our inter-professional team. After many years at the bedside, we often hear about nurses becoming burnt out, but Neil is always positive, even bringing humour to the most difficult of times.” Neil was awarded Preceptor of the Year by the Western University for his outstanding preceptorship; a role that he welcomes every year without exception! He is trusted and respected by everyone on the team. As one attending physician stated, “Neil definitely demonstrates leadership qualities. It doesn’t matter how complex and critical or straightforward and stable the patient is, his care is always exemplary. He treats everyone with respect, dignity, and patience, whether a student, a fellow nurse, an attending physician, or a manager. He inspires confidence in everyone who is lucky enough to interact with him. He leads by example – which may be the best kind of leader of all.” In the community, Neil volunteers at a facility that houses retired greyhounds coming from the U.S. before they are adopted. His passion sparked the interest of his colleagues who donated quilts, food, and toys to welcome the dogs to their new home. Neil McBride brings a unique blend of compassion, creativity, humour, and professionalism to patients, families, and members of the inter-professional team in a way that inspires peace, hope, and healing. He is an exceptional advocate, leader, mentor, teacher, role model, and humanitarian and someone who, in his authentically humble manner, would deny what we all know to be true: Neil is truly a H nursing hero! ■

Nominated by: Celina Siemer, RN, Dr. Cory Anderson, Dr. Ali Al Harbi, Kate Earley, RN, Nellie DeWit, RN, Julie Burford, RN, Charlotte Wise, RN, Sherry Bennett, RN, Shannon Hogeterp, RN, Cheline Lalande, RN, Diana Boonsta, Lori Smith, RN, Brandy Martin, RN, Laura Doyle, RN, Jody Garant, RN, Joanne Perrin, RN, Sebrina Shearing, RN, Laura Wherry, RN, Michelle Cego, RN, Heather Davidson, RN, Julie Brett, RN, Asia Chorostecki, Megan McIntyre, Kim Petteplace, RN, Michelle Scott, RN, Lorraine Dixon, RN, Jon Hogeterp, RN, Nikki Walters, Barb Graham, RN, Ray St. John, RN Stephanie McDonald, Michelle Mantelli, RN, Deanna Masterson, RN, Jodie Demelo, RN, Chantal Singh, RN, Sabrina Wilkins, RN, Colleen Breen, RN, Dr. Ram Singh, MD (Letter of support), Mary Ann Linley, RN (Manager Letter of support)



Patricia Woods

Trauma Therapy Program, Women’s College Hospital Impressive feats


his story is about a heroine named Patricia Woods or “Pat” as her friends like to call her. Pat works in the Trauma Therapy Program (TTP) and the Women Recovering from Abuse (WRAP) program at Women’s College Hospital (WCH) in the Women’s Mental Health Department. To start this story, we begin with a few words from her clients to show the impact she has on her quest for the greater good. “This ride has been a rough one and I am so glad that it was you that led me through it. You have an ability to make me think and speak about events and feelings that I have always denied…You reminded me, in your quiet way, that I was sane and present.” “ You saw the unseeable, your boundaries were impeccable, your compassion grand, your skills sublime. I felt seen, I felt known, I felt safe, I felt healing. I will have you in my heart always.” Pat has been a Registered Nurse for 47 years. She is a well-rounded skillful and knowledgeable clinician. She also brings a creative depth to her work as an RN with a degree in Fine Arts and a Canadian Nurses Association Psychiatric/Mental health certification, as well as a certification in Sensorimotor Psychotherapy – an innovative and profound Psychotherapy approach to working with trauma directly in the body. She is a recipient of the PAC Group inter-professional Teaching Award from Peter Boyd’s Academy with her team in 2003 and a recipient of a teacher’s award from WCH in 2012. In addition to her work with clients, she teaches in trauma seminars and supervises students from Ryerson and the University of Toronto.

Adversity Pat works heroically day in and day out. In her work as a mental health nurse 18 HOSPITAL NEWS MAY 2017

and trauma therapist Pat works with the most vulnerable of clients – individuals struggling with significant sequelae of childhood trauma. In her 1:1 and group therapy Pat works daily with clients who lived through childhood trauma and often are challenged by symptoms consistent with complex Post Traumatic Stress Disorder (PTSD). Pat has learned through 18 years of experience that PTSD leaves many individuals having difficulty functioning in many aspects of their lives. Pat sees clients struggle with severe depression and anxiety. As well they have difficulties with sleep and challenges sustaining work and relationships.



Pat knows all too well that many survivors live with daily flashbacks of earlier traumatic events, are visited with frequent nightmares and it is not infrequent for clients to live in states of dissociation so severe that some of them had difficulty using TTC and other forms of public transportation, or safely moving through the world. Also, Pat would tell you that many of these clients engage in self harming activities, may be highly addicted, and it is not unusual to encounter individuals who move through their days chronically suicidal. It is in this context that Pat comes to work everyday. But Pat doesn’t just come to work, it is the way Pat comes to work that is the main message of this story. Pat works in a multi-disciplinary team consisting of one other nurse, an occupational therapist, social workers, psychiatrists and an art therapist.

Pat does so much for the team including working in WRAP, seeing individual TTP clients, developing groups, writing and research, speaking at conferences, and supervising nursing students. Pat also has her certification in Sensorimotor Psychotherapy (SP) and is one of the SP experts on the team. Pat never assumes she knows more and is always open to new ideas. She is a leader in this field, within this organization, and in the community. She has participated in countless psychotherapy trainings, and has also disseminated her knowledge and wisdom to present at the National and International conferences, WCH grand rounds, at the University of Toronto and GTA hospital wide trauma rounds. She is also a published author and poet. Two of our groups in WRAP and TTP “The Living in A Mindful Body” and “Trauma and the Body” groups are definite legacies she will leave behind for this program and more importantly for all the women who cross our threshold in search of healing and wellness. Pat is always the person that the clients gravitate towards and long to work with. I have seen the care and compassion she shows clients, and the respectful way in which she interacts with each individual which leaves them feeling like they are unique, special and that they matter. The resounding feedback she has been given on a consistent basis is that she is nurturing, compassionate and caring and how her manner of being allows for clients to feel safe and settled here. For many, she represents to them the care they wish they had received as children, and the possibility that it can exist for them now as adults. What a gift. Pat provides individual and group therapy with grace, knowledge and great wisdom. Her commitment and engagement to her work are evident from her passion in sharing her work during supervision and providing others with support as well as clinical advice. She’s not afraid of challenging her peers as well as her clients in a caring and compassionate manner. She has the ability to use her sense of humour

NATIONAL NURSING WEEK 2017 together with her experience and expertise to create a very pleasant atmosphere for those working with her. I also appreciate the time she takes to check in with the interdisciplinary team, to ensure that we are at our best emotionally and mentally, to do this work. I see her mentoring students with wisdom and honesty – and as a preceptor she teaches learners that they need to pay attention to the impact of this work by utilizing supervision and support. She also models for students the importance of identifying and exploring countertransference issues in the work we do. She demonstrates professionalism and a highly ethical practice. Pat is truly warm, approachable, and understanding and at the same time she balances this with being direct, honest and challenging.

Ingenuity, bravery, strength and beyond… Her students admire her too for Pat is a leader in working with modalities in trauma therapy including art based

A HERO(INE) IS A PERSON…WHO, IN THE FACE OF DANGER, COMBATS ADVERSITY THROUGH IMPRESSIVE FEATS OF INGENUITY, BRAVERY OR STRENGTH, OFTEN SACRIFICING HIS OR HER OWN PERSONAL CONCERNS FOR SOME GREATER GOOD. – WIKIPEDIA 2017 approaches and body based approaches to trauma. Here is a collage of quotes that current and past students say about her. “ You have so much very role modeled to me the endless bits and pieces of the therapist I hope to be one day become;” “ You have an incredible ability to make people feel as though they matter around you. I felt like a human, not just another student passing through the building;” “I feel that you are full of wonderful knowledge, creativity and experience that you deliver with empathetic honesty and humour. Thanks for sharing some of your fullness with me;”

Greater good Pat’s clients also have so much to say about Pat. She has been nominated by her clients, many times, through the WCH foundation award’s program. She also keeps in her office a medium sized paper bag full of cards from her clients. One day, Pat let me look through her cards and these are some of the quotes from her clients that I found. “Thanks for Reality!” “Thank you not only for your kindness, but also for your attentiveness and genuine caring for me. I appreciate your listening ear and heart and for your encouragement and helping me heal;”

“The best thing a mind can do is talk to the heart. You do this in book and gesture. It’s a great gift you have Pat;” “This ride has been a rough one and I am so glad that it was you that led me through it. You have an ability to make me think and speak about events and feelings that I have always denied… You reminded me, in your quiet way, that I was sane and present. You truly are an “Angel of Healing;” “ Thank you tremendously for your guidance throughout my journey. You emanate kindness, wisdom, gentleness, a true maturing ability, and there is an instant feeling of safety for me when I’m with you. You have influenced my growth so positively and strongly;” “Thank you so much for making a difference in my life. When I came to you, I was so broken and hurt and confused, not knowing what to say or do. You help me to heal and be able to speak out. You are an awesome therapist;” Pat is a true heroine to trauma H survivors. ■

Nominated by Sue MacRae on behalf of the Trauma Therapy Program clinical team.

Carol Timmings

To Ontario's RNs, NPs & nursing students: Nursing Week is about celebrating practitioners who have the highest public trust of any profession. It's about recognizing the robust knowledge, skills and experience nurses use every day to build a healthier Ontario. And most of all, Nursing Week is about thanking nurses for their phenomenal dedication to Ontarians and to nursing. Whether you are providing evidence-based clinical care, studying, teaching, conducting research, managing a health organization, or influencing healthy public policy, your expertise as an RN, NP, or nursing student is making a profound difference. We thank you for doing our profession proud and striving to make the health system stronger.

RN, BScN, MEd (Admin), President, Registered Nurses’ Association of Ontario (RNAO)

Doris Grinspun RN, MSN, PhD, LLD (hon), O.ONT., Chief Executive Officer, RNAO

Happy Nursing Week.



#YESThisIsNursing We are excited to celebrate Nursing Week with our Nurse Practitioners, Registered Practical Nurses, and Registered Nurses! We recognize the vital role that mental health nurses play in supporting individuals, families, and communities living with mental health challenges to improve their quality of life. Working collaboratively within the interprofessional team, and with patients and families, our nurses support the provision of effective, safe, and quality care. They steadfastly advance a Recovery environment and demonstrate their on-going leadership in the specialty of mental health practice by embracing models of care that focus on co-design and improved patient outcomes. Our nurses demonstrate their commitment to practice

excellence through participation in leadership development opportunities such as the Dorothy Wiley Health Leaders Institute and presenting the important work they are doing to optimize patient care at various conferences. They show their expertise in mental health and geriatric nursing through their pursuit of specialized mental health certifications, including the Canadian Nurses Association specialty certification. We are proud that our organization has been awarded with the 2017 Employer Recognition Award by the Canadian Nurses Association and applaud all of our nurses who have achieved their specialty certification. Thank you to our nurses for supporting and empowering our patients through their Recovery journey.

Jessica B S

he came in like a wrecking ball‌in the most respectful, compassionate, culturally competent, ethical way possible! Prior to her employment in Interior Health just over a year ago, Jessica was a street nurse with one of the harm reduction agencies contracted to deliver client based services. During this time Jessica tirelessly advocated for new and innovative ways to deliver services and is currently involved in evaluating one of her earlier projects – safer foil inhalation for persons who smoke drugs. From the beginning Jessica has been dedicated and committed to her role as

harm reduction coordinator. One of the key barriers in the early days of the Public Health Overdose Emergency was the lack of access to Take Home Naloxone kits in the community and the inability of harm reduction contracted agencies to be able to dispense kits to clients due to system barriers. Jessica very quickly identified this gap, engaged with key internal and external partners on how to remove these barriers, and once removed, developed the educational and training resources required to roll out the Community Overdose Prevention Program. At the same time Jessica worked in partnership with epidemiologists and Mental Health Substance

Thank you to our nurses at Ontario Shores for supporting and empowering our patients through their recovery journey. #YESThisIsNursing!



a Bridgeman

Harm Reduction Coordinator Interior Health Use programs to develop a surveillance process for external partners to report overdoses that occur in a community setting and to increase communication between organizations. Interior Health (IH) has responded to the Public Health Overdose Emergency by implementing various strategies. Jessica has been instrumental in providing leadership and insight to the IH Overdose Response Team Section Leads who are working towards developing and implementing Safer Consumption Services (SCS) and Overdose Prevention Sites (ODPS). Jessica has been working in collaboration and partnership with educators and the Professional Practice Office to develop and implement educational resource materials to support staff in IH as health professional regulations are amended to increase the capacity of staff to distribute and administer naloxone in acute and community settings. Through all of this, Jessica has never lost sight of who the most important people are in the overdose response strategy – the people who use drugs and their families. She tirelessly advocates for the inclusion of peers in all new and ongoing harm reduction strategies and does not hesitate to identify and address situations where peers are being discriminated and stigmatized against and seeks to find shared solutions to reduce these impacts. Jessica has been co-facilitating the Compassion, Inclusion, and Engagement project in IH with First Nations Health Authority and BC Centre for Disease Control (BCCDC) to bring healthcare workers

and peers together to begin to break down barriers, provide safe spaces, and increase dialogue between both groups. Jessica is a true hero that inspires others to join the battle against addiction. Her dedication, courage, kindness and compassion towards those she serves is remarkable. Recently, Jessica was late for an opioid overdose response strategy and planning meeting and apologized stating that she has just been in the back alley with a colleague administering Naloxone to an unresponsive individual. So she saves a life and gets right back to the priority work! With a background in acute psychiatry, emergency mental health, and community addictions, Jessica is a passionate advocate for harm reduction and has worked tirelessly to save lives by expanding availability of naloxone to those most at-risk of an overdose. In 2016, Jessica’s work ensured that over 4,000 Take Home Naloxone (THN) kits were distributed to people who most need them in communities within the Interior Health region. She has become an essential component to the provincial overdose emergency response in Interior Health. Jessica helps to create policy that saves lives and reduces poor health outcomes without discrimination, barriers or bias. Jessica is a champion for identifying and responding to health inequities. Through sheer determination, Jessica has been the key force in changing organizational norms and increasing awareness, decreasing stigma and savH ing lives. ■




Nominated by: Paula Araujo, Kathy Williams, Lorena Hiscoe, Dr. Silvina Mema, Gillian Frosst, Michelle McWhirter



Tricia Newport

Whitehorse General Hospital, and Doctors Without Borders/Médecins Sans Frontières (MSF) Canada


ery few nurses working for MSF Canada have inspired me and many of my colleagues as much as Tricia Newport from Whitehorse, Yukon. She is one of the most dedicated, selfless and passionate healthcare professionals I know, always putting the world’s most vulnerable patients first – no matter if they are Syrian refugees in Lebanon, malnourished children in Chad or vulnerable First Nations communities in northern Canada. She is a true humanitarian, and a great leader who inspires those working with her. Helping others has been her dream since she watched news reports about the famine in Ethiopia in the 1980s as a 10-year old. After working as an outdoor guide and social worker in the Yukon, the Oakville,

Ontario native studied nursing because she wanted to do humanitarian work with MSF. Her first assignment was in Djibouti in 2009, and she has since dedicated much of her career to treating patients in the world’s most difficult humanitarian crisis hotspots. In total, she spent about 50 months on assignments with MSF – working in the Democratic Republic of Congo, Chad, Cameroon, South Sudan, Niger, Lebanon, Greece and Iraq – while increasingly taking on greater leadership positions. In order not to lose touch with the Canadian healthcare system, Tricia works as a nurse at Whitehorse General Hospital between her overseas assignments. In 2014, she completed a Master in Public Health in order to better serve people in need.

THANKING Ontario’s RPNs and all other health professionals during

NURSING WEEK! As we celebrate Nursing Week, the staff and board of directors of RPNAO would like to recognize and thank all of our colleagues and partners, not only in the nursing profession, but throughout the entire health care sector, for the incredible work they do, each and every day. We would also like to take this opportunity to recognize the province’s registered practical nurses (RPNs) for the invaluable contributions they make. As the health care system continues to evolve, RPNs continue to showcase their knowledge and their expertise in a wide variety of settings, making positive differences in peoples’ lives and leading innovation at the point of care. During this special week, we would like to recognize and thank all nurses and other health care practitioners for the amazing and selfless work they do.

While in the field, she works tirelessly to make sure patients get the best treatment possible, while at the same time trying to understand local complexities and cultural beliefs. Colleagues notice that she always remains calm, no matter how tense the situation on the ground is, and that she is always looking for innovative ways to cope with emergency situations. During a malaria outbreak in South Sudan, for example, the rainy season flooded the roads, so no one could get to the hospitals for treatment. To reach patients, Tricia and her team assembled a “motorcycle gang” to carry supplies to 15 villages, where they had trained people to treat the outbreak. Dr. Rogy Masri from Toronto, who has worked with Tricia in Lebanon and is currently a member of her team in Iraq, where she is the medical coordinator, calls her a true leader.” She is


loved by all and respected by her entire team. She exudes kindness and has the thoughtfulness to fully understand the most dire situations.” Masri also describes Tricia as an ‘unsung hero’ who is always humble and reluctant to be recognized for the incredible things she does. He says she is one of the masterminds behind the establishment of the only fully operational healthcare facility in East Mosul, Iraq, serving a population of over 500,000 people, but that she refuses to take any credit. Tricia is also incredibly resilient and ‘tough’. While some fieldworkers struggle with the basic living conditions in many of MSF’s field projects, Tricia considers them as almost luxurious as she lives in a shed without any electricity or running water deep in the Yukon’s wilderness when she is back in Canada. Her daily Yoga and meditation practice keeps her grounded, both in the Canadian North and during assignments in the world’s humanitarian H crisis hotspots. ■


Nominated by: Claudia Blume, MSF Canada 22 HOSPITAL NEWS MAY 2017



Donna McFaul, RPN

was the recipient of the 2016 RPNAO Award

of Excellence in the Care of Older Ontarians, also known as ‘The Martha Award’. Donna is a VON Care Coordinator with the Assisted Living Services High Risk Seniors Program in Belleville.





List of Nominees

2017 Nursing Hero Awards Kwasi Adu-Basowah, Centre for Addiction and Mental Health Francis Agapay, Centre for Addiction and Mental Health Emelia Akoto, Runnymede Healthcare Centre Alison Armstrong, London Health Sciences Centre Kerri Ashforth, Children’s Hospital of Eastern Ontario Barbara Bare, Interior Health Frances Barry, The Hospital for Sick Children Joan Barthel, Hamilton Health Sciences Melanie Basso, BC Women’s Hospital & Health Centre

Eliza Cheung, Mackenzie Health Corinne Cipra, Brockville General Hospital

Erlinda Gallardo, St. Joseph’s Health Centre

Maria Kobylecky, Trillium Health Partners

Rebecca Gill, Kingston General Hospital

Stella Maria Kozuszko, Toronto General Hospital (UHN) HM

Gabriella Golea, Centre for Addiction and Mental Health

Alfredo Cootauco, Runnymede Healthcare Centre

Laura Catherine Grace, Kingston Health Sciences Centre

Barb Cox, Sunnybrook Health Sciences Centre

Pam Green, Holland Bloorview Kids Rehabilitation Hospital

Alice Coyne, Hamilton Health Sciences Centre

Alyse Hansen, Children’s Hospital of Eastern Ontario

Cathie Cullen, Waterloo Region Sexual Assault/Domestic Violence Treatment Centre

Sandra Harriott, Sunnybrook Health Sciences Centre

Karla Custodio, University Health Network Jennifer Dela Cruz, Trillium Health Partners

Emma Harris, Peterborough Regional Health Centre Philip Harris, Hamilton Health Sciences Centre

Odette DeSouza, Trillium Health Partners

Elizabeth Hasler, Southlake Regional Health Centre

Colleen Berngot, St. Joseph’s Health Centre

Meghan Donohue, Sunnybrook Health Sciences Centre

Diana Hauser, Interior Health

Trupti Bhavsar, Runnymede Healthcare Centre

Ada Du, St. Joseph’s Health Centre

Denise Boudreau,

Chantel Duhaime, Children’s Hospital of Eastern Ontario

North Bay Regional Health Centre Jessica Bridgeman, Interior Health (F) Deborah Brown, Sunnybrook Health Sciences Centre Elena Cacchione, University Health Network Rosemary (Rose) Cameirao, Markham Stouffville Hospital Janice Carr, Centre for Addiction and Mental Health Diane Charters, Trillium Health Partners

Christine Hezarkhani, Trillium Health Partners John Hobart, Northumberland Hills Hospital

Kathi Evans, BC Children’s Hospital

Anne Howison, Brockville General Hospital

Jolyne Fadyshen, Thunder Bay Regional Health Sciences Centre

Sivi Joachim, Centre for Addiction and Mental Health

Amy Farrow, Brant Community Health Care System

Nisha Joy, Runnymede Healthcare Centre

Maria Ferreira, Centre for Addiction and Mental Health

Geeta Juta, St. Joseph’s Health Centre

Eileen Fisher, St. Joseph’s Health Centre

Lynn-Ann Keats, University Health Network

Brenda Fraser, Children’s Hospital of Eastern Ontario

Judy Keely, Children’s Hospital of Eastern Ontario


Michelle LaFreniere, BC Cancer Agency Miranda Lamb, Sunnybrook Health Sciences Centre Emily Lamothe, Peterborough Regional Health Centre Diane Leber, University Health Network Anne LeMesurier, St. Joseph’s Health Care London Bonnie Leung, BC Cancer Agency Mu-Ying Lin, Runnymede Healthcare Centre Danielle Lumibao, Holland Bloorview Kids Rehabilitation Hospital Cathy Lyle, Providence Care, Kingston Andrea Machacek, Interior Health Christine Magyar, Interior Health Debbie Mahoney, Markham Stouffville Hospital Neil McBride, London Health Sciences Centre Erin Mcinnis, Interior Health Karen McNeil, Peterborough Regional Health Centre Irene Mesic, Trillium Health Partners Lois Millar, St. Mary’s General Hospital Angie Miller, Markham Stouffville Hospital


Mary Miron, Cornwall General Hospital

Saundra Small, Runnymede Healthcare Centre

Krista Morgan, Peterborough Regional Health Centre

Harvinder Soni, Centre for Addiction and Mental Health

Wendy Moulsdale, Sunnybrook Health Sciences Centre

Gina Stokes, Sunnybrook Health Sciences Centre

Heather Murray, North Bay Regional Health Centre

Jennifer Storie, The Hospital for Sick Children

Edsel Mutia, North York General Hospital

Emma Taylor, Northumberland Hills Hospital

Phuntsok Namgyal, Runnymede Healthcare Centre

Hermelinda Tenorio, North York General Hospital

Elisabeth Nardi, The Centre for Addiction and Mental Health

Nancy Tran, Centre for Addiction and Mental Health

Tricia Newport, Whitehorse General Hospital and MSF Michael Nguyen, Runnymede Healthcare Centre Sadie NormanMclure, Mackenzie Health Barb Ogar, Southlake Regional Health Centre

Younten Tsomo, Centre for Addiction and Mental Health Irina, Vinogradova, St. Joseph’s Health Centre Rose Wang, Runnymede Healthcare Centre Tracie L. Walpole, Dunnville War Memorial Hospital

Jane Penny, BC Cancer Agency

Barb Ward, Brockville General Hospital

Jun Qin, Centre for Addiction and Mental Health

Dana White, Brockville General Hospital

Gloria Rego, Trillium Health Partners

Kyra Wilson, Centre for Addiction and Mental Health**

Margo Roberts, Centre for Addiction and Mental Health

Carrie Winslade, Sunnybrook Health Sciences Centre

Carmen Robinson, Runnymede Healthcare Centre

Patricia Woods, Women’s College Hospital

Annette Ruby, BC Women’s Hospital and Health Centre

Barried Xavier, Runnymede Healthcare Centre

Retu Sapple, Runnymede Healthcare Centre

Rodney Yu, The Hospital for Sick Children

Trudy Sharpe, Providence Care

Erin Zaydik, Trillium Health Partners


Gabriella Golea

The Centre for Addiction and Mental Health


s a nursing expert in the field of mental health nursing, Gabriella Golea, RN contributed much to the development of various nursing practices and policies at CAMH over a span of 30 years of dedicated service. She helped establish CAMH’s very first Nursing Practice Council as a testimony to her belief that nurses, regardless of their role across the organization, should have a say in decisions that affect their work life and the quality of care their patients receive. She has also been a strong advocate for the care of seniors with mental health and addiction issues, having played a pivotal role in establishing CAMH’s Geriatric Mental Health Program. With the founding of CAMH in 1998, Gabriella (or “Gaby” as she has become known to staff and clients alike), was charged by the Chief of Nursing at the time to develop a unifying vision and practice model for nursing within the organization’s interprofessional context. This was no easy feat, since Gaby had to reach out to nurses across the four founding organizations that comprised the newly formed CAMH. This was further complicated by the fact that some nurses and clinical areas did not have access to computers or e-mail. She connected with many nurses (and non-nurses too) the old-fashioned way – going out to meet them in person in their various units. Once a new structure for nursing practice and expectations were drafted for the organization, Gaby participated in the development of ongoing education to help staff nurses adopt new practices and adjust to new ex-

pectations. As with any major change, some nurses were skeptical about, or slow to take up, new practices, which no doubt taxed both Gaby’s patience and resilience. However, Gaby met each challenge with a cheerful demeanor and kept everyone focused on a common priority – excellent mental healthcare for all patients, families and communities. Gaby then moved on to CAMH’s Geriatric Mental Health Program, a program that was floundering in the mid-2000’s. Gaby worked tirelessly to raise practice standards in the program but also to attract both new recruits of all professional stripes, and additional funding to explore innovative interventions to support mentally-ill seniors outside the hospital and in the community at large. Gaby helped to re-structure services using a playbook she called “creating a culture of care”. Her playbook started with a simple vision: “Everyone who touches the Geriatric Mental Health Program, whether a patient, a family member, a staff member, or a community member, leaves the program a better person”. She regularly met with staff across units and outpatient clinics. She shared their joys and cried with them during challenging or particularly trying times. She attended countless weddings, baptisms, bar mitzvahs, and recognition events of both staff and patients. She also held the hand of a female patient with terminal cancer who died on one of the units – the patient had no family and did not want to die alone. There were many other eulogies and memorials for patients and staff that Gaby attend-



ed; in fact, Gaby was often sought out to say a few words about the departed individuals because her words were always authentic, always kind, always compassionate. In addition to her kind soul, Gaby has been an exemplary administrator. She recruited a superb management team and worked closely with them to define service priorities for the patient population in their care. Gaby would often say that the two prerequisites she looked for in anyone she was recruiting was that they had to be nice and they had to be smart, speaking to the need to have clinicians who were both human and compassionate in their approach to elderly patients, but who were also knowledgeable and armed with best practices and current skills in mental health elder care. These issues are close to my heart because for the last two years of my mother’s life, I navigated the healthcare and seniors’ mental healthcare system in Toronto with her. We experienced a system that was more about keeping people alive than about the quality of that life. I had heard about the great care that her Geriatric Mental Health Program had been providing. I was initially reluctant to bring my mother to CAMH because I worked there, but, having exhausted numerous other care possibilities, I decided

to approach Gaby. From the start, I felt that Gaby had my mom and my family’s best interests in mind. Gaby was always checking in with us. No matter how busy her schedule, Gaby took the time to answer our questions, was always compassionate and sensitive to our needs. was always kind, caring and compassionate. I felt blessed that Gaby had entered our lives. Her reputation in the geriatric mental health community extends beyond the walls of CAMH. She was a founding member of the Nurses’ Special Interest Group within the International Psychogeriatric Association and her efforts contributed to new approaches to the care of seniors suffering from the behavioural and psychological symptoms of dementia. I have also spoken to colleagues who have had the pleasure of working directly with Gaby and her team of professionals both in CAMH’s geriatric services and in the Professional Practice Office. They all speak of Gaby’s kindness and compassion and steadfast focus on ensuring patient safety and quality of care in the mental health setting. I appreciate this opportunity to nominate Gabriella Golea in recognition of her contributions to improving mental health nursing practice and geriatric mental health nursing in our H hospital, our city and beyond! ■

Nominated by: Aurora (“Rory”) Kohari



Lois Millar St. Mary’s General Hospital, Kitchener


hen Registered Nurse Lois Millar began her career more than 53 years ago at St. Mary’s General Hospital in Kitchener, patients smoked in their beds and nurses washed their ashtrays at the start of each shift. Syringes

and IV bottles were made of glass. Patients having gall bladder surgery were admitted for two weeks. And when a doctor approached the nursing station, all nurses stood up. Fast forward to 2017 and on her 75th birthday, Lois was earning her recertifica-

tion for Advanced Cardiac Life Support at St. Mary’s, where she continues to work in the hospital’s busy emergency department. “I like learning new things,” she says. “The secret is keeping updated.” She tried retirement in 2004, but within a couple of months returned to St. Mary’s on a casual basis. “I missed it,” she says. “The staff are like family and I like to be there for the patients.” When electronic charting was introduced in the emergency department, Lois was the first one to dive in. “Lois truly embraces change,” says Kathleen Demers, who worked with her in the department as a nurse, educator and manager. “She is a shining example for every new nurse of the power of a positive individual.” “Lois is genuine, honest and always available for her team,” adds Lisa Pell, her current manager. During her tenure at St. Mary’s, Lois has worked in every clinical unit with the exception of the operating room. She spent 25 years on the intravenous team. She currently works day shifts in the emergency department, sometimes up to 30 hours a week. For the past 11 years she has also volunteered at the YMCA in its wellness program. Lois values her role as a mentor for younger nurses and they are generally

eager to learn from her. “They’ll say ‘you’ve got all this knowledge. What do you think?” She believes staff at St. Mary’s continue to live the mission of compassion and respect that is the legacy the hospital’s founders, the Sisters of St. Joseph of Hamilton. During Lois’ early years at St. Mary’s, the sisters lived onsite, held all key administrative roles and ran the kitchen, making butter tarts and jam and serving a hot breakfast to staff at the end of a night shift. Long gone are the early days of Lois’ career when nurses had time to give every patient a nightly backrub. The pace and complexity of the role is vastly different now. “Sometimes you think you’re not doing everything you can for patients and families,” she says. “But it’s what you put into it. You’ve got to prioritize and think ‘what is going to be most important for each patient?” Kathleen Demers says “Lois is everything a nurse should be. She is caring, but also no-nonsense. She transcends time.” Lois’ philosophy is simple. “Do something you love, surround yourself with positive people and do not live in H the past,” she says. ■

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We are Ontario’s nurses.

Representing 64,000 Registered Nurses and allied health professionals.

Nominated by Anne Kelly 26 HOSPITAL NEWS MAY 2017

Celebrating the profession. It takes dedication to be a nurse. An extensive education. Long hours gaining experience and skills. And a lifetime of compassion. It’s not only a profession, it’s a calling.


Debbie Mahoney Markham Stouffville Hospital


t’s no surprise to anyone when they hear that a nurse works long hours – 12 hour shifts are the norm, when your profession is caring for patients in a hospital. But a 48 hour shift is what Debbie (Deb) Mahoney voluntarily offered a family in need, when she slept over for two nights at the family home to help care for a paediatric patient in her final stages of life. Deb is a registered nurse, at Markham Stouffville Hospital. She has worked at the hospital for close to 17 years, in both the emergency department and the oncology clinic. At the clinic Deb usually cares for adult cancer patients, and it was here, that Deb met *Rachel.

starts, and they require a different type of care. After getting to know the family and treating Rachel, Deb not only became a trusted care giver but a part of the family. She learnt that the family was in much need of support, they had previously tragically lost another child from the same disease. Deb took this knowledge to heart and made it her mission to give Rachel and her parents the best care possible.

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Rachel, seven years old, was a paediatric patient at SickKids in Toronto. But upon hearing that the weekly trips downtown were exhausting Rachel and her family, Deb immediately agreed to make accommodations to take on this new younger patient. Deb wanted Rachel and her family, Stouffville residents, to be cared for in their own community. For over a year and a half Deb provided care to Rachel each week, and sometimes, twice a week. Deb is known as MSH’s resident intravenous expert and she made sure all the nurses at the clinic were armed with the knowledge to assist a paediatric patient. Caring for a seven year old is very different than caring for an adult – there are smaller transfusions, have harder intravenous

Then that fateful day came along, when it was Rachel’s (who was then nine years old) time to pass. Deb lived up to her personal promise of providing exceptional care to this family. She offered to stay with the family. The family welcomed Deb’s generous offer. So following her regular hospital shift caring for other patients, rather than heading home for well-deserved rest, Deb headed over to support Rachel and her family in their greatest time of need. At their time of anxiety, stress, and sadness, Deb was able to support Rachel and her parents. Her presence and nursing expertise kept Rachel comfortable and allowed Rachel’s parents to be grieving parents, and not worry about administering medications.

Rachel was able to die at home surrounded by the love of her family and under the steady watchful eye of Deb. Deb slept over for two nights and was

at Rachel’s bedside when Rachel’s journey had come to an end. *Name of the patient has been H changed in the story ■

Nominated by: Dr. Andrew Patterson, Chief Rehabilitation and Palliative Care, Markham Stouffville Hospital 28 HOSPITAL NEWS MAY 2017

Trillium Health Partners



#YesThisIsNursing May 8 - 12, 2017

National Nursing Week is a time to acknowledge the commitment, dedication and professionalism that our nurses bring to their practice each and every day as they provide exceptional patient care. Our more than 3,800 nurses at Trillium Health Partners wish to thank the allied health professionals, physicians, support staff, volunteers and learners who work together with them as partners in creating a new kind of health care. We are proud to work together as part of a team!

Better Together


Elisabeth Nardi The Centre for Addiction and Mental Health


t was an ordinary day in Downtown Toronto. I had just finished my appointment, and was on my way out. My mind was consumed with suicide, and I saw an opportunity, and decided to take it. There I was, standing on top of the parking garage, contemplating jumping and ending it all. As I stared at the pavement below me, I saw security and some other people run out. That’s when I met Elisabeth. I got down off the ledge, and Elisabeth instantly held my hand and talked to me as we walked down to the emergency room. Once we got there, Elisabeth was my nurse, and we sat down to talk and work through what I was feeling. Lis was very compassionate and genuine, and this made it easy for me to express my feelings. She talked to me in a way that made me feel like a person who


was struggling, rather than someone who was a problem. I felt supported and cared for. As someone who struggles with multiple diagnoses’, including major depression and borderline personality disorder; that is something that is very important for me to feel. Elisabeth’s care has encouraged me to reach out and ask for help, rather than automatically reverting to problematic behaviours. I continued to go back to CAMH’s emergency room, hoping that Elisabeth would be there, and maybe even possibly be my nurse. Majority of the time, that wasn’t the case – so I received help from CAMH’s other nurses. But, when it was the case, my heart and mood were instantly lifted. I knew that I was going to get the help that I needed. I distinctly remember one situation where I was in the crisis unit, and I had cried my self to sleep while trying




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to control and manage my urges and emotions. This took a lot of energy out of me, and I just hoped that tomorrow would be a better day. Tomorrow arrived, and I was woken up by a familiar voice. I rubbed my eyes and hoped what I was hearing was true‌and it was. I sat up a and smiled, and said ‘Oh my gosh, hi Lis!’. I was so happy to see her, and to have her as my nurse for the day. I could feel my anxiety lower, and my heart beat with joy. I am so thankful to have ever met Elisabeth. She was the very first nurse that I had at CAMH, and after just one encounter, I had a sense of peace, hope and serenity. Elisabeth’s kindness, compassion and


genuine love and care for her patients shows just how much she values her job as a nurse. As a patient of Elisabeth’s, I can sincerely and whole-heartedly say that without her, I would not be the person I am today. Everyday I continue to struggle with mental health, and it’s anything but easy. But from the few interactions that I have had with Lis, she has inspired me in a way that words cannot even begin describe. She has given me the ability to believe in myself, and to believe that it is possible to get better. Words cannot express how thankful and grateful I am to have had the opportunity to have Elisabeth H Nardi as a nurse. â–

*Elisabeth is now a nurse at University Health Network. Nominated by: Carleigh A. Loshusan

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716.829.8400 MAY 2017 HOSPITAL NEWS 31



The Nurse

By Roopdai Mohotoo and Nita Marcus Florence Nightingale, the lady with the lamp, Mother Theresa in the refugee camp, Caring, compassionate, gentle and kind, A more noble profession, one could not find. The nurse is the doctor's eyes and ears, Records any changes, allays patient fears, Monitors rhythms, takes vital signs Administers drugs, sets up IV lines. The nurse is highly trained in her skills, To assist in the healing of wounds and ills, In the OR, wards or critical care, Her presence unnoticed because she is always there. With devotion and pride, she nobly serves, Though pressures, demands, may fray her nerves The nurse lowly paid, in gold is her worth, For she's truly god's angel sent down to earth by.

Eileen Fisher

St. Josephs Health Centre


was admitted to the Child and Adolescent mental health unit at St. Joseph’s during mid-January, and was discharged 2.5 months later. To be brief, I didn’t think I was even going to make it until Christmas, but I did. Shortly after the new year, things for me starting going downhill in a way that I saw unfixable. I was depressed, tired, and at peace with not being alive anymore. Being admitted to the St. Joseph’s 3L unit put everything on pause. The staff there were amazing, but there is one nurse in particular that sticks out in mind. She has gone above and beyond for me during my two month stay on the unit. Her name is Eileen Fisher,

and she’s one of the biggest reasons why I left that unit with more hope than I’ve had in a while. There were times when I’d be bawling my eyes out thinking that life was never going to get better, and she’d knock on my door and listen to my ramblings for as long as I needed. When I started to get passes off of the unit, I’d sometimes come back with tears in my eyes. Each and every single time Eileen would let me back onto the unit, it was like she would lend me a piece of her heart and say something that would make me realize that there are actually kind hearted people in this world. Every time I left for a pass, she made me promise to call the unit and check in with her, and to come back ear-

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ly if I needed to. She’d wake me up most mornings with a smile and a short pep-talk that would help me out of bed. She’d tell me that I was loved, that I was irreplaceable, and that there was a place for me in this world. She would bring me hot chocolate on my bad days, and sit with me and chat on my good days. This woman is one of the most kindhearted individuals that I have ever known, and that is why I’ve decided to send my story in. Eileen Fisher deserves so much praise for what she does, and my hope is that my story can help shine light on all the amazing work that she has done H and continues to do. ■ Nominated by: Anonymous








Cathie Cullen

Waterloo Region Sexual Assault/ Domestic Violence Treatment Centre


would like to nominate Cathie Cullen as a “Nursing Hero”. Cathie is a Senior Forensic Nurse with the Waterloo Region Sexual Assault/Domestic Violence Treatment Centre. Cathie has been a forensic nurse with our centre for approximately 15 years. Cathie demonstrates care and compassion with every client she sees but her recent interest in human trafficking has allowed her to connect with victims in a way that many people can’t. During one call, the victim’s trafficker attended the hospital and physically removed the victim from the emergency department. When Cathie attended the hospital, she found the couple sitting in the Tim Horton’s which is in the lobby of the hospital. Cathie walked over to

the victim and introduced herself and stated that she was ready to see the client at which point the client complied. Cathie and the on-call Social Worker were able to provide support and treatment, allowing the victim to have a shower, a nap, some food and drink and a change of clothes. Safety planning was also done. The victim connected to Cathie and at one point asked if she could go home with her. Cathie is eager to assist other nurses and passes her knowledge onto them with no hesitation. In our region, Cath-

ie is considered an expert in “strangulation” and eagerly shares this information with Crown Attorneys and the Waterloo Regional Police Service. In partnership with police, she has assisted in the development of on-line training for all Waterloo Regional Officers on signs and symptoms of strangulation and what questions that should be asked. Cathie also provides training to all new police recruits, EMS staff, nursing staff, students and other professionals. In addition to being part of the oncall team, Cathie also assumes the following responsibilities: • training and education • ensures that supplies are maintained at the two hospitals we provide service to

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• assists in interviewing, orientation and training of new nurses • provides leadership and mentoring to other nurses on the team • assists with day to day activities with the program • assists in the development of standard work and processes Cathie is a Nursing Hero in many ways and the above just outlines a few. I hope that you too will consider her a H Nursing Hero. ■

Nominated by: Julia Manuel, MSW, RSW, Manager, Sexual Assault/Domestic Violence Treatment Centre



Rosemary (Rose) Cameirao

Markham Stouffville Hospital


aturday at Costco is usually a routine shopping experience for most people. Shoppers are in the busy aisles, finding all the things they need and are rushing to the cash register. On June 4, 2016, Rosemary (Rose) Cameirao was just like every other shopper except when she used her skills, training and quick thinking to save a life. When you hear someone shout “Call 911” and you’re a nurse, your instincts kick in and you’re doing everything you’ve been trained to do – even if you are not an emergency responder. As a registered nurse at Markham Stouffville Hospital’s (MSH’s) paediatric clinic and inpatient unit, and NICU, Rose supports and cares for our youngest patients – from newborns to 18 years old. She is amazing with our patients and their families, including new moms who have been discharged after giving birth. She is extremely patient and conscientious always making

time to listen to all their concerns despite a busy schedule. Rose used the same care and emotional support she uses at MSH for a 67 year old woman named Mary who choked on a hot dog at Costco that day in June. She was lifeless when Rose went to her – she performed CPR three times and the hotdog popped out. Mary immediately came to and was breath-


ing. Rose then continued to comfort Mary and her husband, Joseph until EMS took them to the Emergency Department at MSH. Despite all of this happening on her day off, Rose literally went the extra mile and picked them up at MSH when Mary’s care was complete to bring them back to Costco to get their car. She also helped with the incident report at Costco and even asked for their money back on the hotdog. Costco management did much more than that – they paid for the ambulance and all their groceries – Rose even got a free chicken! As one of Rose’s colleagues at the hospital, I was amazed when she shared this story with me. But I wasn’t surprised. Knowing Rose, this is exactly how I would have expected her to act. Rose was so concerned about everyone around her and directed everyone at the scene to make sure everything and

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everyone was taken care of. Shoppers and staff at Costco saw this amazing side of Rose for a few minutes. Her colleagues and the families she cares for at MSH see this side of her every day she comes into work. Rose makes sure that everyone is taken care of and provides emotional support and reassurances to all involved. Myself and her other colleagues at MSH have a lot of respect for Rose, she is an outstanding, supportive and very giving person and nurse. We are very lucky to have her in our MSH family and the Markham community. She has been at MSH since the day it opened 27 years ago – she embodies MSH’s philosophy that patient care is at the H centre of everything we do. ■

Nominated by: Wendy Cheung

Nurses are with us every step of the way. Thank you from OsgoodePD.

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Elizabeth Hasler

Southlake Regional Health Centre


rs. Elizabeth Hasler, better known as Liz, is one of our senior most nursing staff members in our department of Psychiatry; she is the team leader for our Schizophrenia Clinic. She recently was presented a staff loyalty award after completing thirty years at Southlake Regional Health Centre. She manages a heavy case load of complex patients who have schizophrenia, which is a challenging population. Her work experience is quite broad, with a wide scope of patient skills. Mrs. Hasler started her career at Southlake Regional Health Centre in 1973 at surgical floor. In 1977 she took maternity leave then returned as part time. In 1986 she worked at a Rehabilitation unit, and also worked on the Nurses Float team, and chronic care. In 2000 Mrs. Hasler worked on neurology and orthopedic rehabilitation unit. In 2006 Mrs. Hasler started her full time position in Adult Mental Health inpatients. Mrs. Hasler usually starts her day much earlier than her scheduled time. All the team members appreciate her professional attitude, her ability to work long hours and her calm manner. She is always smiling, which puts all the patients and staff at ease. All the work deadlines are easily met due to her hard work. She is respectful towards her colleagues and non-judgemental towards her patients. Her confident manner is underpinned with solid years of experience and a vast clinical knowledge. Her commitment to her patients and staff is outstanding. Mrs. Hasler is the face of providing excellence in patient-centred care, i.e. her work days start early to try and accommodate patients that have jobs to go to and she meets them before the patient leaves for work sometimes as early as 0630 AM. She works tirelessly to ensure patients have their medications whether an inpatient or outpatient, organizing with both nurses and pharmacists to have meds ready when patients need them. She ensures smooth transitions

of care from the inpatient to the outpatient schizophrenia program, her hand overs with patients, their carers and families are considered to be of superior quality. She spends considerable time with families and caregivers as well to support, teach and reassure to provide best possible psychoeducation. Her peers describe her as a constant learner who makes her presence felt at every educational opportunity, she actively participates, even at her own spare time and using her own expenses, which is highly creditable. Her organizational and prioritizing skills are impeccable, for example she arrives early, and will not leave the unit until all needs are met whether a patient or the team needs help. She practises very safely, if she is unaware of a particular clinical matter, she seeks to find answers for the patient, staff and herself. She is genuine, sincere, an ultimate professional, respectful, compassionate about mental health issues and her patients. Mrs. Hasler is quite knowledgeable, as evident in her day to day work. She is a reliable and dedicated nurse. It is a common perception in our department that –‘If Liz is around, things will not go wrong.’ She has a good understanding of psychotropic medications, and invariably includes a psychosocial approach in the treatment plans. Often clinicians have benefited of getting better psychodynamic formulation of patients, after discussing with Mrs. Hasler. Mrs. Hasler is retiring from her job, by the end of this year, but this has not deterred her enthusiasm in any way. Her zeal to work hard is infectious; it promotes a healthy work environment. She is a regular attendee at the local and regional educational programme and all the speakers recognize her avid learning attitude, as she is very vocal during the discussions. On umpteen occasions, I have seen Mrs. Hasler rise up to the challenges secondary to the clinical issues and dealing with them successfully. Her ex-


perience is a great clinical asset, which almost all of the psychiatrist colleagues truly admire and appreciate. Often, she ably resolves the issues, even before others around her can realize. Her pedantic working style, where she takes care of even minutest details is

worth applauding. Her demeanor with psychiatric patients is a perfect role model example for younger staff in our department of mental health. She has very high professional standards. Her knowledge of Mental Health Act is of H high quality. ■

Nominated by: Dr Gaurav Mehta and Janet Giannini

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National Nursing Week May 8-14, 2017

Compassionate. Professional. Respectful. These are the values at the heart of nursing practice at Humber River Hospital. By generating new knowledge, leading health care change, stimulating innovation, implementing best practices, and supporting the education and professional development of students, peers and colleagues, the Humber River Hospital nursing team elevates the health and well-being of patients and families across all clinical programs and services. Congratulations to our nursing team from everyone at Humber River Hospital as you celebrate National Nursing Week 2017.


Understanding pain to help patients By Daniel Punch


heila O’Keefe-McCarthy’s earliest nursing lessons came from the first person she ever met. A nurse and midwife who emigrated from Ireland, O’Keefe-McCarthy’s mother earned a reputation as a respected clinician, and was the “go-to person” when the family’s Lindsay, Ontario neighbours needed health advice or a vitamin B shot. She also taught her daughter about the sacred bond between nurse and patient. “(My mother) instilled in me the privilege and honour of being in someone’s life at a vulnerable time,” O’Keefe-McCarthy says. “It’s a gift.” But it wasn’t until she volunteered as a 17-year-old candy striper at Lindsay’s

Ross Memorial Hospital that she fully appreciated her mother’s lessons, and began to see nursing as an alternative to her dreams of a career in show business. She remembers entering a room in the hospital’s ward for persons with dementia to find an older woman distraught and yelling. Instinctively, she took the woman by the hand, looked into her vibrant blue eyes, and hummed an old Irish lullaby. The woman calmed down. “We connected on a higher level,” O’Keefe-McCarthy recalls. She went home that night and told her mother she wanted to go into nursing. “She nearly fell off her chair,” she remembers. Thus began a highly decorated career that has already spanned more than three decades. Continued on page 39

Sheila O’Keefe-McCarthy feels privileged to have cared for cardiovascular patients throughout her three-decade career.

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What is the evidence on

opioids and pain management? By Jonathan Mitchell


anada is the world’s second largest per capita consumer of prescription opioids. The growing rates of addiction, overdoses, and death continue to be seen across the country. In British Columbia alone, illicit drug overdoses claimed the lives of 914 people in 2016 making it the deadliest overdose year on record, an increase of nearly 80 per cent compared to the previous year. Opioid overdoses resulted in 343 deaths in Alberta in 2016, up from 257 in 2015. On November 18, 2016, the Federal Minister of Health Dr. Jane Philpott and the Ontario Minister of Health and Long Term Care Dr. Eric Hoskins convened a national conference to address Canada’s growing opioid crisis. Commitments were made by federal and provincial/territorial organizations focusing on the prevention, treatment and reduction of harm associated with problematic opioid use. For guidance on breakthroughs in health technologies, governments, healthcare organizations, clinicians, and patients turn to CADTH – an independent, not-for-profit agency that delivers balanced evidence on drugs and medical devices. At the November national summit to address Canada’s growing opioid crisis, CADTH made a commitment to identify best practices and provide evidence-based recommendations, advice and tools focused on both pain management interventions (drug and non-drug), and the treatment of opioid addiction.

New resources Opioids and pain management are two topics where significant work is underway at CADTH. This leads to a wealth of assessments, advice, recommendations, and tools, which are all

available for use by healthcare professionals, patients, and governments. We have gathered all these resources together in topic-specific evidence bundles. For the latest evidence on opioids, go to Categories include Pain Treatment; Misuse, Overdose, and Harms; Addiction Treatment; and Alternatives to Opioids. Here you will find our 2017 report Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness which indicated that there is no evidence that other opioids are superior to buprenorphine for treating chronic non-cancer pain. Another example is the fall 2016 report Buprenorphine/ Naloxone Versus Methadone for the Treatment of Opioid Dependence which can be found under Addiction Treatment. This report suggested that buprenorphine/naloxone is a safe, effective, and cost-effective choice for treating opioid use disorder compared with methadone. The effective treatment of opioid use disorder is one of many strategies that will help to address the opioid crisis in Canada. Many other examples of alternatives to opioids are profiled at www.cadth. ca/opioids. One of the most common medications for treatment of acute pain – from muscles, ligaments, tendons, joints or bones – are non-steroidal anti-inflammatory drugs (NSAIDs). Topical NSAIDs were shown to be effective in reducing pain from acute musculoskeletal conditions, such as sprains, strains or sport injuries. Adverse events were rare and usually related to skin reactions. Emerging technologies are also profiled. An implant placed underneath the skin may offer a new treatment option for certain people coping with opioid addiction. The Probuphine

implant, the first of its kind, uses four rods placed underneath the skin on the upper-arm to deliver a constant, non-fluctuating dose of the drug buprenorphine, for up to six months at a time. It is intended for patients who are ‘clinically stable’ on low-to-moderate doses of the same medication, taken in the form of a pill or a film dissolved in the mouth.

The latest evidence on pain management At, we have compiled evidence on the management of pain – both acute and chronic. This includes pharmacological treatments (such as gabapentin), physical therapies (such as shockwave therapy), psychological therapies, and multidisciplinary treatments. Physical Therapy Treatments for Chronic Non-Cancer Pain (including a discussion of acupuncture, massage, and yoga) and Behavioural and Psychological Interventions for Chronic Non-Cancer Pain (including a discussion of Cognitive Behaviour Therapy) are but two of the reports found here that were published in the last six months. Evidence is available at www.cadth. ca/pain on treatments for chronic pain

that do not involve medication and that patients can use in their own homes. One such technology is transcutaneous electrical nerve stimulation or TENS where electrodes are placed on the skin around the area of pain. The area is then stimulated with low-voltage electricity usually for 30 minutes up to an hour, twice each day. The available evidence (see the CADTH report published in December 2016) does not prove that it works, but it also does not prove that TENS in the home does not work. In order words, it is unclear how effective TENS in the home may be for chronic pain and we need more evidence.

Additional resources are being developed Both the opioid and pain resources will be updated regularly with more evidence, including rapid evidence reviews (Rapid Response Reports), Environmental Scans, and our larger Optimal Use projects with expert recommendations, as they are completed. To learn more about CADTH and the evidence we offer to help guide health care decisions in Canada, visit, follow us on Twitter @CADTH_ACMTS, or speak to a CADTH liaison H officer in your region. ■

Jonathan Mitchell, M.Sc., CHE, FISQua is a consultant for CADTH’s Knowledge Mobilization and Liaison Program. 38 HOSPITAL NEWS MAY 2017


Understanding pain Continued from page 37 O’Keefe-McCarthy graduated from George Brown College in 1982 and spent her early career in various roles at Toronto General Hospital (now part of UHN). She learned the value of mentorship right from the start, receiving guidance from veteran nurses, and serving as preceptor to others just beginning their careers. “I’ve not gotten anywhere without the help of others,” she says. “So I love to share the wealth.” In 1989, she was hired in the intensive care unit at Ross Memorial, where she still practises to this day. The majority of her patients over that time have suffered from cardiovascular ailments, and she found nearly all of them had one thing in common: pain. “I don’t like to see patients suffer with pain,” she says. “(It) really drives me out of my mind.”

THE FIRST STUDY TO EXAMINE CARDIAC PAIN AND ASSOCIATED ANXIETY IN THE FIRST HOURS OF AN EMERGENCY HOSPITAL ADMISSION FOR CHEST PAIN. Despite its prevalence, O’Keefe-McCarthy found pain is largely misunderstood by health-care professionals, and she yearned to do more for her patients. She knew pursuing higher education was the best path toward that goal. She completed her nursing degree in Ryerson University’s post diploma program in 2004, then earned her master of nursing at the University of Toronto (U of T) in 2007. Inspired by her clinical practice, her doctoral research for U of T – completed in 2013 – evaluated health professionals’ knowledge and attitudes around cardiovascular pain management. This

research, conducted at Ross Memorial, was the first study to examine cardiac pain and associated anxiety in the first hours of an emergency hospital admission for chest pain. From this research, she found a correlation between pain and anxiety – when anxiety increases, pain often does the same. “That was a very important thing,” she says. “It’s a major opportunity for clinical education.” O’Keefe-McCarthy’s findings earned her the Award of Merit for Outstanding PhD Thesis from Sigma Theta Tau International in 2014.

Now an assistant professor at Brock University in St. Catharines, her research delves even deeper into cardiovascular pain and symptom management. She is also developing an iPhone app for patients and health professionals to monitor heart pain and anxiety. In the classroom, she teaches students that nursing requires both academic and emotional intelligence – just as her mother imparted to her many years ago. “Giving (students) the knowledge, skills and abilities to be the best they can be is really thrilling,” she says. While her CV is filled with accolades, including two RNAO Recognitions Awards, O’Keefe-McCarthy says her goals have always been simple: to improve clinical practice for the sake of patients. “Am I going to change the world? Probably not. But I may help at least one person have a better experience… And H that’s what motivates me.” ■

Daniel Punch is staff writer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the January/February issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO).


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The need for a national affordable and supportive housing strategy for seniors By Daniel Levac sk any senior where they would prefer to live and the answer you will likely receive is – at home – with family and loved ones. Unfortunately, given the changes to our demographics, this will not be an option for some. In this day and age, with the steadily increasing cost of healthcare and the limited new tax dollars being invested in our healthcare system, it is more crucial than ever for hospitals and healthcare organizations across Canada to treat patients at the right place, at the right time, with the right provider and at the right cost. Hospitals continue to be overwhelmed with alternate level of care (ALC) patients. The average waiting list for long-term care (LTC) homes in Ontario is currently up to two years, which means that people are waiting in hospitals and have to find interim solutions until a LTC bed becomes available. To address the ALC crisis, the Ontario provincial strategy was mandated to promote aging at home through the Home First Philosophy as opposed to adding more LTC beds to the overall system. At Bruyère, we believe that keeping seniors in the community for as long as possible and providing them with the required supports to remain healthy and well must be a priority. This is why we recently submitted a motion through The Great Canadian Healthcare Debate for the federal Ministry of Health and the Ministry of Infrastructure and Communities to develop a joint affordable and supportive housing strategy for seniors, focused on community living. It is a unique opportunity for us to address one of the most pressing issues facing our healthcare system. We have been advised that our motion has made the cut for the top 10. As the process continues, we hope to have the opportunity to debate and pass policy resolutions that will help improve the Canadian healthcare system for everyone. Keeping and supporting seniors in their home for as long as possible before


Daniel Levac

THE AVERAGE WAITING LIST FOR LONG-TERM CARE (LTC) HOMES IN ONTARIO IS CURRENTLY UP TO TWO YEARS they rely on institutional care frees up acute care beds for those who need it and reduces wait times for admissions to LTC. It would save the system money while significantly impacting the quality of life of seniors, who would remain more active and involved in their community. Hospital patients waiting for LTC are not stimulated through social activities as they would in a proper assisted living setting or a LTC home. We feel there is an urgent need for national and provincial leadership to

create community-based living models for seniors to address the ALC crisis and the excessive wait times for LTC beds. The largest impediment to address this is housing affordability. The World Health Organization states that there are many determinants that impact health, one of them being housing. In fact, “evidence of health impacts focus on improvements in housing and improved mental health and general health”. Furthermore, providing affordable and supportive housing is highly cost

effective. Acute care costs $1,000 per day whereas home care only costs a fraction of that amount, at $50 to $70 per day – a 93 per cent saving. This approach also supports dignity, autonomy, as well as mental and physical health. By providing support with activities of daily living, many people would happily be able to remain in their home and maintain a healthy lifestyle. Another important health determinant is socialization and the avoidance of loneliness. A successful national affordable and supportive housing strategy must be embedded in a philosophy of community living. There are thriving communities across Canada that are wonderful examples of this innovative approach, both in the for profit and not-for-profit sectors. Seniors are living within a care continuum where they can get varying levels of care and services depending on their needs. Many of these communities allow people to maintain their independence and remain involved in decision making about their care for as long as possible. They also allow couples requiring different levels of support to continue living in the same setting, where one person lives in independent living and the other, in a LTC home on the same site. Our own Bruyère Village and The Perley and Rideau Veterans Health Centre Village are excellent examples of this model in action in Ottawa. Both are not-for-profit organizations that provide different levels of housing (independent living, assisted living and LTC on one site), with affordable housing built within the model. There are also provisions to care for seniors with mild to moderate dementia in a community setting within a concept called cluster living. As a leader in seniors’ health, Bruyère will be relentless in its advocacy efforts for a national affordable and supportive housing strategy for seniors. After all, our vision is to enhance lives H and transform care. ■

Daniel Levac is President and CEO, Bruyère Continuing Care. 40 HOSPITAL NEWS MAY 2017


How one Toronto hospital is taking action on


By Erica Di Maio magine it’s your vacation and you arrive at your sunny destination only to be told your room isn’t ready. You sit in the lobby, watching the clock, feeling discouraged as minutes turn into hours, then days, and the waiting area becomes increasingly over-crowded, noisy, chaotic, and you can’t find an employee who can tell you when the waiting will end. Now, imagine if rather than a tropical resort it was a hospital emergency department (ED), and the waiting was in a hallway and lasted several days. This is the reality for many Ontarians – and for hospitals across the country who experience critical overcrowding and heavy emergency resource demand.


Managing a 24/7 complex operation The ability to manage fast-paced, complex operations is critical to the success of patient safety and patient care delivery at a large, academic, multi-site healthcare institution. A number of unexpected events including a flu outbreak, people experiencing complications after surgery, a surge in ED visits or performing a large number of transplants in a few days can impact the organization’s operations and the most effective processes need to be in place to accommodate these shifting needs. To address this, the University Health Network’s (UHN) Lean Process Improvement team led a rigorous two-day workshop earlier this year

including more than 80 UHN leaders and team members across four hospital sites and many disciplines – including nurses, physicians, professional practice, supports services and more – to begin the development of an Overcapacity Protocol action plan. Executive Vice President (EVP) and Chief Operating Officer, Mike Nader, and Dr. Charlie Chan, EVP and Chief Medical Officer at UHN are spearheading efforts to optimize clinical operations and recognize that while changing practices and organizational culture is difficult, it’s also necessary for sustainability.

“This work directly supports our focus on caring safely and team engagement,” Mike says. “Healthcare is generally a reactive culture. When we shift from a reactive to proactive culture, we release more time for our staff to focus on the needs of the patient.” “We need to have more efficient processes in place to ensure the right patient is in the right location, being cared for by the most appropriate experts. We should admit patients who need our specialized acute care service. However, those who do not should be treated and supported in their transition back home and into the community.” Continued on page 44

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Surgical safety is a shared responsibility By Dr. Lorraine LeGrand-Westfall


he effectiveness and safety of surgery has steadily improved over the last many decades in Canada. Despite these significant advances in surgical care, patient safety incidents do sometimes occur. With over one million surgical procedures performed annually in Canada, there remains a commitment for ongoing quality improvement. At its core, surgical care is about teamwork. It occurs in a highly complex environment that requires finely-tuned processes and tools, and skilled individuals who collaborate and communicate in the best interests of the patient. Much like Formula 1 racing is about more than just driving the car, surgical care is about more than just the procedure. In Formula 1, hundreds of people make up the team including technical and commercial experts, designers, aerodynamicists, R&D, mechanics and more. Similarly, surgical care relies on a team of highly skilled physicians, nurses, anesthesiologists, and operating room personnel working together to manage a highly complex and dynamic environment. The tools and technology employed are incredibly sophisticated. Training is crucial, particularly as technology and procedures are constantly evolving. No step is too small

in terms of preparation, coordination, checking, double-checking, clarifying expectations, and managing potential obstacles and a changing environment. Collaboration and clear communication between team members, all while keeping the patient at the center, are essential to ensure safe delivery of care. A recent detailed review of medicallegal cases in Canada between 2004 and 2013, explored the issues related to surgical care safety incidents. This review was conducted by The Canadian Medical Protective Association (CMPA) and the Healthcare Insurance Reciprocal of Canada (HIROC), who combined their medical-legal data related to surgical safety incidents collected over that 10-year span to produce a retrospective analysis. The two organizations, along with the Canadian Patient Safety Institute (CPSI), are now using the findings to advocate for extensive system and practice improvements. In their analysis, the organizations identified 1,583 CMPA and 1,391 HIROC medico-legal cases involving an in-hospital surgical incident. Peer expert reviews identified system and provider issues in 53 per cent of CMPA and 49 per cent of HIROC surgical incidents. Almost two-thirds of cases involved non-oncology/non-trauma

repairs or excisions (e.g. inflammation and infection). Trauma-related care represented 12 per cent of CMPA and three per cent of HIROC datasets. Oncology-related cases represented 14 per cent of CMPA and eight per cent of HIROC datasets. Patient harm (i.e. physical and psychological outcomes) involved injury to organs, blood vessels or nerves; wrong surgery (wrong body part, patient, procedure); unintended retained foreign bodies; hemorrhages; or burns. Retained foreign bodies or wrong surgery were identified in 12 per cent of CMPA and 18 per cent of HIROC surgical safety incidents. System factors, including an inadequate, or non-adherence to a surgical safety protocol, were also found to be key contributors to surgical safety incidents.

Learning from the analysis CMPA and HIROC delivered a number of recommendations to address system, physician, and other healthcare provider factors. Some of these included: • Implementing standardized protocols (e.g. surgical safety checklist) to support inter-disciplinary team situational awareness (i.e. keeping track of what is happening and anticipat-

ing what might need to be done) and improve verification practices (e.g. patient, site, procedure, and count). • Performing a comprehensive patient assessment, and obtaining and documenting an informed consent. • Adopting strategies to identify and mitigate cognitive biases. • Ensuring all standard and non-standard items are counted (e.g. sponges, towels, packing, needles, instruments, and items “too large/ obvious” to be left behind); separate the sponges to view them concurrently; ensure all new items added during surgery are documented. • Employing self-reflective practices to allow for clinical improvement and shared learning. The CMPA believes that improving surgical safety culture requires the cooperation and commitment of the entire healthcare team in the adoption of reliable care processes and continued practice improvement. All healthcare professionals need to be engaged and advocate for the development of safe systems of care. The report, Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data, is available at: tem-and-practice-improvement. ■

Dr. Lorraine LeGrand-Westfall is a surgeon and Chief Privacy Officer and Director, Regional Affairs with the CMPA. We would like to acknowledge the contributions of HIROC and CMPA’s Medical Care Analytics team. 42 HOSPITAL NEWS MAY 2017


New Canadian-developed ablation procedure provides pain relief to patients with

spinal tumours

By Melicent Lavers-Sailly ain relief is an important clinical challenge for managing skeletal metastases (cancer that has spread to the bone). In 2016, an estimated 202,400 Canadians developed cancer. Metastatic bone disease occurs in 60 to 80 per cent of cancer patients, most frequently among those whose cancer originated in the breast, prostate, liver, and lung. In addition, 70 per cent of metastatic bone cancer patients develop at least one lesion in the spine. Bone metastases can cause severe pain, bone fractures, spinal cord compression, and hypercalcaemia – all of which can degrade a patient’s


METASTATIC BONE DISEASE OCCURS IN 60 TO 80 PER CENT OF CANCER PATIENTS. quality of life. Studies indicate that the most frequent complaint for 79 per cent of patients with skeletal metastases is pain associated with the disease. That pain is usually progressive and significantly reduces quality of life. The gold standard for palliative care of painful bone metastases is radiation therapy (RT); however, it does not work for everyone. RT reduces pain by half for only 40 per

cent of patients with skeletal metastases; while 30 per cent will still be in pain. In addition, it can take anywhere from seven to 10 days for RT to start reducing bone pain, and may take up to six weeks before the patient feels the full effect. Exposure to radiation is also a concern – it progressively degrades the strength, ductility, and toughness of the bone tissue leading to an increased risk of fractures. More spe-

cifically, conventional RT has been shown to increase the risk of vertical compression factors by five per cent, while SBRT (stereotactic body radiation therapy) can increase that risk by up to 39 per cent. Health Canada recently licenced a procedure that promises to play a significant role in addressing the pain associated with bone metastases for these patients. Known as the OsteoCool™ Bone Radiofrequency Ablation system, it was designed, developed and is manufactured in Canada by Baylis Medical. Medtronic acquired the technology in 2015 and together they have partnered to further innovate the system. Continued on page 45


Functional Neuromodulation Techniques in

pain management By Dr. Alejandro Elorriaga Claraco


ain related problems continue to consume great amounts of healthcare resources with only marginal improvements in the overall rate of clinical success, particularly in the area of chronic pain. The main reason for this situation is the complex nature of chronic pain, when the unpleasant feeling has expanded beyond the sensory cortex to affect other areas of the brain, particularly those dealing with emotion and cognition (thought). As a result, chronic pain patients suffer a wide array of dysfunctions at the psychoemotional, psychosocial, behavioral, metabolic, endocrine and immune system levels. So far, pharmacological and surgical approaches have provided benefits only to a relatively small number of cases, while having contributed along the way to create a national “opioid crisis” due to the addiction and adverse effects of these drugs in patients taking them on an ongoing basis. The solution to chronic pain? Neither easy nor singular, but definitely includes more knowledge about the nature of the problem. According to current evidence, the most effective tool we currently have to deal with chronic pain conditions is the Multidisciplinary Pain Management approach, with over 40 peer reviewed scientific papers published in the last decade supporting this model. Multidisciplinary pain management programs are based on the bio-psycho-social model, and integrate different physical and psychological treatment approaches by an interdisciplinary therapeutic team. High treatment intensity (mean 27 hours per week) is important and, according to research, interventions of less than 100 hours are not sufficient to show improvements for patients suffering from disabling low back pain. The focus of the treatments is to help patients to self-manage their condition. To validate this approach, here is one of the

MULTIDISCIPLINARY PAIN MANAGEMENT PROGRAMS ARE BASED ON THE BIO-PSYCHOSOCIAL MODEL, AND INTEGRATE DIFFERENT PHYSICAL AND PSYCHOLOGICAL TREATMENT APPROACHES BY AN INTERDISCIPLINARY THERAPEUTIC TEAM recommendations from the American College of Physicians, just published in February 2017: “For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.” Interestingly, many of the recommended techniques seem to work by leveraging physiological mechanisms of neuromodulation, a well-known property of the nervous system to regulate its own activity in response to internal and external stimuli. Based on this, we can name these techniques collectively “Functional Neuromodulation Techniques” (FNT). Some FNT involve the use of fine solid needles, such as electro-acupuncture, traditional acupuncture, and dry needling, and research from the last decade has validated its use not only for the treatment of pain but also for other conditions in which the nervous system function has been impaired. One important discovery from recent years has been the lasting effects of these treatments for pain problems. A recent review by Prof Hugh MacPherson (University of York, UK) concluded that “...acupuncture has benefits that extend over a longer period than was previously thought. Short courses of acupuncture, 10 to 12 sessions

commonly provided on a weekly basis, are associated with sustained benefits lasting one or two years in cases of back and neck pain, and IBS (irritable bowel syndrome)”. For years it has been known that numerous neurotransmitters and neuropeptides are released in the central and peripheral nervous system in response to electroacupuncture stimulation, such as those from the endogenous opioids system, known since the 70’s. In recent years, new chemical substances produced in the body have also been implicated in the analgesic and anti-inflammatory effects of acupuncture, such as the endocannabinoid system or the cholinergic anti-inflammatory reflex that works in conjunction with the potent anti-inflammatory effects of met-enkephalin. Additional mechanisms discovered also include the modulatory effects of acupuncture on the autonomic nervous system which controls our vascular system. This could explain the observed effects on hypertension. According to Prof. John Longhurst (University of California), electroacupuncture applied for 30 mins, once weekly for eight weeks, lowered blood pressure in hypertensive patients after 4-6 weeks for as long as one month after cessation of treatment. In conclusion, ongoing scientific research continues to validate the value of integrating Functional Neuromodulation Techniques such as electro-acupuncture into an effective multidisciplinary pain management H plan. ■

Dr. Alejandro Elorriaga Claraco, MD,is the founding Director (1998) of the McMaster University Contemporary Medical Acupuncture Program and the Advanced Program on Neurofunctional Sports Performance. 44 HOSPITAL NEWS MAY 2017

Overcapacity Continued from page 41

At the two-day workshop, healthcare teams extensively examined and debated their current practices – first by site, and then as a UHN collective – to identify and land on triggers that cause the hospitals to go into overcapacity mode. For example, two of four UHN hospitals have emergency departments with a continuous flow of patients being admitted. Therefore, the total number of admitted patients, individuals waiting for ED consults and planned versus unplanned surgeries can all lead to unpredictable surges in patient volumes. Once triggers were identified, escalation levels were established to indicate actions and resources required by interdisciplinary teams to meet the demands of the hospital – level one being low risk, standard operating levels, and four meaning the hospital is at critical risk of not being able to safely support patient volumes. The OCP also supports staff in de-escalating appropriately when the hospital has come out of overcapacity and needs to close beds and get back to regular state.

‘We can and need to change how we do things’ UHN’s Overcapacity Protocol soft launched in April using OCP levels and triggers to communicate patient volumes and launch into specific actions as hospitals shift from low, medium, high and critical risk. As the work is being trialed across units, UHN will use best practices and key learnings to formally launch OCP in the coming months. “We need to do better by our patients,” says Brenda Kenefick, Director, Lean Process Improvement at UHN. The ‘overcapacity’ practice has become normalized for many hospitals and we need to reset the standard.” “Our hospitals are bursting at the seams. Our teams are doing their best to keep up the pace to care for our patients, but we need better processes in place to support them. We can and H need to change how we do things.” ■ Erica Di Maio communications advisor at University Health Network.

FOCUS The OsteoCool™ Bone Radiofrequency Ablation system.

Spinal tumors Continued from page 43 RF ablation delivers targeted radio frequency (RF) energy consistently to a tumour, creating frictional heat that kills the cancer cells. The procedure is commonly used to target soft tissue metastases, but less widely used on bone cancer – and in particular spine metastasis – because of the potential risk of damage to nerve tissue and/or the spinal cord itself. OsteoCool was specifically developed to maximize the ablation of bone metastasis. It is a minimally interventional technology that can be used in an operating room setting under sedation, or with a local anaesthetic.

Through a small incision, imaging is used to guide thin tubes (cannulas) to the affected site in the patient. Small, water-cooled, bi-polar probes are then inserted, and temperatures are increased up to 70°C at the distal tip for a pre-set time. Where required, cement can then be injected into the ablated area to stabilize the bone

and reduce the risk of fractures. When combined with RT, Radiofrequency Ablation has been shown to deliver greater pain relief in a shorter timeframe. Up to 95 per cent of patients with spinal tumours having both experienced a decrease in pain that was considered clinically significant; furthermore, opioid use decreased significantly at

Melicent Lavers-Sailly is the PR & Corporate Communications Manager at Medtronic Canada.

eight to 12 weeks. Complete pain response at 12 weeks was 16.6 per cent with RT alone, and 53.3 per cent with RFA + RT with no increase in analgesic intake. The pain and discomfort associated with bone metastasis and spinal tumours have long presented a significant challenge for palliative care professionals. Fortunately, newer specialized technologies are proving effective in bringing relief to patients, and hopefully, improving their quality of life during an extremely difficult time in H their lives. ■


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Helping to relieve worry for those with suspected

prostate cancer By Amanda Jackman


he time from suspicion to diagnosis is a complex and important phase of the cancer journey. It is characterized by the need for many tests and consultations and can create anxiety and stress for patients and families. St. Joseph’s Hospital is pleased to welcome the Prostate Diagnostic Assessment Program (PDAP) which has consolidated all prostate biopsy procedures to St. Joseph’s Hospital. This improved system of care will provide timely access to high quality diagnostic services, accelerate treatments, reduce wait times, and enhance quality of life throughout the assessment of prostate cancer. Medical, surgical and radiation treatment will continue to be provided at decentralized sites within London, including London Health Sciences Centre (LHSC). On November 29, staff from St. Joseph’s and LHSC celebrated the official grand opening of the new PDAP located at St. Joseph’s Hospital. Staff who were integral to the launch of the program were praised by Neil Johnson, VP at LHSC and Karen Perkin, VP at St. Joseph’s for their dedication to the planning and the commitment to make this much needed service available to the community.

Don Park, a patient who was diagnosed with prostate cancer understands first-hand the fear that people experience with the suspicion of prostate cancer. Don was a contributor to the project and shared his personal story at the opening. “I understood the patient perspective at every stage of the diagnostic process and recognize those involved with the PDAP were trying to alleviate stress and anxiety at every touch point.” Don, who experienced the old system, shared his difficult experience. “It took 21 weeks from my family doctor’s recommendation to get a PSA test because my prostate seemed enlarged, to confirmed diagnosis by a urologist. “The tension and worry grew each week thinking about the unknown and fearing the worst,” says Don. “It seemed to take forever to move to each next step.” Don was in a “mental shock” when he was told her had serious prostate cancer and if left untreated he would only have five to seven years left to live. “To be told there is a real ‘end-of-life’ possibility with a probable time line is mind numbing.” “My experience was incredibly difficult but because of it, I was able to help the development of the PDAP project.


Providing personalized

bereavement care Members of the project team officially open the PDAP. Left, Jane Van Bilsen, South West Regional Cancer Program; Dr. Hassan Razvi, St. Joseph’s Health Care London; Ann Bornath, St. Joseph’s Health Care London; Don Park, Patient; Karen Perkin, St. Joseph’s Health Care London and others.

At various stages of the PDAP development I was asked for my feelings and opinions as a patient. No matter what the professional expertise was around the table I was genuinely listened to and my thoughts and opinions were used in the creation of the program. “This new program will help others experience less stress and anxiety though their process.” It was through the collaboration of many key stakeholders and donor support, which made it possible to purchase key equipment and enhance the program’s space, which made the PDAP a reality – providing better access to care for those who are suspected of prostate H cancer. ■ Amanda Jackman is a Communication Consultant at St. Joseph’s Health Care London.

By Evelyne Jhung hen Jessy Mathai, an oncology-hematology social worker, joined the Palliative Care Unit team a few years ago, she would often get referrals for families whose loved ones had just passed away. But because the Palliative Care Unit was one of three areas she was covering, she couldn’t always connect with the family in a timely manner. “I wanted caregivers to be able to access bereavement support whenever they needed it from any member of the healthcare team,” says Mathai. Mathai and Sheila Deans-Buchan, a nurse practitioner on the Palliative Care Unit, set about creating a bereavement risk screening process in response to the lack of a formal bereavement care program. “A couple of years ago, we realized we didn’t fully understand what the Bereavement Program, as it was called, really meant,” says Deans-Buchan. “Volunteers were mostly spearheading that type of work – for example, making followup calls and sending condolence letters to friends and family – with little staff involvement.” Since then, accountability has transferred from the volunteers to staff, and all staff can be involved. Bereavement care doesn’t just fall



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on the shoulders of a social worker or spiritual care staff member. The screening tool helps staff identify in advance who would want or need followup. It is a set of 15 yes-or-no questions divided into three themes – psychological, social and circumstances of illness or death – that any member of the care team can fill out based on knowledge or observation of the patient’s family or caregiver. The result is more individualized and effective bereavement care.

Evelyne Jhung works in communications at St. Michael’s Hospital.


Working Environment

Photo credit: Yuri Markarov, Medical Media Centre

Sheila Deans-Buchan, an NP on the Palliative Care Unit, completes the bereavement care screening questionnaire after meeting with the family of a patient.

“A family member or friend who would be considered at high risk and needing followup would be someone who is unaccepting of the illness; is experiencing family conflict; and where the patient is younger and with a new or sudden onset diagnosis,” says Mathai. “This is someone who needs more than a phone call; we would make a referral to a family doctor or psychologist or external bereavementgrief organizations.” Included in the bereavement care pathway is providing support to caregivers before their loved one dies. For example, the care team holds meetings for every patient where family members are given an update, asked how they’re coping and whether they need help with funeral planning. The team also has daily interactions with family members at the bedside. For children, members of the team provide grief resources and connect with the child’s school, if necessary. “Families were grieving but because they weren’t under our care, we had no way of providing therapeutic care for them,” says Deans-Buchan. “With our new bereavement risk screening process, any member of the care team can provide families and caregivers with appropriate and individualized H support.” ■

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