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Canada’s first C. difficile dog

Onlin Online ne educ education cat

FOCUS IN THIS ISSUE

EMERGENCY SERVICES/TRAUMA/ EMERGENCY PREPAREDNESS/ INFECTION CONTROL

www.hospitalnews.com SEPTEMBER 2016 EDITION | VOLUME 29 | ISSUE 9

Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Programs implemented to reduce hospital acquired infections. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious diseases.

INSIDE Ethics .................................................... 4 Evidence Matters ................................. 7 Safe Medication ................................. 14 Legal Update ......................................20 From the CEO's desk.......................... 21 Doctors without Borders .................... 24 Careers ............................................... 31

Emergency preparedness

The Fort McMurray wildfire Story on page 8

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EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

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In Brief

More doctors, but average payments to physicians virtually unchanged

The number of physicians in Canada increased to more than 82,000 in 2015, according to new numbers released by the Canadian Institute for Health Information (CIHI). For the ninth year in a row, the number of physicians increased at a faster rate than the population, resulting in more physicians per person than ever before – 228 doctors per 100,000 population. According to Physicians in Canada, 2015, although total payments to physicians increased by four per cent from the previous year to reach $25 billion in 2014–2015, the average gross clinical payment per physician remained virtually unchanged at $339,000. This amount varied by type of physician specialty: on average, family physicians received $271,000; medical specialists received $338,000; and surgical specialists received $446,000. “Understanding the supply, payments and activities of physicians across the

For the ninth year in a row, the number of physicians increased at a faster rate than the population country helps us to understand not only how many physicians there are and how much we pay for their services, but also how healthcare resources are allocated,” says Geoff Ballinger, CIHI’s manager of Physician Information. “It’s important to realize, however, that the average payment estimates are gross amounts that in most cases include the overhead costs of running physician practices, such as staff salaries, medical equipment and supplies, and office rent.”

Facts and figures

• The number of physicians per person has increased in all provinces since

2011. In 2015, Nova Scotia had the most physicians per 100,000 population (261), followed by Newfoundland and Labrador (243) and Quebec (242). The provinces with the fewest physicians per 100,000 were P.E.I. (181), Saskatchewan (196) and Manitoba (204). • In 2015, nearly 40 per cent of all physicians in Canada were female, up from 36.5 per cent in 2011. • Women represented a larger proportion of family medicine physicians (45%) than specialists (35%). • Based on the number of MD degrees awarded by Canadian universities, the number of physicians is likely to continue increasing. In 2015, Canadian universities awarded 2,817 MD degrees, representing a slight increase from the previous year. Between 2011 and 2015, the number of MD degrees awarded in Canada increased by approximately H 12 per cent. ■

New treatment for high-risk AML patients closer to reality There is encouraging news on the horizon for patients with an aggressive form of blood cancer. A new treatment option, called Vyxeos, has the potential to improve survival among high-risk acute myeloid leukemia (AML) patients. The current treatment regimen for patients with AML has not changed in nearly 40 years. The majority of AML patients are over 60 and their prognosis is poor – only five to 10 per cent surviving five years beyond diagnosis – with little improvement in many years using the current standard of care, particularly for those patients who have high-risk AML. In contrast, Vyxeos, a drug developed by Celator Pharmaceuticals (recently acquired by Jazz Pharmaceuticals), has shown significantly higher survival rates in high-risk AML patients in its final phase of clinical trials. AML is a cancer of the bone marrow and the blood that progresses quickly without treatment. In Canada, about 1,200 men and women are diagnosed with AML every year and the vast majority face a grim prognosis. In March this year, the U.S. Food and Drug Administration put the drug on the fast track for approval by granting Breakthrough Therapy designation to Vyxeos. It has taken a lot of time and resources www.hospitalnews.com

to get Vyxeos to this stage. In 2007, The Leukemia & Lymphoma Society (LLS) in the U.S. established a Therapy Acceleration Program, partnering with biotechnology companies to support clinical trials of investigational drugs, like Vyxeos.

AML is a cancer of the bone marrow and the blood that progresses quickly without treatment. LLS quickly saw the potential of Vyxeos during its preliminary performance at the early stages of clinical trials and in 2009 committed to contribute financially first with Phase two and continuing to Phase three to ensure its completion. Half of the research projects funded by The Leukemia & Lymphoma Society of Canada are focused on AML. “Our adjudication process for awarding research grants is a responsibility shared by a group of world-class researchers who are experts in their respective fields of blood cancer research,” explains Shelagh Tippet-Fagyas,

president at The Leukemia & Lymphoma Society of Canada. Two-year operating grants are awarded every July and the call for applications begin every October. September is Blood Cancer Awareness Month. Visit LightTheNight4bloodcancer.ca to make a donation to The Leukemia & Lymphoma Society of Canada. Donations will be matched, up to $100,000 by iA Financial Group from September 1 H to October 22. ■

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Healthcare funding Nearly three-quarters (74%) of Canadians responding to a public opinion poll conducted for the Canadian Medical Association (CMA) feel that the federal government should provide additional funds to provinces and territories based on their proportion of elderly citizens to help meet growing and evolving healthcare needs. The CMA’s 16th Annual National Report Card on Health Care focused on solutions to address the healthcare needs of Canada’s aging population that could be included in the soon-to-be negotiated Health Accord between the federal, provincial and territorial governments. As the discussions for the new Health Accord draw closer, the survey found that few Canadians (15%) are generally aware of the negotiations between their provincial, territorial and federal governments. Despite a lack of awareness, Canadians generally agree on the funding priorities that should be addressed in the new Health Accord. The top funding considerations are: • A strategy for seniors’ health (84% ranking it either very or somewhat important); • Improved mental health services (83% ranking it either very or somewhat important); • Prescription drugs (80% ranking it either very or somewhat important); • Palliative care (80% ranking it either very or somewhat important); and, • Home care (79% ranking it very or somewhat important).

Canadians grade health care services in Canada

• Seven in ten (73%) Canadians give the overall quality of healthcare services available to them and their families an ‘A’ or ‘B’ grade. Over one third assigns an ‘A’ grade (37%). • When it comes to accessing care in their communities, three in five Canadians grade access to a family doctor as an ‘A’ or ‘B’ (66%). About half (58%) grade access to wellness and preventative care as an ‘A’ or ‘B’. • A higher proportion of Canadians grade access to palliative care in a hospice or hospital as an ‘A’ or ‘B’ (50%) compared to palliative care at home (36%). • About four in ten grade access to home healthcare services (48%) and access to mental healthcare services (45%) as an H ‘A’ or ‘B’. ■

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Ethics

UPCOMING DEADLINES OCTOBER 2016 ISSUE EDITORIAL SEPT 13 ADVERTISING: DISPLAY SEPT 23 CAREER SEPT 27 MONTHLY FOCUS: Patient Safety/ Mental Health and Addiction/Research:

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Hospital discharge: Reaching a breaking point By Jonathan Breslin

here is a systemic issue that gets little attention in the media but is rapidly growing into one of the most significant problems in our Province: hospital discharge. At any given time in an Ontario hospital there are a number of patients who no longer require acute care services and are waiting for discharge to another setting, such as home or long term care. These patients are designated “ALC” for “alternate level of care”. In May 2016, 15 per cent of all Ontario acute care beds were occupied by ALC patients. On June 30, 2016, more than one-third (36 per cent) were waiting for placement in long-term care. An additional 18 per cent were waiting for discharge home, either with or without home care or community services. The statistics vary widely by LHIN. In the North West LHIN, 24 per cent of inpatient beds were occupied by ALC patients in May 2016. On June 30, 64 per cent of ALC patients in the South East LHIN were waiting for long-term care placement. The implications of this data are readily apparent. If 15 per cent of Ontario hospital beds are occupied by people who don’t need them, that’s equivalent to removing 15 per cent of acute care beds from the system. That means 15 per cent fewer beds available for people who do need hospital care. Not only does that contribute to backlogs in emergency departments, but it also results in lower quality care for patients who end up stuck on emergency department stretchers for 36 hours or more. Then we have to factor in the cost to the system (which is paid by all

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ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

Barb Mildon,

RN, PHD, CHE , CCHN(C) VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

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EDITOR

KRISTIE JONES

Why do ALC patients get stuck in acute care beds? There are many contributing factors: the rapidly aging population, the limited and stagnant supply of long-term care beds, the lack of affordable alternatives (such as assisted living facilities and retirement homes), and the increasingly scarce resources available in the acute care system. Another factor is the legislative framework, which requires consent to place someone in long-term care. Of course that requirement exists for good reason: to protect some of our most vulnerable citizens from being forced into facilities against their wishes or isolated from loved ones by being placed in facilities where their loved ones are unable to visit.

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System

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In some cases patients can be discharged into a home setting but family members don’t feel safe with the patient at home and/or can’t afford to hire the necessary private home care services to support the patient at home. In other cases the substitute decision makers (typically family members who have legal authority to provide consent on behalf of a mentally incapable patient) have specific preferences for long-term care homes, which can result in the patient being on very lengthy waitlists. Not infrequently this leads to a stalemate, with ALC patients occupying beds for weeks, months, and in extreme cases, even years. The systemic factors listed above won’t change any time soon so we (hospital staff and families) need to figure out how to work collaboratively in the best interests of patients. As hospitals there are things we could do better to improve the process. We could do a better job of identifying and working to address the concerns of families and other potential barriers to discharge early in a patient’s hospitalization. We could also do a better job of providing meaningful information to family members to explain the complex system. We need to conduct more research on the impact of hospitalization on the frail elderly and do a better job of sharing the evidence that already exists – evidence showing that for the frail elderly, staying in hospital longer than absolutely necessary is actually the worst thing for H their health and well-being. ■ Jonathan Breslin PhD, is an Ethicist for Southlake Regional Health Centre and Mackenzie Health.

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

Akilah Dressekie,

Ontario Hospital Association

David Brazeau

STEFAN DREESEN

editor@hospitalnews.com

PUBLISHER

HOSPITAL NEWS SEPTEMBER 2016

If 15 per cent of Ontario hospital beds are occupied by people who don’t need them, that’s equivalent to removing 15 per cent of acute care beds from the system.

ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO

denise@hospitalnews.com

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of us as taxpayers): the cost of a hospital bed runs an average of $800/day, while the cost of a long-term care bed or home care is a fraction of that. Do the math: as of June 30, 2016, there were a total of 2765 ALC patients occupying acute care beds in Ontario at an average cost to the system of $800/ day ($ 2.2 million dollars per day).

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EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus

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Code Stroke saves precious minutes By Lindsay Smylie Smith he morning started out for Robert (Bob) Collins like any other. Bob was getting ready to get coffee when his arm felt strange. “I felt kind of funny – so I leaned against the table,” he remembers. “It seemed to pass and I felt ok.” Bob continued to his bedroom and sat on the bed to get dressed. The next thing he knew he was falling right onto the hardwood floor. Bob says his first thought was to try and get up. “I couldn’t understand what had happened,” he says. But Bob’s wife Sharon did – and she knew exactly what to do. “I yelled to him to stay where he was and I got the phone to call 911,” Sharon says.

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Time is brain

Shelley Hawton, District Stroke Coordinator at the North Bay Regional Health Centre says Sharon did the right thing by calling 911. “We say ‘time is brain’ because it is estimated that for each minute that passes during a stroke, 1.9 million brain cells die,” Hawton says. “That is why it is so important for people to recognize the signs of stroke, and to call 911.” The Heart and Stroke Foundation of Canada has adopted the use of the acronym FAST to help people learn and recognize the signs of stroke. F – Face: is it drooping? A – Arms: can you raise both? S – Speech: is it slurred or jumbled? T – Time: to call 911 right away. Jim Stewart, Manager, District of Nipissing Paramedic Services says in addition to providing immediate emergency medical care during safe rapid transportation, paramedics are critical to stroke care and essential to help save precious minutes when dealing with a potential stroke. “There is an expertise our paramedics bring to the critical first moments after a stroke, which is why calling 911 when you suspect a stroke is so important,” Stewart says. “Paramedics across the region are trained to determine if a patient should be brought directly to a stroke centre rather than their local hospital. Also they are notified if the CT scanner is down and can re-route patients to another hospital, potentially saving even more time.” The paramedics who arrived at Robert and Sharon Collins’ house that morning initiated a Code Stroke.

Code Stroke

Hawton says staff have been working hard to align stroke care at the Health Centre with the Canadian Stroke Best Practice Recommendations. “Most notably is the launch of our Code Stroke process in the Emergency Department in February 2016,” Hawton says. Code Stroke means hospital personnel and stroke team members are ready to start diagnosis and treatment of a potential stroke as soon as the patient arrives at the Emergency Department. A Code Stroke patient is prioritized for things like lab tests and the CT scanner. “This new process involves multiple hospital departments who collaborate to ensure patients experience a seamless journey with minimal time wasted,” Hawton explains.

Door to needle time

Bob Collins and his wife Sharon (centre) are joined by Emergency Department RN Jean Durnford and Shelley Hawton, District Stroke Coordinator. experiencing a stroke. The North Bay Regional Health Centre is one of five hospitals in northeastern Ontario equipped to provide the ‘clot-busting drug’ to stroke patients meeting the criteria for the treatment. Hawton explains door-to-needle time is a term given to the time from arrival to the Emergency Department to the time TPA is given. “Our aim is to have a doorto-needle time under 60 minutes,” Hawton says. Bob’s door to needle time was 36 minutes. By the time Sharon arrived at the hospital, the tests were completed and the Emergency Department physician, Dr. Derrick Yates, had contacted a stroke neurologist by video conference who confirmed Bob was a candidate for TPA. Bob remembers the feeling of paralysis take over his right side. “I couldn’t move at all,” he says, “and it was starting to affect my vision too.”

Time was of the essence – they had to decide quickly if they wanted the TPA. “I looked over at Bob and said ‘do you want this’ and he nodded. So we went for it,” Sharon says. Jean Durnford, RN was Bob’s nurse while he was in the Emergency Department. Bob says Jean was an important presence to him. “She was the first one I saw as I was recovering,” Bob says. “She was so kind and was able to put me at ease.” Within half an hour Bob’s paralysis lifted: he could see again, he could move his arm, move his leg, everything. He said it was amazing. Jean remembers watching the TPA take effect. “He had total paralysis on one side, and to see a complete resolution was so rewarding,” Jean remembers. “It’s nice for us to see cases like Bob’s, it reminds us why we are here.” Bob says Jean’s excitement was a motivator for him. “Watching her excitement

made me feel really good – she inspired me to keep going.”

Recovery

Bob was admitted to the Critical Care Unit (CCU), and is proud to say he was able to walk himself out three days later. “They tell me that doesn’t happen very often,” he says. Now back at home, he works hard at his recovery, participating in the hospital’s outpatient programs. Bob and Sharon are so thankful to everyone who helped them that day, and actually returned to the hospital to share their gratitude in person. “From the paramedics, Emergency, CCU and physiotherapy staff, my wife and I are so grateful to everyone who helped us with my recovH ery,” Bob says. ■ Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre.

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TPA is a clot busting medication that can be given to some patients who are www.hospitalnews.com

SEPTEMBER 2016 HOSPITAL NEWS


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Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Canada’s first C. difficile dog

Teresa’s husband, Markus Zurberg, is a Quality & Patient Safety Coordinator for Vancouver Coastal Health, which takes infection control seriously. Vancouver Coastal Health has implemented a number of measures to combat the spread of antibiotic-resistant organisms and has won national and international awards for this innovative work. It was the first health authority in Canada to utilize ultraviolet light to supplement the disinfection process, clean equipment is tagged and barcoded to ensure routine inspections and maintenance are performed, and Vancouver Coastal Health participates in voluntary as well as mandatory provincial surveillance programs. Angus will be a great addition to this comprehensive infection fighting team.

By Carrie Stefanson ogs can do amazing things from hunting down criminals to sniffing out drugs. But Angus, a two-year old English springer spaniel, is a detection dog like no other. Angus has officially passed all of his training to detect C. difficile or C.diff, a superbug that attacks people whose immune systems have been weakened by antibiotics and the most common cause of infectious diarrhea in hospitals and long-term care facilities. “We strive to continue to find ways to provide better care, and sometimes the answer is not more technology, but instead, man’s best friend,” says Health Minister Terry Lake.

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Angus can find C. diff in areas of the hospital that would otherwise go unnoticed to the naked eye.

Angus after work

Perfect for the job

Angus has been training for the past year-and-a-half and is now ready to begin working at Vancouver General Hospital. “We’re thrilled to have Angus join our infection fighting team in the battle against C. diff,” says Dr. Elizabeth Bryce, Regional Medical Director Infection Control, Vancouver Coastal Health. “We recognize Angus is still young and building up his stamina, so we’re exploring several options for his deployment.” Angus has been issued hospital ID, and could be working this fall. Angus can find C. diff in areas of the hospital that would otherwise go unno-

Angus, the superbug sniffing dog with owner Teresa. ticed to the naked eye. Finding these hidden reservoirs is crucial to eradicating C. diff. Once the bacterium is detected, the area or patient room is cleaned with a state-of-the-art UV light disinfecting robot that removes 99.9 per cent of the C.diff spores.

An idea was born

Teresa is all too familiar with the consequences of C.diff. She became infected

after being treated for a gash on her leg. She lost 20-pounds and spent a week in hospital. “It was awful, I almost died” she says. Her experience with C. diff and her background as a certified trainer of bomb-detecting and drug-detecting dogs prompted her to search far and wide for a suitable K-9 partner. Angus, who hails from Montana, was the perfect fit. Vancouver General Hospital was a natural hospital to approach because

When he isn’t working, Angus likes to hang out with Roger Dodger, the Zurberg’s other spaniel. He has also taken up the sport of dock-diving and, after much coaxing managed to convince his owners to purchase a backyard pool. Angus has many friends and is garnering significant media attention. You can follow his adventures on his Facebook page. *Angus is the first CERTIFIED C-Diff dog in Canada (there’s another in H training). ■ Carrie Stefanson is a Public Affairs Officer at Vancouver Coastal Health.

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Screening for superbugs

Evidence Matters

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in the era of antimicrobial resistance By Teo Quay acteria don’t usually come to mind as a leading threat to global health. Yet, in the not so distant future, infections caused by antibiotic-resistant bacteria are forecasted to result in more deaths than cancer and diabetes combined. You might ask why antibiotic-resistant infections are increasingly common. The rise of bacteria causing these outbreaks can be explained by the evolutionary concept of “survival of the fittest”. Antibiotic treatment wipes out most, but not all bacteria. The few survivors multiply and are more likely to survive further antibiotic exposure. Have you ever stopped taking an antibiotic prescription early? Not finishing prescriptions, and general overuse of antibiotics, in the healthcare sector and beyond, have sped up the natural development of antibiotic resistance. Medically, these bacterial species are referred to as antibiotic-resistant organisms, but a more common term you might have heard is “superbugs”. Some superbugs are deadlier than others. Generally, the more drugs a superbug is resistant to, the greater risk it poses. Recently, scientists discovered the most frightening superbug yet – one resistant to all, even last resort, antibiotics. As our options for effective antibiotic treatments dwindle, common medical procedures that carry a risk of infection, including Caesarean sections and joint replacement surgeries, may become riskier. If you develop an antibiotic-resistant infection, there is a greater risk that treatment won’t work and that you will experience complications – which can be serious, even leading to death. So how do we begin to address this problem? The most effective strategy to slow the spread of superbugs is reducing antibiotic use – and using them responsibly when they are absolutely necessary. But this is challenging, and other strategies are needed. Infection screening is one approach that aims to reduce the spread of infection amongst patients who are being admitted to hospital or other healthcare settings. When you undergo screening, swabs are taken from multiple body sites and sent for laboratory testing. If superbugs are detected, you might be moved to an isolated area to avoid transmission to others, and you might be provided with more intensive antibiotic treatment. Benefits of these precautionary measures may seem obvious, but they are not without risk. Screening could inadvertently identify some patients colonized with superbugs who may have never developed or transmitted an infection. Ironically, unnecessary treatment of these low-risk patients could further contribute to antibiotic resistance. Screening is also resource intensive and Canadian institutions spend millions of dollars to support laboratories, staff, and the cost of treatment. So who should be

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screened in order to reduce the spread of superbugs, but avoid potential harms and unnecessary costs? Should only high-risk patients – for instance, immunocompromised patients or patients in intensive care units – be screened? Is this too risky and should patients who have been in close proximity to outbreaks or who have been in hospital long-term also be included? Or, should healthcare facilities screen every patient (universal screening)?

Overall, facilities may benefit from screening for superbugs, and there is more evidence to support targeted screening than universal screening. To help resolve this uncertainty, the medical community turned to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – to find out what the evidence says. CADTH searched for evidence on the comparative clinical and cost-effectiveness of different screening strategies and found 21 publications – one systematic review, five clinical studies, and 15 economic evaluations. The decision to screen (versus no screening) is supported by clear evidence

d of clinical and c o s t- r e l a t e d ut, benefits. But, what about the more complexx isher to sue of whether use universal versus creening? targeted screening? reening of Targeted screening atients may rehigher risk patients ion and prevention sult in detection b off infections, i f ti d of a similar number and similar gains in patient quality of life compared to universal screening programs, at a lower cost. It may also be more feasible in facilities where there are limited resources. Another potential benefit could be reduced unnecessary antibiotic use. Overall, facilities may benefit from screening for superbugs, and there is more evidence to support targeted screening than universal screening. Healthcare facilities often face the hard task of deciding on the best infection control strategies to invest in. To decide what type of screening is best for them, facilities will have to assess the feasibility of isolating patients, ability to provide timely lab tests, and availability of other infection control measures such as programs to support appropriate use of antibiotics, and staff education about infection prevention. However, the evidence identified by CADTH may help hospitals and healthcare authorities understand that testing every patient that comes through the doors of the facility

is, in most uncases, t necessary. IIn ffact, some health authorities in Canada have already removed universal admission screening for certain superbugs in favour of targeted strategies. Widespread screening may still be useful in some limited situations, for example, a cancer centre where patients are at high risk of infections. However, evidence suggests that in most circumstances, targeted screening for superbugs may help avoid unnecessary costs and antibiotic use, reduce inconvenience to patients, and help reduce the spread of infection and the larger threat of antibiotic resistance. If you would like to learn more about CADTH and the evidence we have to offer to help guide healthcare decisions in Canada, please visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: www. H cadth.ca/contact-us/liaison-officers. ■ Teo Quay is a Clinical Research Officer at CADTH.

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Focus

Cover story

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

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2

1. Wildfire smoke billows up behind an AHS EMS unit. EMS crews remained a constant presence throughout the evacuation, to provide support as needed. 2. A temporary triage area was quickly established by AHS staff at Suncor’s Firebag site after staff and patients from the Northern Lights Regional Health Centre arrived on site following the evacuation of Fort McMurray.

Shutterstock image

*Photos (other than cover image) provided by Alberta Health Services

Emergency preparedness: The Fort McMurray wildfire By Sara Warr and Jason Morton

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he morning of Monday May 2, 2016 began like any other day. Patients at the Northern Lights Regional Health Care Centre (NLRHC) in Fort McMurray were attended to by their healthcare teams. Nutrition and Food Services staff pre-

HOSPITAL NEWS SEPTEMBER 2016

pared meals. Encroaching wildfires in the area had begun to cast a shadow – some neighbourhoods had already been evacuated, even patients of the Fort McMurray Recovery Centre south of the city – but nobody expected what was to come. That morning, leadership at the hospital

gathered to discuss emergency planning – just in case. They had been receiving regular updates on the blaze and wanted to be prepared for the worst. Even so, everything felt fairly normal. “We all went home at the end of the day,” recalls Monique Janes, Patient Care Director. “Then on Tuesday things started to change.” By noon on Tuesday the blaze had escalated, threatening new areas of the city. With more neighborhoods being placed under mandatory evacuations, and staff and patients hearing news over the radio, it was difficult for many to keep their minds on work. “A lot of our nurses had internal struggles,” says Pam Lund, Emergency Department and ICU Manager. “They had children whose schools or daycares were being evacuated and their husbands were working at the plant sites an hour away or out fighting the fire.” “I was feeling it myself, being a mother with my kids in school,” says Janes. “I made a call to my husband – I said, ‘you’ve got to get the kids out of school. Look after them. I can’t leave the hospital. I have way too much to do.’” An Alberta Health Services (AHS) zone-wide Emergency Operations Centre (ZEOC) had already been set up, in constant communication with the municipality’s EOC. “We knew events were progressing,” explains David Matear, Senior Operating Director at the NLRHC. “We anticipated that the situation could change very quickly and we wanted to get ahead of that in our decision making.”

The 30 wheelchair-bound continuing care clients on the fourth floor were one of the biggest concerns. Staff decided to bring them down to the main floor and look after them there, so a swift and comfortable exit could be made if necessary. At about 5:00 p.m., the hospital began to evacuate, a wall of fire visible in the nearby ravine. “We were trying to keep people calm,” says Janes. “When we got the mandatory evacuation, we were ready. We did it floor by floor.” Patients began boarding buses and ambulances. One ventilated ICU patient required an air ambulance, which landed adjacent to the hospital. Everyone remained amazingly calm and patient during the whole ordeal. “Not one person complained or cried,” says Lund. “There was no panic whatsoever. They trusted our staff and knew we were going to get them to where it was safe.” Physicians and staff from all departments helped wherever they could. Nutrition and Food Services packed up food and water for the trip and unknown destination. “We had so many people come together,” recalls Janes. “We had our facilities maintenance staff and our protective services guys loading crash carts and equipment – everything that we could need to run an emergency department. We didn’t know where we were going or how long we’d be there and what would be available.” Meanwhile, the ZEOC, the North Zone Emergency Operations Centre, was working a few steps ahead of the on-the-ground staff to ensure care would continue after evacuation. www.hospitalnews.com


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EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

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3. The Urgent Care Centre, set up to provide health care to first responders and to support residents as they began to return, included an OR. 4. While the Northern Lights Regional Health Centre was being restored to operations, an Urgent Care Centre was set up using Portable Isolation Containment Systems (PICS) units so that AHS staff could continue providing healthcare. 5. Monique Janes, Patient Care Director, and Pam Land, Emergency Department and ICU Manager, in the Northern Lights Regional Health Centre. It shows little sign that it had to be fully evacuated just months ago. “Even though patients hadn’t been moved from the hospital yet, the ZEOC was looking into how and where our patients would be cared for when they eventually arrived in Edmonton. We were providing them with information on our patients and conditions and care needs, while planning our evacuation,” says Matear. As planned, Lund was in one of the first ambulances to leave, along with some of the extra equipment. Other ambulances and buses followed, with Janes near the middle of the group. “I could see the flames just across the street and up a bit and I could feel the heat,” Janes says, recalling the journey. Protective Services staff stayed behind to help sweep the building to ensure no one was left behind.

In total, 73 acute care patients and 32 continuing care clients were safely evacuated in less than two hours. David Matear was the last of the hospital leadership and staff to leave the site, amidst the flames and thick black smoke. In total, 73 acute care patients and 32 continuing care clients were safely evacuated in less than two hours. Once at Suncor’s Firebag site, an oilfield work camp 120 km northeast of Fort McMurray, physicians and staff worked around the clock to ensure patients received the care they needed. Though the hospital had been evacuated, the task wasn’t finished. Now at the Firebag site, patients needed their care continued and also to be flown to points of safety. Staff swiftly set up a triage area in an empty airplane hangar. “We had new patients coming in who were having medical issues,” says Janes. “We were essentially running an emergency room in Firebag. We had people coming in who were sick with a variety of issues, including respiratory and cardiac problems, so we had to triage and medevac them as appropriate.” Physicians and staff worked 24 to 36 hours straight to assess patients and get them on flights to the south during this second wave of evacuations. www.hospitalnews.com

A new group of doctors arrived to spell off the exhausted team that had handled the evacuation. “At any one time there were between three and five 737s on the runway, and we had a couple dedicated medevac planes at our disposal,” adds Dr. Brian Dufresne, one of the relief team. “So I think all-in-all the transfer of critical patients was fairly quick and smooth.” As all patients were evacuated from Firebag, it didn’t mean the need for health care in the community had ended. First responders were in the community, working hard in difficult circumstances. It was crucial to ensure there would still be ample healthcare available for them. Initially a medical centre was set up in Gregoire, south of the city, for first responders, but this could not fully support the reentry into the city and hospital. To that end, a team of 10 AHS EMS staff flew in to Fort McMurray to join the team to create an Urgent Care Centre (UCC) in the city, using Portable Isolation Containment Systems (PICS.) The PICS units are a series of portable, inter-connected, modular shelters allowing AHS to provide healthcare with clean air, clean water and significant space – all key factors that need to be addressed in a smoky environment without clean water. “It was a huge task,” says Sam Primerano, AHS EMS Fleet Operations Team Lead, who headed up the operation. “We had a great team and everyone worked together and we were able to get that up in one and a half days which is, I think, unprecedented for something that large.” The UCC included four 20 x 40 foot rectangular shelters, five 20 x 20 foot octagon shelters, and five vestibules to connect the shelters. It was supported with a HEPA filtered HVAC system, heating, air conditioning, a generator for power supply and interior lighting. The structure included 30 patient spaces and was fully equipped to deal with significant urgent and emergent health issues – similar to the level of care and treatment one would expect from an emergency department. It even had an operating room. The UCC opened May 14 and was taken down June 28. In the meantime, the NLRHC was filled with over 500 contracted workers and AHS staff members working in shifts around the clock to prepare the hospital for the return of residents to the city. It hadn’t suffered any fire damage but there were significant issues caused by smoke and water. Continued on page 10

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5 Preparing emotionally for disasters or emergencies Be prepared Taking care of practical details ahead of time can help lower stress during an emergency When you have no control over a stressful situation, you still have control over how you understand and respond to it. Having a plan can help you stay calm and feel more in control. That can help you make better choices during a disaster or emergency. Here is a checklist to help prepare your family: • Make an emergency kit. Include food that won’t spoil and clean water to drink, enough for everyone in the family (even your pets.) • Have a list of emergency contact phone numbers ready. When you are under stress, you might not remember phone numbers. Choose a friend or family member from outof-province to be your main contact in case you get separated from your family. Make sure everyone in your family knows who to contact and where to meet if you are separated. • Keep a copy of important papers and a contact list with your emergency kit. It’s a good idea to have a copy for you and each family member. • In a crisis, it is important to communicate. Make a plan to communicate any special needs

(ex. medical conditions or supplies) for you or family members. Write this information down and keep a copy with you. Share your plan with friends. How do I start planning? Imagine there is an emergency (ex. fire or flood in your home) and you need to leave your home quickly. What are the best escape routes from your home? Find at least 2 ways out of each room. Write them down; now you have started your emergency plan. Make sure everyone in your family understands the plan and what they need to do to be safe. Let your children and teens help with the planning. Why is it important to be emotionally prepared for traumatic events? Going through a traumatic event can create a number of losses, which may bring uncertainty and anxiety about the future. Your environment might have changed a lot. Adjusting to new things can be hard. Being emotionally prepared for a disaster or emergency can help you reduce your stress and anxiety. If you can manage stress every day, it will help you cope during challenging times. It can also help you to recover from trauma faster and with fewer long-term effects.

MINDFULNESS & BUDDHISM IN PROVIDING CARE Sustainable Compassion Training Workshop October 16, 2016 (Sunday-full day) Conducted by Dr. John Makransky PhD, Associate Professor, Boston College Co-founder of Courage of Care Coalition. Sustainable Compassion Training is a set of contemplative practices designed to help people realize an internal power of unconditional care that is healing and sustaining. Through this ability practitioners become more fully present to themselves and others without suffering empathy fatigue and burnout. A continuing professional development event accredited by U of T Faculty of Medicine and the College of Naturopaths of Ontario.

$175/workshop (early bird fee $150, register by Sept 30)

‡ Prof. Makransky will also deliver the keynote address at

the Applied Buddhism Conference at the University of Toronto. October 14, 2016 (Friday 7 p.m.)

VISIT

www.wisdomtoronto.com for Conference information and registration.

LOCATION (both events): INFORMATION

Emmanuel College, University of Toronto, 75 Queen’s Park Cres.

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SEPTEMBER 2016 HOSPITAL NEWS


10 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Emergency department supertrack: Innovative new model reduces wait times By Amber Daugherty hen Vivian Holmberg’s 15 year old son tripped and fell during a basketball game and it looked like he had seriously hurt his ankle, she brought him in to St. Joseph’s Health Centre’s Emergency Department right away. Unsure if he had any broken or cracked bones, Vivian knew they were probably facing a long wait until they would see a doctor and find out if her son would be back out playing on the court anytime soon. A family with three growing kids, the Holmbergs are no stranger to the range of services St. Joe’s has available right in their neighbourhood. This time, thanks to our Emergency Department’s Supertrack, in less than two hours Vivian had confirmation that her son’s ankle wasn’t broken and was able to take him home. “We’ve been through St. Joe’s a million times,” she says. “Waiting in the Emergency Department can be very stressful, even for minor health problems. This time, we had the x-ray and got the results really quickly. The doctor was amazing – it was great.” A year after launching, this innovative model is reducing the amount of time patients are spending in the Emergency Department. Every day, 53 per cent of our patients are sent through Supertrack after being screened by our triage nurse. They move into a designated area where they are

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Emergency physician Dr. D’Arcy Gagnon assesses a patient in Supertrack, a new initiative to reduce wait times. assessed by a physician within 30 minutes, and then directed to the most appropriate area for continued care. In Vivian’s case, her son was connected with Diagnostic Imaging for x-rays. Most patients with minor injuries who go through Supertrack are discharged within two hours. Patient Care Manager Donna Didimos says Vivian’s story is one of many positive patient experiences she’s heard about over the past year.

“The idea of Supertrack is to ensure patients are seen quickly so that treatment can start and be completed right away,” she says. “The staff in our ED have worked hard to create and implement a process that provides our patients with the right care, at the right time, in the right area,” says Donna. The new model is also having a positive impact on how our patients feel about their experience in the Emergency Department with 85 per cent saying

they appreciated the quality of care they received. “Supertrack is about providing quality care in a timely manner,” says Dr. Agostino Bellissimo, Chief of Emergency Medicine and Chef Medical Informatics Officer. “It puts the patient experience at the centre H of our work.” ■ Amber Daugherty is a Communications Coordinator at St. Joseph’s Health Centre in Toronto.

Emergency preparedness

ANTIMICROBIAL STEWARDSHIP IPAC Canada and its antimicrobial stewardship colleagues, are partners in preventing the spread of resistance. IPAC Canada represents its members in the pursuit of patient and staff safety and in the promotion of best infection prevention and control practices. We work regularly with other professional associations and regulatory bodies to develop guidelines. Our members come from across the continuum of care. Visit our website www.ipac-canada.org to see the many benefits and resources that are available to members. INFECTION PREVENTION AND CONTROL CANADA (IPAC CANADA) HOSPITAL NEWS SEPTEMBER 2016

Continued from page 9 “The biggest issue was the smoke caused by the fire and it was obvious when you walked into the hospital,” says David Ponich, AHS North Zone Director, FME. “Smoke made its way into the building leaving behind a strong smell and some residue, which compromised some of the hospital infrastructure and equipment.” Water sprayed on the hospital’s roof to protect it during the peak of the fire had also caused some damage. There was much to be done. Every ceiling tile in the facility (nearly 8,200 of them) was removed and replaced. The ventilation system was cleaned, water systems rigorously flushed out and both air and water quality tested regularly. Carpets, linens, curtains, and towels were cleaned and others replaced. Several walls had to be re-painted. Hundreds of pieces of medical and lab equipment had to be cleaned, tested, and verified to ensure they were not affected by the smoke. A team of electricians and plumbers went through the site room by room to ensure the plumbing and electrical systems were functioning properly. “It was quite the undertaking,” says Jimmy Aumont, Maintenance Manager, NLRHC. “You can imagine the coordination of having so many vendors and staff working on various projects throughout the building at all hours. It was a real team effort with our staff and our vendors. ” In addition, after all this work was completed, AHS Environmental Services, Infection prevention and Control and Workplace Health and Safety specialists had to approve the areas before clincal staff could begin restocking

and organizing clinical areas to receive patients. Those efforts allowed AHS to reopen the hospital’s Emergency Department on June 1 – the first day of public re-entry into Fort McMurray. Core services became available on June 13, most services operational by June 21 and then the entire facility by June 28. Today the Northern Lights Regional Health Centre is again filled with activity and patients receiving the care they need. While it might appear business-as-usual, as if the entire facility hadn’t evacuated with a wildfire at its heels months earlier, those involved haven’t forgotten. Emergency preparedness is always very important at a hospital but Matear says he can’t imagine how they would have practiced or drilled for what they experienced. “Just the scale of it, it’s so huge, it would be hard to prepare for.” Normally an evacuation would involve just one part of the hospital, or perhaps the entire hospital to a nearby evacuation point, he says. Evacuating an entire hospital to an airplane hangar 120 kms away with a wildfire raging nearby was not something any of them had envisioned. “We definitely know that emergencies can happen but I don’t think you could have imagined the scale of this event,” he says. “It was a monumental task and everybody worked extremely hard to make sure it went very, very smoothly.” *With files from Sean Woods and Erika H Dart ■ Sara Warr and Jason Morton are senior communications advisors at Alberta Health Services. www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 11

HealthAchieve 2016 November 7–9, Metro Toronto Convention Centre healthachieve.com

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Remember the Last Time You Felt Inspired? We Do. Let us inspire you with a fresh lineup of compelling speakers Séan McCann

Amy Cuddy

Don Tapscott

Feature Breakfast Monday, November 7

Official Opening Monday, November 7

eHealthAchieve Keynote Monday, November 7

Founding member of the hit band Great Big Sea and addiction survivor, Séan will share his inspiring story on how music can help you find balance and meaning in your life – to connect, heal and bring happiness.

Social psychologist and professor at Harvard Business School, Amy is a world renowned expert on how our body language can change our thoughts, feelings, behaviors, and physiology, impacting how well – or how poorly – we perform.

As one of the world’s leading authorities on innovation, media, and the economic and social impact of technology, Don argues that the second era of the Internet has profound implications for health care.

Raymond Wang

Rudyard Griffiths

Christine Elliott

Innovative Environmental Sustainability Monday, November 7

Financial Management Breakfast Tuesday, November 8

Small, Rural and Northern Health Care Tuesday, November 8

In the world of climate change, energy crisis, and natural resource shortages, the up-andcoming generation of youth is not one to sit passively. As the founder of Sustainable Youth Canada (SYC), Raymond shares SYC’s founding story and aim of creating a national identity for youth to unite for sustainability.

A highly sought after commentator on global economics, geopolitics and corporate decision making, Rudyard never shies away from discussing the big issue of the day.

Recently appointed by the provincial government as the first Patient Ombudsman, Christine has been an advocate for vulnerable people for many years and has served as a volunteer with many community organizations, including the Grandview Children’s Centre and Durham Mental Health Services, which named one of their homes in her honour.

*Ticketed Event

*Ticketed Event

Don’t miss your chance to be inspired by these incredible speakers. For more information about HealthAchieve and to register today, visit healthachieve.com.

www.hospitalnews.com

SEPTEMBER 2016 HOSPITAL NEWS


12 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Hospital-wide evacuation drill a success By Gemma Villanueva mergencies can happen quickly and without warning. No matter how much you’ve prepared, you don’t know if you’re truly ready until you’re faced with the situation. Emergency preparedness is a top priority at The Hospital for Sick Children (SickKids), as this can have a huge impact on patient and staff safety. Over the past year, SickKids has engaged in mock drills for various emergency scenarios that can occur in hospitals. The first emergency preparedness drill was a Code Orange external disaster exercise, and the most recent was a Code Green evacuation exercise. The recent Code Green exercise began with the fire alarm sounding on the overhead system, alerting staff of a hospitalwide drill: “Exercise, exercise, exercise. This is a Code Red.” The “virtual incident” began with a mock fire in the Microbiology Lab at 9:30 a.m. on Aug. 9. The drill tested SickKids’ response, procedures and technological needs in the event of a Code Green. In this type of emergency, the code signals an internal evacuation of patients, families, staff and visitors. A Code Green scenario could impact a clinical unit, fire zone, entire floor, multiple floors or the whole hospital. Another announcement was made during the practice run: “Exercise, exercise, exercise. Code Green.” The escalation meant there was a need to evacuate occupants from a particular location that was, or had potential, to be dangerous. In the Emergency Measures Command Centre, leaders representing departments from across the organization were busy coordinating the hospital-wide emergency response. SickKids “controllers,” who wore a white ball hat and/or a yellow safety vest, enabled and guided the exercise. They provided cues during the drill, so that

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HOSPITAL NEWS SEPTEMBER 2016

Photos courtesy of SickKids

This furry “patient” was safely moved from 5A to 5D with his patient identifiers, medical chart and wheelchair. participants could go through actions and team processes within the Code Green drill. SickKids “observers” walked around with clipboards to note any opportunities for improvement, as participants executed their team’s specific fire and evacuation plans. The mock drill featured a horizontal evacuation, which moves patients and occupants to a safe area on the same floor. On the overhead system, the evacuation of floors was called consecutively for logistical purposes. In a real emergency situation, an evacuation may be concurrent. At 9:57 a.m., staff on the fifth floor unit A received evacuation instructions. All staff on the unit reported to the front desk. Cristina Franco, Registered Nurse, 5A, was the Area Leader; she performed a

head count of staff and provided instructions for moving patients to the evacuation location. She referred to a tracking list, and started assigning roles to each staff member. “Patients” – who were simulated with dolls, stuffed toys and mannequins on stretchers and wheelchairs – were m o v e d from 5A to 5D. Before leaving the area, staff ensured all patients had proper identification bands, their medical charts, any required medical equipment and medications. Staff safely transported patients from the north to the south side of the hospital. In the exercise scenario, no patients had been injured in the evacuation process or

fire in the fi re. Real patients stayed safely in their rooms and had a front-row seat on the action. Nursing staff remained on the units to ensure that regular clinical care was not interrupted during the exercise. Downstairs at the Operating Room Desk, staff members waited for additional instructions or announcements. When a Code Green is called, both clinical and non-clinical staff from any area of the hospital – as well as staff in other SickKids buildings – may be redeployed to help with the evacuation of patient care areas. In the mock Code Green exercise, simulated communications asked parents not to come to the hospital during the evacuation. The Public Call Centre was set up so families and the public – played by volunteers – could contact SickKids for additional information. SickKids held a mock media briefing to respond to the requests that were flooding in from volunteers posing as journalists. At that time 109 “patients” had been evacuated. The Code Green exercise was officially lifted at 11 a.m. All patient units from the 2nd to the 8th floors were successfully evacuated from the north to the south side of the hospital. “Both of SickKids’ simulated emergency preparedness exercises in the past year were mornings extremely well spent,” says Dr. Michael Apkon, SickKids President and CEO. “Although they are challenging to carry out, particularly with a busy hospital, they are also critical to ensuring that we are able to react nimbly and effectively H in the case of any real emergency.” ■ Gemma Villanueva is a Communications & Public Affairs intern at SickKids. www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 13

ED docs combine skills with philanthropy By Julie Dowdie

n the Emergency Department (ED) at The Scarborough Hospital (TSH), doctors are improving care using more than their skills and expertise. They’re also making an impact through their philanthropy. This past July, TSH started a new fellowship program for ED physicians to be trained in advanced Point-of-Care Ultrasound skills.

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In the ED, care depends on teamwork – a group of health professionals who are in sync. “Point-of-Care Ultrasounds are where the future of emergency medicine lies,” says Dr. Sachin Ramkissoon, ED Ultrasound Director at TSH. “Instead of having to request and wait for an ultrasound from the diagnostic imaging department, these units can be brought to the patient and are used to determine everything from internal bleeding, to how the heart is pumping, to the location and health of a fetus. This means shorter

www.hospitalnews.com

wait times, better care, and an increase in patient satisfaction.” Two physicians are training in the EDs at TSH to earn their Registered Diagnostic Medical Sonographer certification and an Emergency Ultrasound Fellowship certification. They will be trained by TSH’s Emergency Ultrasound Fellowship Director Dr. Jeffrey Shih, who received his advanced Emergency Ultrasound Fellowship training at Yale University. In addition to the launch of the Fellowship program, Point-of-Care Ultrasound results are now being recorded electronically into the patient’s record. Every scan is reviewed by either Dr. Shih or Dr. Ramkissoon. As well, more than 70 per cent of the ED physicians at TSH have been trained to the standards set out by the Canadian Emergency Ultrasound Society. “It’s all a part of our goal to deliver world-class emergency medicine care to our global community,” says Dr. Ramkissoon. Bringing Point-of-Care Ultrasounds to TSH has truly been a team effort. In 2014, TSH’s ED physicians funded the purchase of several probes and the software, collectively donating about $30,000. This year, they donated enough to fund another four units at a total retail cost of more than

Dr. Sachin Ramkissoon (left) and Dr. Jeffrey Shih examine a patient using a Pointof-Care Ultrasound machine. $200,000. The hospital’s two EDs now have six state-of-the-art Point-of-Care Ultrasound machines. The doctors’ community spirit doesn’t stop there. For the last 10 years, they have also sponsored an annual retreat for ED staff. They provide funding and travel grants for an event that helps to build skills and team morale. And, the doctors also purchased personalized scrubs for the entire team (in addition to buying their own new scrubs). In the ED, care depends on teamwork – a group of health professionals who are in sync. You see the coordination in how they work and now in what they wear. Traditionally, healthcare workers provide their own uniforms, so styles and

patterns vary. With the new ED scrubs, the style is the same, and each profession has its own shade, with staff members’ names embroidered along with the hospital logo. It helps to boost team spirit, makes for an even more professional look, and helps patients and families to identify each person on their care team. TSH’s Chief of Emergency Services, Dr. Norm Chu, points out that the scrubs – like the overall generosity of the ED doctors – have an important meaning. “They emphasize the connection between us, and that we’re on the same team for the patient H and for each other.” ■ Julie Dowdie is a Communications Officer at The Scarborough Hospital.

SEPTEMBER 2016 HOSPITAL NEWS


14 Safe Medication

How to prevent QT-Prolongation medication incidents in the community By Roshan Tahavori, Kevin Li, Steven Lam, and Certina Ho hen the heart muscles contract, there is a time delay required for electrical signals to reset before it is able to contract again. The QT interval represents the time delay for the ventricles of the heart. There are normal ranges between how long the time delay may last, but when the QT interval exceeds the upper normal limit, it is known to be prolonged. Drug therapy is the most common cause of prolonging the QT interval; and many of these drugs are amongst the top 100 medications prescribed in Canada. When QT prolongation occurs, there is a significant risk to develop an irregular heart rhythm known as torsades de pointes, which may result in sudden cardiac death. ISMP Canada conducted this multiincident analysis to examine medication incidents involving the potential for QT prolongation that are commonly encountered within the community setting. Incidents were retrieved from the ISMP Canada Community Pharmacy Incident Reporting (CPhIR) program from the period between April 2010 and June 2016. A total of 92 incidents met the inclusion criteria and were included in this multiincident analysis. Three main themes were identified in this analysis.

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Theme 1 – Prescriber Triggered Potential for QT Prolongation (Table 1)

Prescriber triggered potential refers to medication incidents that occurred at the prescribing step of the medication-use process. The list of drugs known to cause QT prolongation is vast and continually updating from emerging clinical evidence.

Combined with the limited use of computerized clinical decision support systems in medical clinics, the expectation to be aware of all QT-prolonging medications adds to the ever-growing burden and stress to the human brain power or memory of the prescribers. The prevalence of prescriber triggered medication incidents highlighted the niche for safety and quality improvement that can be enhanced by technology or computerization and readily accessible clinical resources or tools at the point-of-care during the initial stage of prescribing (Table 1).

Theme 2 – Potentially Inappropriate Pharmacist Interventions (Table 2)

Medication incidents grouped within this theme involved pharmacists’ interventions that may have been inappropriate and may have led to potential, inadvertent patient harm. Unlike physicians, most pharmacists are familiar with the use of computerized clinical decision support systems to check for drug-drug interactions. However, drug interactions concerning QT prolongation may require additional assessments in order to evaluate the associated clinical significance. Sometimes, not every single drug interaction will require an intervention. Inappropriately doing so may lead to delayed treatments, inappropriate substitution to suboptimal therapies, or unnecessary expenditure of time and resources in the healthcare system. On the other hand, overriding some of these drug-drug interactions flagged by the clinical decision support systems due to alert fatigue may lead to significant patient harm. There-

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Theme 3 – Patient Potentiated Risk for Harm (Table 3)

The final theme captured the medication incidents that were brought on by the patient. In such instances, the patient’s actions or inactions, such as failure to communicate medication changes to healthcare providers in the circle of care of the patient, may have increased the likelihood of QT prolongation. When patients are consulting or seeking care from multiple prescribers (e.g. from the use of walk-in clinics or specialists clinics), they may fail to fully communicate all pertinent medical and medication in-

Contributing Factors Prescriber’s unfamiliarity with QT prolonging agents Absence of computerized clinical decision support systems or systems with limited functionality for flagging drug-drug interactions with the risk of QT prolongation Lack of communication among healthcare providers involved in episodic care (e.g. walk-in clinics) and transitions of care of patients

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Recommendations Ensure that computerized physician order entry systems have programming or clinical decision support functionality to detect drug-drug and drug-disease interactions and are updated regularly

Table 2 – Potentially Inappropriate Pharmacist Interventions Recommendations Contributing Factors Regularly evaluate and update alerts in Community pharmacy computer the clinical decision support systems at systems are not capable to fully the pharmacy evaluate the severity or clinical significance of drug-drug interactions Avoid over-reliance on technology and with the risk of QT prolongation make clinical decisions in conjunction with appropriate patient assessment Alert fatigue or over-reliance on and professional judgement technology or clinical decision support systems for clinical interventions or Perform proper assessment of patientrecommendations oriented risk factors and communicate all findings to the patient’s primary care physician and other healthcare providers in the circle of care of patient

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formation needed for the clinician to safely prescribe. Similarly, attending multiple pharmacies may limit pharmacists’ access to a complete medication history of the patient. This multi-incident analysis has identified common areas where QT prolongation incidents may occur in community pharmacy practice. Medication incidents may increase the risk of negative health consequences. All parties involved in the medication-use process have a role in mitigating these risks. Prescribers, pharmacists, and patients can collaborate to prevent these medication incidents from H happening in the future. ■ Roshan Tahavori is a staff pharmacist at the Hospital for Sick Children; Kevin Li and Steven Lam are PharmD Students at the School of Pharmacy, University of Waterloo; and Certina Ho is a Project Lead at ISMP Canada.

Table 1 – Prescriber Triggered Potential for QT Prolongation

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HOSPITAL NEWS SEPTEMBER 2016

fore, proper assessment of patient-oriented risk factors with respect to QT prolongation and drug therapy management are necessary before any intervention should be executed by the pharmacist.

Table 3 – Patient Potentiated Risk for Harm Contributing Factors Patients consulting multiple prescribers Attending multiple pharmacies

Recommendations Communicate all healthcare encounters and carry an up-to-date medication list to share with all healthcare providers in the circle of care of patient www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 15

First patient in BC to undergo

new brain treatment By Carrie Stefanson hen Jamie Crane-Mauzy stood at the start line of the slopestyle event at the World Ski and Snowboard Festival in Whistler on April 11, 2015, she had no idea it would be the race of her life. “The last thing I remember was falling asleep the night before. I don’t recall the event at all,” says Jamie. Just 15 seconds into the competition while attempting a double back flip on the first jump, she crashed. Jamie suffered a severe traumatic brain injury that resulted in microbleeds throughout her brain and brain stem. She was flown to Vancouver General Hospital, where she remained in a coma for eight days. What Jamie didn’t know was that she was the first patient in B.C. to undergo autoregulation monitoring, a technique where doctors determine the precise oxygen and blood pressure levels so a patient’s brain can rest. Doctors were worried that Jamie’s brain wasn’t receiving adequate life-sustaining oxygen levels. Dr. Mypinder Sekhon, Critical Care Medicine, Vancouver Coastal Health says the medical team inserted a catheter into her brain, which was attached to a monitor set, and then manipulated her blood pressure with powerful medications to

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make her heart pump harder. This allowed Jamie’s blood pressure to increase dramatically. As a result, her brain oxygen levels normalized over the ensuing hours,” says Dr. Sekhon. Jamie was kept in a medically induced coma to allow her brain to recover.

Jamie’s recovery

Today, Jamie is back skiing although not competitively. She has no noticeable signs of the injury that nearly claimed her life. “I had to learn everything again; How to walk and talk, and remember who I was and everyone I knew,” she says. “But I stayed strong and I healed. A big portion of my recovery is being happy.” She travelled to Vancouver with her sister, Jeanee Crane-Mauzy, to thank the doctors who helped save her life.

A strong health care system

Dr. Donald Griesdale and Dr. Sekhon studied the treatment at the University of Cambridge in the United Kingdom and were instrumental in bringing it to Vancouver. They along with Doctor Brian Toyota, Head of Neurosurgery, Vancouver Coastal Health, determined that Jamie was a good candidate for autoregulation monitoring. “Jamie’s incredible recovery is due to the strength of our health system, acting

World class U.S. Skier Jamie Crane- Mauzy is the first patient in BC to undergo autoregulation monitoring. swiftly to save her life,” says Health Minister Terry Lake. “Credit goes to the quick thinking of the doctors working in critical care medicine at Vancouver Coastal Health, who used innovative treatment that allowed Jamie’s brain the best chance at healing.”

Medical results

Since Jamie’s accident, 36 other patients have been treated with autoregulation monitoring at Vancouver General Hospital.

“Sixty per cent of our patients have had favourable outcomes, compared to 37 per cent with traditional treatment,” says Dr. Donald Griesdale, Critical Care Medicine, VCH. “This technique is giving severe brain trauma patients a better shot at recovering to the point where they are able to H live independently.” ■ Carrie Stefanson is a Public Affairs Officer at Vancouver Coastal Health.

SEPTEMBER 2016 HOSPITAL NEWS


Online Education Empowering healthcare professionals to provide high quality palliative care By Jiahui Wong and Deyan Kostovski n Canada, cancer and heart disease remain the leading causes of death and are responsible for nearly half of all deaths. With an aging population more Canadians are receiving these diagnoses and the majority of them are preferring to die at home. To meet this growing demand, healthcare providers need educational support to recognize when palliative care services are appropriate and demonstrate the confidence, competency and compassion in the provision of these services. Palliative services have been made available across Canada but the access and the quality of care varies. Many patients with terminal illness still die in acute care settings and receive few palliative care services. In order to provide evidence-based palliative care to patients, healthcare providers across all disciplines need to recognize when and how to apply the comprehensive palliative care approaches. Now more than ever healthcare professionals require support; the federal government’s passing of the assisted dying bill in June will amplify the need for these specific skill sets.

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A key factor hindering quality palliative care is the lack of systematic standardized training in palliative and end-of-life care. With the exception of palliative care specialists, healthcare providers across the broad spectrum of care receive no comprehensive palliative care specialty training in their professional degree programs. Evidence suggests that optimal outcomes occur when care is provided earlier on by competent interprofessional teams who are equipped to manage the range of care required, particularly, the ability to carry out sensitive discussions, address pervasive symptoms, minimize suffering and conserve dignity at end-of-life. Since 2008, de Souza Institute at the University Health Network has been funded by the Ontario Government to provide evidence based continuing education to healthcare providers in cancer and palliative care. Over the past eight years, using online learning modules, workshops, and competency measures, the institute has reached more than 8,000 healthcare professionals and has become a go-to-place for healthcare professionals seeking additional cancer care or palliative care training.

The interactive iEPECO Online Course uses a combination of instructional videos and infographics to provide high quality palliative care training across Canada. Our online learning platform has been enthusiastically welcomed for its flexibility to address learning needs. Individuals can complete varying levels of training that match their needs at any time, from any setting. This flexibility is important; it is dynamic in responding to the training needs of busy cli-

nicians where time is at a premium. Learners can start and return to the system as needed, the curriculum provides immediate feedback to learners on their state of knowledge, documents learning hours and provides guidance towards new areas for development. Continued on page O17

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Online Education O17 Continued from page O16 Specialized training is important, but we cannot overstate the importance of having high quality training that encompasses the entire disease trajectory, that starts with the diagnosis and includes a broad range of settings from home care and long term care to community care. Using a well-known course, Education for Palliative and End of Life Care – Oncology (EPECTM-O) as an example: originally developed by a team in the US and offered exclusively through workshops, it was adapted by the Canadian Partnership Against Cancer in 2011. To increase accessibility and enhance the uptake, de Souza Institute is developing a new online version, iEPEC-O. This online course includes the core competencies in palliative symptom management, and places an emphasis on comprehensive team-based care, cultural sensitivities and a person-centred approach. This self-directed eLearning course has been designed to maximize the learning experience using interactive case studies, including those outside of cancer, allowing direct point of care clinicians to apply evidence-based knowledge, tools and interventions immediately in day to day practice. The task at hand is significant, but we can deliver high quality palliative care with a highly skilled workforce supported by an accessible, standardized, clinically-relevant and evidence-based continuing education program. Furthermore, it ensures that patients living in rural and remote areas receive the same high quality care aligned H with their disease trajectory and wishes. ■ Jiahui Wong is Manager and Deyan Kostovski is Communication Lead, de Souza Institute, University Health Network.

Emergency preparedness Online course for public health E

mergency preparedness requires planning and activities to prevent, protect against, respond to, and recover from emergencies that may put human health at risk. Ontario has required emergency response to infectious diseases (SARS and H1N1, for example), extreme weather events and other environmental hazards such as flooding and forest fires. Hospitals, which play a unique role in emergency management, are described as the ‘first receivers’ of emergency or disaster victims (compared to ‘first responders’, such as police or fire services). The role of public health in an emergency, however, has always been less clear. Public health is neither a first responder nor a first receiver. Using real-world examples, Public Health Ontario’s (PHO) Introduction to Public Health Emergency Preparedness online course illustrates the role of public health as ‘preventers and mitigators. This course introduces foundations of public health emergency preparedness, including definitions, concepts, strategies and tools, all in three interactive modules. The online course was developed at the request of the learners in PHO’s in-person public health emergency preparedness workshop. Removing the lecture and creating the online course allowed for more interactive discussion and hands-on ex-

Hospitals, which play a unique role in emergency management, are described as the ‘first receivers’ of emergency or disaster victims

perimentation with various emergency preparedness tools. These tools include: • incident management system (IMS) • the hazard identification and risk assessment (HIRA) • the emergency response plan • the continuity of operations plan (COOP) • training and exercises • the communications plan • planning and evaluation Importantly, the IMS can be used to coordinate all activities related to various plans as they are executed in the phases of the emergency management cycle. The learner has an opportunity to experiment with these emergency management tools, mapping them to the emergency management cycle to see how they interact. This gives the learner a much greater understanding of various tools, compared with traditional emergency management train-

ing courses, which tend to focus on one tool. In these traditional courses, there is often no context as to how this tool would be used in a real incident, or how it would interact with various other tools and systems. The modules are foundational to the face-to-face workshop (Public health emergency preparedness: an IMS-based workshop) that is currently conducted by PHO for public health units, but can also be adapted by a broader audience of emergency management professionals outside of public health. The web-based format provides an easily accessible resource that can be used by a variety of stakeholders in different learning environments, including academic settings. Since its release in April of 2016, over 800 people have completed the course, with representation from across the healthcare community including public health units in several provinces, plus hospitals, the Public Health Agency of Canada (PHAC), and the World Health Organization (WHO), as well as members of the greater emergency management community. For more information about this online course, or public health emergency preparedness, please contact PHO.eoc.Liaison@oahpp.ca. Learn about Emergency Preparedness and more at Public Health H Ontario by visiting our website. ■

Empower Yourself and Your Staff with Online Training Modules From Global Harmonizing System (GHS) to Wound Care and more, the Ontario Hospital Association’s (OHA) range of online modules will enable you to train yourself and your staff efficiently and within budget. These online training modules empower participants through self-paced independent learning. The interactive modules enrich the learning experience, while program quizzes assess and enhance students’ knowledge. A variety of learning styles are addressed through text, audio, video and instructive activities.

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SEPTEMBER 2016 HOSPITAL NEWS


O18 Online Education

Enhancing care through online learning By Melissa Londono

Providing staff with courses that can be accessed anytime and anywhere, keeps staff engaged and prepared with the latest practices to deliver high quality and safe care

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nline courses are quickly becoming the preferred way education is delivered to both university and college students as well as for staff in larger organizations. In a fast-paced healthcare environment, where there are multiple shifts and a variety of disciplines, online learning makes it easier to have personalized education and to stay up-to-date on the latest healthcare innovations. “As a leading community academic hospital, continuing education for both clinical and non-clinical staff is a priority for North York General Hospital,” says Jennifer Bowman, Vice President People, Strategy & Clinical Support. “Ensuring education is accessible to and convenient for our staff and physicians supports our vision of excellence in integrated patientand family-centred care through learning, innovation and partnerships.” According to Bowman, providing staff with courses that can be accessed anytime and anywhere, keeps staff engaged and prepared with the latest practices to deliver high quality and safe care. North York General offers a variety of online courses including mandatory training which has courses on health, safety and privacy awareness. Clinical staff in different disciplines also stay up-to-date with new practices and procedures by taking specific

Tina Chopra, Clinical Nurse Educator at North York General Hospital, creates learning modules for ‘My Learning Edge’ for staff to access at their convenience. courses for their area of care. Nurse Educators prepare presentations and quizzes and have them uploaded to their staff’s online learning profile. “Several years ago it was much more challenging to have staff complete mandatory training or provide departmental education with in-class sessions or on paper,”

says Jamie Campbell, Director Organizational Development. “Now we use our online learning management system, called My Learning Edge, which can be accessed from home or in hospital, and as a result we have seen a much higher compliance for mandatory training as well as department specific training.”

Other courses also offered to staff include Microsoft Office programs, a four-course workshop to become a Diversity Champion (training that provides staff, physicians and volunteers to become ambassadors, role models and key resources for staff who want to learn more about Diversity and participate in programs and various initiatives) as well as hospital specific tools. Manager onboarding information can also be uploaded to new employees taking on a managerial role to help them become familiar with hospital policies and procedures and key departments in the hospital. “We continue to build our online educational resources for our staff and physicians,” Jamie says. “Our priority is to continually enhance our skills and knowledge through life-long learning. Online courses are one way we’re advancing care through H teaching and learning.” ■ Melissa Londono is a communications coordinator at North York General Hospital

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Online Education O19

New free online accredited course:

Methadone for pain in palliative care arlier this year Canadian Virtual Hospice launched Methadone4Pain.ca – a free, online course for physicians wishing to improve their knowledge and develop core competencies for methadone prescribing in palliative care. The course is also relevant to pharmacists and nurses managing patients prescribed methadone. To date, over 115 healthcare providers have received the certificate of completion. “It’s important that more physicians be able to prescribe methadone because there are certain pain circumstances where it provides almost a remarkable unique benefit,” says Dr. Mike Harlos Medical Director of the Winnipeg Regional Health Authority Palliative Care Team, who co-led the development team with colleague Dr. Pippa Hawley of the University of British Columbia and BC Cancer Agency. Methadone is a proven, cost-effective pain control alternative. It is particularly useful in cases of opioid intolerance. It can improve outcomes for palliative patients wishing to remain at home. However, Methadone is a federally regulated drug; a special exemption license is required to

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prescribe. As a result, there is a lack of physicians who can prescribe Methadone. This self-directed course is accredited by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. It includes three modules: • Introduction and Indications for Methadone • Initiation for Analgesia • Safety and Support for Physicians and Patients Healthcare providers can work through

the modules at their own pace from the comfort of their home or office. To obtain the exemption license, physicians must fulfil the requirements of their provincial licensing body. Methadone4Pain.ca was developed by Canadian Virtual Hospice and leading Canadian palliative pain management specialists, in collaboration with The Canadian Society of Palliative Care Physicians, The College of Family Physicians of Cana-

da, Pallium Canada and de Souza Institute. Funding for the development of the course was provided by the Canadian Partnership Against Cancer. For more information, visit Methadone4Pain.ca or contact Marissa@virtualhosH pice.ca, (204) 478-1758 ■ Marissa Ambalina is a Communications Specialist at Virtual Hospice.

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Access our popular, pre-recorded health law programs at any time, from anywhere you are. Our latest offerings include: • The 2016 Legal Guide to Privacy & Information Management in Healthcare • Physician Assisted Suicide and the Implications of Carter: One Year Later • Current and Emerging Issues in Fertility Law • 4th Annual Mental Health Law for Children and Youth

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SEPTEMBER 2016 HOSPITAL NEWS


20 Legal Update

Emergency situations: The hospital is prepared, but are your critical suppliers? By Michael Watts and David Solomon n Ontario, hospital boards are required to ensure that the administrator, medical staff, chief nursing executive, staff nurses and nurses who are managers at the hospital, develop plans to deal with, (i) emergency situations that could place a greater than normal demand on the services provided by the hospital or disrupt the normal hospital routine, and (ii) the failure to provide services by persons who ordinarily provide services in the hospital (Hospital Management, RRO 1990, Reg 965, s 2(3)(e)). These requirements confirm that hospitals owe a private duty of care during emergencies to persons affected by hospital decision-making (e.g., staff, patients, visitors, etc.), and represent one of the core expectations of the general public – that hospitals will still operate during emergencies. This article briefly discusses how standard “force majeure” clauses in typical services agreements can excuse non-performance by critical suppliers in emergencies, even where the hospital is expected to continue to provide services. Emergencies include any event beyond a hospital’s control that could impede its ability to provide services. Hospitals should therefore “flow through” the requirements above to their critical suppliers, by ensuring, (a) that they have business continuity or contingency plans in place, and (b) that force majeure clauses exclude emergencies where the

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HOSPITAL NEWS SEPTEMBER 2016

hospital will be expected to continue to provide services. The Ebola pandemic of 2015 and the SARS pandemic of 2002-2003 demonstrated that hospital emergencies are regular periodic occurrences. The class action litigation that followed the SARS pandemic confirmed that hospitals owe a private duty of care when responding to emergencies. The government, however, does not owe any such duty when acting in a “policymaking capacity” and discharging its overarching public duty of care. (see Williams v. Canada (Attorney General), 2005 CarswellOnt 3785 (ONSC) and Abarquez v Ontario, 2005 CarswellOnt 3782 (ONSC)).

Hospitals that adopt standard, unqualified force majeure clauses in their services contracts do so at their own peril. Many hospitals are dependent on private sector suppliers to provide services ranging from utilities and building systems, to medical and surgical supplies, drug supplies and pharmacy services, and food, linen, security and ambulance services. The agreements for these services often contain standard “force majeure” clauses. “Force majeure”

is legalese for a “superior force” resulting in “unforeseeable circumstances that prevents someone from fulfilling a contract.” A force majeure clause operates to excuse or suspend a party’s performance obligations to the extent they are frustrated by the force majeure event. A typical definition of force majeure includes “…an event or a cause beyond the control of a Party for the purposes of this Agreement, including… local or national emergency, storm, earthquake, flood, accident, fire, nuclear or other explosion, radioactive or biological or chemical contamination, disease, epidemic, quarantine restriction...” Importantly, a force majeure event can arise even if it does not take place near the hospital – pandemics or epidemics in other countries and regions can create shortages of critical supplies (e.g., vaccines, personal protective equipment, etc.) if they are diverted to the most affected areas. There are standard contractual exclusions from force majeure that are designed to prevent a party from using it as a shield to a breach of contract, such as events or causes (a) that are the reasonably foreseeable consequence of the negligence or deliberate act of the party in breach, (b) that could have been avoided through the exercise of reasonable diligence on the part of the party in breach or any person engaged by such party, or (c) resulting from a lack of funds. If there are known force majeure

events that are likely to occur during the term of the contract, such as market fluctuations, government embargos, designated “war zones”, etc., these can also be excluded from force majeure if the parties will be expected to perform the contract under such adverse circumstances. Hospitals that adopt standard, unqualified force majeure clauses in their services contracts do so at their own peril. If a critical supplier can rely on force majeure to excuse performance in an emergency that will disrupt operations, the hospital may have no recourse against the supplier. This is why we recommend that hospitals require their critical suppliers to have and produce for inspection, business continuity or contingency plans indicating how they will continue to provide services in foreseeable emergencies. We also recommend that hospitals modify force majeure clauses to exclude emergencies where the hospital will be expected to continue to provide services. In doing so, hospitals will at least have some comfort that their critical suppliers will be able to provide services during emergencies, and that they will have legal H recourse if they fail to do so. ■ Michael Watts is a Partner and David Solomon is an Associate in the Toronto office of law firm Osler, Hoskin & Harcourt LLP.

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From the CEO's Desk 21

Integrating the voice of the patient By Jean Bartkowiak

ike most hospitals in Canada, Thunder Bay Regional Health Sciences Centre operates within an increasingly challenging healthcare environment: Indeed, we observe a growing population of vulnerable and medically complex patients that no longer require specialized acute care but cannot be discharged home. This exacerbates what are already demanding fiscal pressures. We struggle to address chronic surge capacity. As a young and growing academic health sciences centre, we work together with our system partners to ensure we accomplish our mission and priorities effectively and efficiently. Patients are our partners, and the other healthcare providers in the system are part of the solution. Patient and Family Centred Care (PFCC) is the philosophy that guides us. This concept to healthcare provision calls for patients and families to be the focus of all our actions. Many hospitals are embracing the PFCC philosophy, and are involving patients and family members in medical decisions like never before. What is different at our Hospital is that from the beginning, we have intentionally integrated the voice of the patient at all levels. Patients are members of every program and service council, including the Senior Leadership Council and the Board of Directors. They are at the table, contributing to decisions and plans to tackle the challenges we face.

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Close to 100 persons volunteer as Patient Family Advisors (PFAs) providing a patient perspective in virtually all areas of the Hospital. Patient Family Advisors, volunteers who have experienced care at our Hospital, are intimately involved in discussions at the highest levels. Close to 100 persons volunteer as Patient Family Advisors (PFAs) providing a patient perspective in virtually all areas of the Hospital. Since fully committing to PFCC, PFAs have been involved in over 600 working groups, committees, councils and teams. Some examples include Board Quality, Hiring, CEO selection, Strategic Planning, Accreditation, Staff orientation, Education, Program development, Website development and policy review. When we have to consider complex issues and weigh the consequences of difficult clinical or financial considerations, a Patient Family Advisor contributes in enriching the discussion and ultimately, the decisions. In this way, we are transparent, accountable to the people we serve, and unfailingly focused on the best outcomes for patients and families. Ours was one of the first hospitals to include PFA as an active member of the Quality of Care Committee, bringing a unique perspective to discussions regarding critical incidents that have occurred, www.hospitalnews.com

and the recommendations that result. This is a significant step forward. We had seen the benefit of PFA involvement in other areas, and how it improved outcomes. The PFA active participation adds balance and a valuable perspective, which is particularly important in quality improvement recommendations. The Quality of Care Information Protection Act (2004) identifies that the patient voice must be represented throughout the care provision process. We not only work with patients and families but, to comply with the Act, we’ve taken that one step further by including a PFA on our Quality of Care Committee. Patients involved in an incident are always part of the review, of course; however the PFA represents ‘all patients voices’ and adds a consistent perspective at the committee level. Our full integration of volunteer PFAs has been met with surprise from other hospitals. There is often unease because the councils and committees discuss the most critical incidents and highly confidential information. My advice is this: Trust that your volunteer is involved for the right reasons and you will be rewarded with better outcomes. Our PFAs are selected through an application process, and receive the same orientation as Hospital staff. Their commitment to and respect for confidentiality is equal to that of our staff. We’ve been practicing PFCC for the past eight years, and our Strategic Plan 2020 displays our continued commitment to grow and embed the PFCC philosophy at our Hospital. PFCC is not something that just happens. It’s about making an intentional commitment to a journey with a richer appreciation of what it means to work in collaborative partnership with patients and families. It changes the way you deliver care and services to shape a better organization. In fact, this year, Accreditation Canada implemented changes to enhance the focus on patient and family centred care. According to their website, Accreditation Canada is now evaluating healthcare and social services organizations against new requirements that ask organizations to: Partner with patients and families in planning, assessing, and delivering their care; include patient and family representatives on advisory and planning groups, and; monitor and evaluate services and quality with input from patients and families. In addition, Ontario’s Patients First Legislation provides an action plan that “exemplifies the commitment to put people and patients at the centre of the system by focusing on putting patients’ needs first.” This external endorsement supports all hospitals to enhance PFCC, and validates the work we are doing at Thunder Bay Regional Health Sciences Centre. Our PFCC commitment has had a tremendously positive effect on the overall patient experience. We know we are leading a trend with other hospitals that are engaging their patient community in enhancing the focus to patient and family centred care. Thunder Bay Regional Health Sciences Centre has been designated by Accredi-

Jean Bartkowiak tation Canada as “Leading Practice” in Patient and Family Centred Care. We are also proud that we received two prestigious awards from the Canadian Patient Safety Institute (CPSI), one as an organization, and one for the work our Patient Family Advisors do. The CPSI is a national organization that monitors patient safety and patient experience across Canada. Although we are already recognized leaders in PFCC, we view this commitment as an ongoing journey to better the overall experience of care. As we continue on this

journey, I am confident we will more successfully adapt our organization to effectively address the challenges we face. Most importantly, we will make improvements that will be observed by our patients and their families. To learn more about Patient and Family Centred Care or how our Patient Family Advisors make a positive difference, contact PFCC@tbh.net or visit H www.tbrhsc.net ■ Jean Bartkowiak is CEO, Thunder Bay Regional Health Sciences Centre.

Great Minds Meet Here Upcoming Fall Conferences October 4 Patient-First Solutions for Chronic Conditions: A Systems and Family Focus October 14 QIPs Workshop: Achieving Performance Excellence

November 17 Effective Process Management Skills Workshop November 29-30 Emergency Department Administration Conference

October 18 Strategies for Workplace Civility and Conflict Resolution in Health Care

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SEPTEMBER 2016 HOSPITAL NEWS


22 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Emergency rooms interactive tool ensures accurate forecasting By Martin Davidek and Diane Mendes mergency rooms (ERs) in Ontario face many pressures. Patient volumes are rising steadily and providing timely access to care is an ongoing challenge. To support hospitals across the province, Cancer Care Ontario (CCO) has developed a new Pay for Results (P4R) Forecasting Tool, allowing ERs to measure their performance and plan for expected volumes in a more realistic and accurate way. The interactive tool forecasts the outstanding months in the calendar year and projects expected year-end ER volumes. Using these projections, the tool calculates a combined calendar year value for each indicator used to determine the site’s final P4R score and rank. Users can see both the monthly projections as well as the calendar year aggregate for all P4R sites. In addition, hospitals can assess the impact of various scenarios, which results in better planning and increased efficiencies. “The development of the tool was in response to feedback we received from users involved in the planning and evaluation of P4R,” says Jason Garay, Vice-President, Analytics and Informatics, CCO. “The key benefit is that hospitals can now test various scenarios and plan ahead to meet yearend targets.” Seventy-three hospitals in Ontario are part of the P4R program, which facilitates continuous improvement regarding access to ER resources and supports the planning and implementation of initiatives to reduce the time patients spend in emergency departments. Since the P4R Forecasting Tool was released in May 2016, it has been accessed more than 150 times by over 50 unique users. Planning for the second phase of the project is already underway to incorporate new enhancements to the tool to further assist hospitals with accurate planning. “The new P4R Forecasting Tool is an innovation that will enhance the field’s understanding and use of ER data,” says Stephen Bellinger, Officer, Performance and Decision Support, North East Local Health Integration Network. “I look forward to using the tool and seeing how it will assist with the analysis and forecasting of ER performance.” CCO’s Access to Care program enables improvements in the access, quality and efficiency of healthcare services. The program aims to reduce ER Length of Stay by implementing and using information management/information technology solutions, and by tracking patients as they move across the continuum of care. For more information about the tool, please contact CCO’s Access to Care program at atc@cancercare.on.ca or contact H your hospital ERNI Coordinator. ■

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A debrief with the Toronto Fire Service highlighted that in the event of an actual emergency, Runnymede’s extensive sprinkler coverage would help minimize the speed of a fire’s spread and buy staff extra time to remove patients from affected areas.

Enhancing fire safety with training and partnerships By Michael Oreskovich t Runnymede Healthcare Centre, implementing effective fire management strategies supports the hospital’s top priority: patient safety. Inadequate preparation for emergency situations is a serious matter, and the stakes are very high. Runnymede’s most recent fire safety inspection, conducted in cooperation with the Toronto Fire Service, was a success that revealed many leading practices and solidified the hospital’s reputation as a centre of excellence. Runnymede’s fire evacuation processes must be exceptionally efficient in order to meet the needs of its patients, as the majority have limited mobility because of their injuries or medically complex conditions. The emergency policies and procedures at Runnymede address this identified need by outlining staff members’ responsibilities and specific methods for safely transferring patients to designated areas away from harm. The policies and procedures adopt the standardized

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Runnymede runs monthly fire drills and annual mock evacuations, with staff members acting as “stand-ins” for patients.

language recommended by the Ontario Hospital Association (OHA) and include a code red for fire and code green for evacuation. Excellent policies are only half of the equation, however. According to Bruce Westwater, Runnymede’s director of information services, “ensuring that hospital staff are well-trained and have the necessary supports for responding to a code red and code green is crucial.” Runnymede trains all new staff on emergency policies and procedures as part of the hospital’s orientation program. “After orientation, online education tools like videos, policy documents and other resources are always available for staff members to review on an as-needed basis,” said Westwater. To further embed awareness of fire safety policies and procedures in staff, Runnymede runs monthly fire drills and annual mock evacuations, with staff members acting as “stand-ins” for patients. The evacuation exercises, conducted in partnership with the Toronto Fire Service, help to ensure that Runnymede’s code red and code green policies and procedures can be effectively executed not only on paper, but in practice as well. When the latest annual mock code red and code green exercise ran in late 2015,

it demonstrated a true test of the strength of Runnymede’s emergency preparedness by simulating a worst-case scenario: a fire starting in a ward room of four patients with the number of on-site staff at its minimum. The exercise was tremendously successful. Runnymede staff cleared patients from the simulated fire zones in only 20 minutes – significantly faster than the 85 minute time limit allotted by the fire inspector. A debrief with the Toronto Fire Service highlighted that in the event of an actual emergency, Runnymede’s extensive sprinkler coverage would help minimize the speed of a fire’s spread and buy staff extra time to remove patients from affected areas. The debrief also recognized Runnymede’s implementation of new technology that enhances connections between the hospital’s heat detectors and communications systems. “When a heat detector is triggered, our receptionist is notified of the precise location of the alarm,” says Westwater. “When the fire department arrives, the reception personnel are then able to convey exactly where the alarm was generated and first responders don’t lose time searching for the source of the fire.” Triggered heat detectors also cause electronic signage around the hospital to display the location of the alarm so that all staff members instantly have information about where the fire can be found. Runnymede shares insights like these with its peers through a collaborative team of member hospitals from around the Greater Toronto Area (GTA). Called the Toronto Hospital Emergency Preparedness Quality Improvement Committee (THEPQIC), the team’s purpose is to enhance best practices in emergency preparedness for hospitals in the region. Continued on page 31

Martin Davidek is Group Manager and Diane Mendes is a Senior Analyst, Emergency Room, Access to Care, Cancer Care Ontario. www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 23

Innovative solutions to infection prevention and control By Claire Samuelson

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nfection prevention and control is an essential part of quality patient care. Canada’s academic healthcare organizations are at the forefront of research designed to reduce the risk of infection in our hospitals and other healthcare facilities. HealthCareCAN, the national voice of healthcare organizations across Canada, highlights many of these advancements in Innovation Sensation, a database that features over 200 media stories related to the prevention and control of infectious disease. A selection of these stories are featured below. Poor hand hygiene is a problem blamed for thousands of hospital deaths per year. Researchers at University Health Network’s Toronto Rehabilitation Institute are attempting to solve the problem by equipping nurses with badges that buzz when staff members forget to wash their hands. The system requires staff to wear a badge that communicates with sensors located throughout patient areas, and go off when workers neglect to wash. Hygiene performance is recorded by the chip inside the badge, the data downloaded later by the facility. Canada’s first test with electronic monitoring of hand-hygiene dramatically improved practices at the Toronto Rehabilitation Institute, and could dramatically reduce the risk of infection if implemented widely. Immunization is one of the safest and most effective measures in public health, playing a vital role in keeping Canadians healthy. A smartphone app developed by a team of Ottawa scientists called ImmunizeCA offers Canadians a convenient way to track their immunization history and schedule. Led by a team of researchers from The Ottawa Hospital and the Children’s Hospital of Eastern Ontario, the app will be updated and enhanced, incorporating new features such as customizable schedules, information for individuals with health conditions, and catch-up schedules for newcomers to Canada, including refugees. These key features will further help protect Canadians from infectious disease. A study at Provincial Health Services Authority suggests that Canadians who received the flu vaccination halved their risk of infection that year. The estimate was drawn from a network of several hundred physicians throughout the country. An important implication from the data relates to the care of people who are at high risk of complications if they become infected. Such patients should still be monitored closely for flu-like symptoms throughout the year. Researchers at Kingston General Hospital have discovered a new treatment for C. difficile, a bacterium that causes severe intestinal distress and disease for sufferers. C. difficile takes over the intestinal tract of a patient when a course of antibiotics has already eliminated all resistance. It has recently been discovered that stool transplants from healthy donors are quite successful in combating C. difficile infection. However, the idea of receiving someone else’s healthy stool is unappealing to most patients. This inspired scientists at Kingston General Hospital to test whether such transplants could be successfully done without using actual stool. They created a synthetic mixture and tested it on two www.hospitalnews.com

elderly women with C. difficile infection who had failed treatment with antibiotics. Within two to three days, both women felt significantly better and no longer experienced symptoms of C. difficile. A vaccine trial undertaken by Providence Health Care aims at further combating C. difficile. Royal Columbian and Surrey Memorial hospitals have recruited subjects to participate in the two-and-ahalf year clinical trial that may help yield a new tool in fighting the spread of the potentially life-threatening infection. While the infection has historically affected elderly patients with chronic illness, it is

increasingly affecting younger people and showing resistance to antibiotic treatment. A Vancouver hospital has become the first in Canada to test a germ-killing robot that promises to dramatically reduce hospital-acquired infections. Vancouver General Hospital is testing the device, which uses powerful ultraviolet light to kill germs and viruses such as norovirus and C. difficile in hospital rooms, on a five-month pilot project. When the device is turned on, a robotic voice gives a 15-second countdown before a bright blue UV light shines around the room, killing harmful bugs and bacteria on all surfaces.

Health research allows for the discovery of innovative solutions aimed at reducing the risk of infection in Canada’s hospitals and other healthcare facilities, ensuring a safe and healthy environment for patients, family, and healthcare providers. For more innovations related to the prevention and control of infectious disease, please visit HealthCareCAN’s Innovation SensaH tion database. ■ Claire Samuelson, MA (Bioethics) is Policy Analyst, Research and Innovation at HealthCareCAN.

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24 Doctors without Borders

(above) A Syrian refugee carries his two-year-old daughter in the rain-soaked Taybeh makeshift refugee camp outside Baalbek in Lebanon’s Bekaa Valley, January 18, 2013. Unhygienic conditions in the camp are leading to various communicable illnesses, especially among children. The camp is home to approximately 300 people who fled conflict in Syria. (right) Nurse Tricia Newport from Whitehorse, Yukon, recently returned from Tripoli, Lebanon where she worked for 6 months as a project coordinator for an MSF project with Syrian refugees.

Doctors without Borders By Tricia Newport

ents can tell stories of joy and stories of anguish. I lived in a canvas tent in Northern Canada for 10 years. It was my choice, and I loved it. I loved the challenge of being self-reliant and of living without electricity and running water. Mohammad and his family also live in a canvas tent. Their tent is not in Northern Canada, but in Northern Lebanon, along the Syrian border. I met them while I worked for Medecins Sans Frontieres/

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Doctors Without Borders (MSF) for six months in 2016. In January 2016 I sat on the floor of the tent where Mohammad, his mother, his wife and his nine children lived. It was winter, and we huddled around the woodstove as snow fell outside. As Mohammad showed me photos of their life in Aleppo, it reminded me of how I used to proudly show people photos of the tent I chose to live in. Seeing Mohammad’s photos and the beauty of old Aleppo, it

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was clear that their tent living was not by choice, but by absolute necessity. I began working as a nurse with MSF in 2009. Since then I have worked with some of the people this world has forgotten most. In the Democratic Republic of the Congo, Djibouti, Cameroon, and South Sudan I have worked with people fleeing conflicts that were unmentioned in western media. In Niger and Chad I worked with people continuously struck by waves of malnutrition caused by a complexity of factors out of their control. Besides a few photos of malnourished children, their stories were rarely told in western media. The Syrians I met in Lebanon can also classify as a forgotten population. While stories of the Syrian conflict are regularly recounted in the news and the politics and plights of Syrians in Europe are in the media on a daily basis, the stories of families such as Mohammad’s go unheard. Mohammad and his family arrived in Lebanon in 2013. They fled Aleppo during one of many bomb strikes. They arrived in Lebanon with very little. They couldn’t afford to rent an apartment or a garage, so they were forced to rent a small canvas tent in one of the many Informal Tented Settlements (ITS) set up in Northern Lebanon. ITS are the result of the Lebanese government forbidding refugee camps in the country. Mohammad’s mother has diabetes and high blood pressure. The travel and stress of the situation had caused her diabetes to become extremely unstable. Upon arriving in Lebanon she needed medical care that specialized in chronic diseases such as diabetes. Mohammad’s wife was also pregnant with their ninth child, and needed prenatal care. Other Syrians living in the ITS told the family to go to MSF’s nearby free health clinic.

Since 2011, MSF has run health clinics in North Lebanon. These clinics provide free consultations for acute illness, antenatal and postnatal care, mental health and chronic disease. It was in one of the four MSF clinics in North Lebanon that I first met Mohammad and his family. While I began working with MSF as a nurse, in Lebanon I worked as the project coordinator. As the project coordinator I assessed the context and the needs of everyone living in the area and I spoke with different people about the experience of Syrians and vulnerable Lebanese living in the north. I spoke with government officials, medical officials, religious leaders, and the people living the stories – Syrians and vulnerable Lebanese. As I sat on the tent floor in January, I heard a sentiment that I came to hear repeatedly during my time in Lebanon. Mohammad and his family want to return to Syria, but they can’t right now. Syria is home, but for now they are stuck. Stuck living in a canvas tent, and for them there is no clear future. Employment is hard to find, education for the children is irregular, and food is expensive. The tent is cold in the winter and hot in the summer. But, I was told repeatedly, at least healthcare and medication is free, thanks to MSF. My experiences with MSF constantly teach me about the power of relativity. I loved my 10 years in the canvas tent in the wilds of Northern Canada. Those years taught me that anything is possible, and made me feel that the world was full of open doors. For the hundreds of thousands of Syrians living in canvas tents in Lebanon, it is not the same experience. The only door that seems open is that of the H canvas tent. And that of the MSF clinic. ■ Tricia Newport is a nurse in Whitehorse, Yukon www.hospitalnews.com


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Trillium Health Partners adopter of new Code Silver By Laura Watkins

ospital emergency codes are critical in enabling hospital staff to ensure the safety and well-being of patients, visitors and other staff. Recently, the Ontario Hospital Association (OHA) added Code Silver to its standardized list of emergency codes, which is an emergency response specific to a violent situation involving a weapon. Code Silver is distinct from other emergency codes, as it immediately involves the police, something that doesn’t happen with other hospital codes until a later stage of severity. Simon Bridgland, an Emergency Management Specialist at Trillium Health Partners (THP), explains that automatic police involvement is a good thing. “While the police focus on the tactical portion of the incident, our management team can focus on the safety of the hospital, the patients, families, staff, physicians, learners and volunteers. We are also able to coordinate our command centre and improve our communication with internal and external parties.”

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A simulation excercise takes place in the emergency department t St. Michaels hospital.

Simulated emergencies inspire real improvements By James Wysotski he trauma bay in St. Michael’s Hospital Emergency Department bustled with activity as a new patient was rolled in on a stretcher. With a possible leg fracture and significant blood loss, X-rays were quickly ordered and the Massive Transfusion Protocol went into effect. Everyone performed as if a life were at stake. The difference this time? The patient was a mannequin. The exercise was the seventh of 12 insitu ED simulations planned by Drs. Chris Hicks and Andrew Petrosoniak, emergency physicians and trauma team leaders who are co-principal investigators of the TRUST (Trauma Resuscitation Using in-Situ simulation Team training) study, which seeks to augment lecture-based and traditional simulation learning by observing how staff interact both with themselves and the actual ED environment, as well as how smoothly the hospital’s processes and systems work. The simulation scenarios last 15-20 minutes and include any on-shift staff in the ED, as required. Each is based on actual critical events that happened at the hospital, but spun differently. “It’s not anecdote driving change anymore,” says Dr. Hicks. “We’re able to produce evidence that substantiates what people already know – and some stuff that they didn’t know.” But it isn’t just these combined observations and analyses inspiring recommendations for improvement, it’s the 20-minute debriefs after each simulation that provide the “invaluable feedback that can lead to change,” says Dr. Petrosoniak. “People feel like they have a voice and see the benefits for themselves, to their work flow, to the department and to the patients’ safety.”

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HOSPITAL NEWS SEPTEMBER 2016

Code Silver is distinct from other emergency codes, as it immediately involves the police.

“I don’t want this to be a 12-month study that just stops. What we do should carry forward and become a regular training exercise that happens at St. Michael’s Hospital and nowhere else, so that we can be leaders in that field.”–Dr. Chris Hicks Initially, staff seemed hesitant about adding more work to already busy days, but after a few sessions Dr. Petrosoniak noticed a “culture shift” toward patient safety and how to improve it systemically. Showing staff how their ideas effected change aided the buy-in of making simulations just another part of the day’s routine, says Dr. Hicks. Changes to the hospital’s Massive Transfusion Protocol – a way of rapidly moving blood across the hospital – showcase the study’s success. Dr. Hicks says that while the protocol looked good on paper, all sorts of unanticipated challenges arose in the real world. Simple things like which route to take while transport-

ing the blood, waiting for elevators and where to stand in the trauma bay all added up to precious time lost. Through the study’s analysis, the average delivery time was cut in half to about eight to nine minutes. This improvement exemplifies the difference between design and user experience, thereby showing the value of continued in-situ ED sessions. “This is a study, but we hope this training becomes something that happens as a matter of routine,” says Dr. Hicks. “You do this to make yourself and your team do H patient care better.” ■ James Wysotski works in communications at St. Michaels Hospital.

While Code Silver is different in many ways, it does have similarities to Code White, an emergency response specific to a violent situation, however Bridgland explains that the staff have to act quickly to make the distinction and ultimately the decision of which code to call. “It’s a quick question you have to answer in your own head – what’s the intent when it comes down to it? Is there intent to cause harm or is this person just someone who’s lost touch with reality and really needs to be handled as a Code White?” The implementation of Code Silver was important for THP to continue and strengthen its high level of commitment to the safety of patients, visitors and staff. In April 2016, THP became an early adopter and launched Code Silver across the organization. John P. Angkaw, the Director of Enterprise Risk at THP, explains that the need for Code Silver was identified last year as there was a rare gap within the emergency response codes specific to these types of violent incidents. The potential involvement of a weapon is significantly different than other incidents and THP saw the need to equip themselves with different safety techniques, should the situation arise. As part of the development process, an external review of the adoption of Code Silver in other hospitals across North America was conducted, as well as a comprehensive internal engagement plan targeting front line staff and leadership. Continued on page 31 www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 27

Jim walks the walk.

Jim Vigmond’s handshake is as firm as his commitment to helping his personal injury clients receive fair verdicts. This founding partner is also committed to his philanthropic pursuits. Among his many charitable organizations, Jim raises funds and travels to Cambodia every year to assist underprivileged women house themselves while giving them the opportunity to go to law school. Lending a hand comes naturally. With exceptional experience in spinal cord and brain injury law, Jim knows that his legal contributions will make a profound difference in the outcome of his client’s life. For Jim, their right to fair compensation isn’t just of vital importance; it’s his professional mission. Jim doesn’t have to be in court to talk the talk. Jim would be quick to tell you that despite all his success, nothing compares to the joy of actually being able to make a difference in someone’s life.

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SEPTEMBER 2016 HOSPITAL NEWS


28 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

A distinct recognition for Fraser Health By Sandra Morrison ecently Fraser Health celebrated receiving an Award of Distinction from Accreditation Canada for its trauma network. Trauma Distinction recognizes trauma systems or networks that demonstrate clinical excellence and an outstanding commitment to leadership in trauma care.

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Participating in the Trauma Distinction program holds organizations to higher standards, and it has given Fraser Health a heightened awareness of its trauma system. Ms. Chris Windle, Director, Clinical Operations, Royal Columbian Hospital, and Director, Trauma Services, Fraser Health, says participating in the trauma distinction was immensely satisfying for the organization as a whole. “We were enthusiastic to show how Fraser Health is dedicated to continuous quality outcomes and providing better care for patients. Everyone was involved. Committed professionals from across the spectrum of trauma care joined in the conversations.

The trauma distinction accreditation team at Fraser Health. All of our health facilities and providers were discussing Fraser Health’s response to trauma care.” There’s a lot of hard work to be done before the on-site survey. One challenge was the size of their region. Spanning an area from Boston Bar to Burnaby, Fraser Health serves approximately 1.7 million people, one third of B.C.’s population. It’s the largest and fastest growing health authority in the province and provides trau-

ma care in all 12 of its acute care hospital sites in both urban and rural locations. “Each and every staff member plays an important role in the care of trauma patients. We’re proud of our trauma network,” says Chris, “which includes administrative, nursing, physicians, allied health, and trauma registry staff. The Trauma Distinction program allowed them to showcase their regional excellence and ongoing quality improvement in trauma services.”

IPAC Canada: A national force behind safer care By Suzanne Rhodenizer Rose nfection Prevention and Control Canada (IPAC Canada)/Prévention et contrôle des infections Canada (PCI Canada) is a national, multi-disciplinary, voluntary professional association uniting those with an interest in infection prevention and control in Canada. IPAC Canada has over 1650 members in 21 chapters across the country. All our members and partners are dedicated to the health of Canadians by promoting evidenced-informed best practices in infection prevention and control. Celebrating its 40th anniversary, IPAC Canada was incorporated as the Association for Professionals in Infection Control Canada in 1976 eventually becoming Community and Hospital Infection Control Association (CHICA Canada) in 1985 and IPAC Canada in 2014. IPAC Canada works toward its goal of wellness and safety of Canadians by promoting best practice in infection prevention and control through education, standards, advocacy, and consumer awareness. We do this through the provision of resources, education opportunities, and collaboration with partner stakeholders. In May 2016, IPAC Canada held its annual National Educational Conference, themed Wisdom Begins with Wonder, in Niagara Falls, Ontario. In addition, the organization celebrated its 40th Ruby Anniversary which provided members the opportunity to reflect on how far they have come individually as well as how far IPAC Canada has come,

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HOSPITAL NEWS SEPTEMBER 2016

recognized internationally as an organization that has excelled due to the strong and dedicated membership base and engaged corporate and strategic partners. Indeed, members have contributed time and energy over many years to produce scientifically based tools, guidelines, and other resources to support infection control professionals across Canada. For instance, the practice experts in our Standards & Guidelines Committee develop and review infection prevention and control best practice documents.

IPAC Canada works toward its goal of wellness and safety of Canadians by promoting best practice in infection prevention and control through education, standards, advocacy, and consumer awareness. The resources are often position statements or practice recommendations that have been initiated by our one of the twelve interest groups. Current position statements and practice recommendations can be found at http://www.ipaccanada.org/links_position.php. Throughout our 40 years, we have been mentored by expert and dedicated leaders both locally and nationally. Our chapters are an integral source of net-

working and education. Governing such an important body and seeking the creativity to attract and sustain members falls to the Chapter President and Chapter Executive. Those who have held these positions have our grateful appreciation. On the national stage, our 28 Past Presidents have dealt with a myriad of issues that have impacted the association and the profession, from birth, to growth, to sustainability. All of us are grateful for their vision and their ongoing support. Many of our members have provided extraordinary service to the association and the profession and have been recognized through awards and acknowledgement. None more so than the 16 members who have been rewarded with Honourary Member status. The Boards of Directors of CHICA Canada and IPAC Canada have always been an exceptional group of professionals who unfailingly concern themselves with bettering the association, the profession and ultimately health care. The legacy of chapter guidance, presidential governance and extraordinary service served us well and has given us strength of renewed purpose. It is through the strength of its membership and a small but mighty office team that IPAC Canada maintains a prominent position on the healthcare stage. Congratulations, and a heartfelt thank-you to everyone who has made H this organization what it is today! ■ Suzanne Rhodenizer Rose is President of IPAC Canada.

Evaluators visited four sites and held teleconferences with the others, so all locations were able to provide input. According to Chris, the on-site survey was a morale booster for staff. “They were extremely proud to discuss with the evaluators the clinical work they do for patients and families. And the evaluators were very dedicated. They asked tough questions at times as they followed the patient’s journey, and they put their heart and soul into the process to learn about our system.” Fraser Health’s model of trauma care deviates somewhat from the norm, which is usually a surgeon-led interdisciplinary team. In Fraser Health the trauma team consists of emergency physicians, trauma general surgeons, and anesthesiologists. Feedback from the evaluators was positive, who noted this relatively novel model of providing trauma care has resulted in excellent patient outcomes. “I think this shows there’s not just one way of doing things,” says Chris. “Moving forward we will be researching and reporting on the outcomes of our mixed-model of providing trauma care.” The Fraser Health trauma network is dedicated to a philosophy of providing quality and safe healthcare to all patients and their families. Quality improvement doesn’t stop after the on-site survey. Performance indicators reporting and monitoring is ongoing for quality initiatives and clinical excellence, and Fraser Health will continue to share its results with Accreditation Canada. “Participating in the Trauma Distinction program holds organizations to higher standards, and it has given Fraser Health a heightened awareness of its trauma system. You look at your quality improvement initiatives to see how you could do things differently, making it better for your patients, which will help us in providing best trauma care possible,” says Chris. Chris notes that Fraser Health is following up on the evaluators’ recommendations. “We’ll continue doing ongoing quality work and share data across all the sites. We’re working on creating a robust annual report that incorporates the different indicators, focusing on quality improvement across the trauma spectrum. We’re also establishing formal reporting systems for all 12 sites.” The Trauma Distinction process stimulated great conversations focused on quality improvement, and led to more ideas for research and publications. And the benefits go beyond Fraser Health’s patients and families. At provincial meetings of trauma health authorities, Fraser Health shares information and learnings that affect trauma care throughout the province. Chris says the Trauma Distinction process is an excellent way for organizations to assess their level of performance in relation to established standards. She encourages others to pursue it. “Focusing on a quality improvement journey helps to explore any gaps. Just allow plenty of time, and talk with organizations that have already experienced it. The Trauma Distinction program proved to be a great process for Fraser Health. It was a lot of hard work, but good work, that gives us opportunities for moving forward into H the future.” ■ Sandra Morrison is the Writer/Editor at Accreditation Canada. www.hospitalnews.com


EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Focus 29

Current hand hygiene measurement system doesn’t measure true compliance By Sybil Millar he way hospitals measure and report hand hygiene rates does not accurately reflect the true compliance rates of healthcare providers, according to a newly published study. “The current measurement and reporting system for hand hygiene rates overestimates how often healthcare providers clean their hands, because it doesn’t account for the natural changes in behaviour that happen when healthcare providers know they are being watched,” says Dr. Jerome Leis, lead author of the study and staff physician, general internal medicine and infectious diseases at Sunnybrook Health Sciences Centre. The study also found that this natural change in behaviour, known as the Hawthorne effect, might lead to invalid comparisons between different groups of healthcare providers. “Across the province, institutions report hand hygiene rates of around 90 per cent, but physicians are often reported to have much lower hand hygiene compliance than other healthcare providers. We wanted to find out whether this group was truly less likely to clean their hands, or if

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lower compliance rates among physicians were because of issues with the observational method itself,” says Dr. Leis. In the current system, a designated auditor carries out regular hand hygiene audits, and healthcare providers are often aware they are being evaluated. Results can be grouped by profession, unit or program area.

“The current measurement and reporting system for hand hygiene rates overestimates how often healthcare providers clean their hands. This approach is used to benchmark performance in institutions throughout Ontario. For this study, two students were trained to covertly measure hand hygiene compliance during their clinical rotations at Sunnybrook between May 27, 2015 and July 31, 2015. Students rotated in the emergency department, general medi-

cal and surgical wards for up to a week at a time. At the end of the study period, the covert student observers reported an overall hand hygiene compliance rate of 50 per cent, versus the 84 per cent compliance rate recorded by hospital auditors during the same time frame. The researchers also found the performance gap between groups of healthcare providers closed significantly when no one knew that hand hygiene was being measured. “These findings show that hand hygiene is a problem across all groups of healthcare providers, not just physicians,” says Dr. Mary Vearncombe, study co-author and Medical Director, Infection Prevention and Control. She also notes that while the study provides a more accurate picture of hand hygiene rates, Sunnybrook’s hand hygiene has improved over the last 10 years, as evidenced by the concurrent reduction in the transmission of super-bug infections like MRSA. A benefit of the current hand hygiene reporting and measurement system is that direct observation offers in-the-moment feedback and educational opportunities, as well as a chance to reward staff who were

“caught clean handed”. “Different methods for measuring are complimentary, not mutually exclusive,” says Dr. Vearncombe. One of the most important factors that influenced the hand hygiene compliance of physician teams was whether attending physicians cleaned their hands. The study found compliance rates increased significantly to 80 per cent when attending physicians cleaned their hands, versus a decrease to as low as 20 per cent when attending physicians did not clean their hands. “Given that the new academic year begins in July with new resident physicians on the ward, this study underscores the importance of role modeling hand hygiene behaviors that can shape long-term practice patterns,” says Dr. Leis. Based on the findings from this study, “we are working with other hospitals across the Greater Toronto Area to implement new ways of measuring hand hygiene compliance, including electronic monitoring, with the goal of improving patient H safety,” says Dr. Leis. ■ Sybil Millar is a Communications Advisor at Sunnybrook Health Sciences Centre.

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Denise Hodgson

at 905-532-2600 x2237 or denise@hospitalnews.com

Call Today! Stefan Dreesen

at 905-532-2600 x2235 or stefan@hospitalnews.com

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SEPTEMBER 2016 HOSPITAL NEWS


30 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Educational & Industry Events To list your event, send information to “events@hospitalnews.com”. We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com” Q September 20, 2016 2016 iHT2 Health IT Summit Toronto, Ontario Website: www.ihealthtran.com Q September 20-21, 2016 4th Annual Patient Experience Summit Toronto, Ontario Website: www.patientexperiencesummit.com Q September 28, 29 & 30, 2016 Mental Health For All Conference Hilton, Toronto Website: www.conference.cmha.ca Q September 29-30, 2016 Ontario Hospital Association-Health Care Financial Management Toronto, Ontario  :HEVLWHZZZFRKDFRPÀQDQFLDOPDQDJHPHQW Q October 16, 2016 Sustainable Compassion Training Workshop Emmanuel College, University of Toronto Website: https://bit.ly/ECABSI Q October 17-18, 2016 Saskatchewan Health Care Quality Summit Saskatoon, Saskatchewan Website: www.qualitysummit.ca Q October 17-18, 2016 AFHTO 2016 Conference Westin Harbour Castle, Toronto Website: www.afhto.ca Q October 24-25, 2016 CHIMA National Conference 2016 Chateau Lacombe Hotel, Edmonton AB Website: www.chima-conference.com Q October 30-November 2, 2016  Critical Care Canada Forum Toronto, Ontario Website: www.criticalcarecanada.com Q November 7-9, 2016 HealthAchieve Toronto, Ontario Website: www.healthachieve.com Q November 27–December 2, 2016 RSNA 2016 McCormick Place, Chicago, United States Website: www.rsna.org Q December 8, 2016 Data Analytics for Healthcare Toronto, Ontario Website: www.strategyinstitute.com Q January 24, 2017 Mobile Healthcare Toronto, Ontario Website: www.strategyinstitute.com To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS SEPTEMBER 2016

Product Feature: VirtaMed

VirtaMed pushes the boundaries of surgical simulation By Hope Sneddon

efore a pilot steps into the cockpit of an airplane, they must undergo intensive flight simulation training. After all, an active pilot has thousands of lives in their hands every day. Flight simulation helps them practice and prepare for difficult situations before they take off, so why not do this for surgeons? This question was what sparked Swiss company, VirtaMed to develop surgical simulators. Virtual surgical simulation is still relatively new as a training tool for hospitals and surgical clinics, however, it is starting to become more and more popular. Previous methods of simulation involved rubber models, but no virtual visualization of a procedure or objective feedback could be provided, which are both extremely important for surgery training. In North America, The American Board of Orthopaedic Surgery (ABOS) introduced a mandate in 2013 requiring surgical trainees to have simulation training as part of their surgical skills training. The VirtaMed ArthroS™ simulator provides a safe and risk-free environment for trainees to learn and practice on a variety of anatomies that include the hip, shoulder, and knee without compromising patient health. Whether trainees need 10 attempts or 100, the simulator is always available and a great alternative for OR practice or the use of cadavers. Arthroscopy procedures, such as ACL reconstruction, require a lot of training and skill to perfect. With a simulator, trainees can learn how and where to place ACL grafts and also learn the consequences of mistakes. When using a VirtaMed ArthroS™ simulator, trainees are able to see a virtual inside and outside view of the knee (or other anatomical joint like hip and shoulder) as well as use real surgical tools on a real anatomical model. This allows for both tactile and visual feedback for different pathologies and anatomies. Trainees can explore the joints and learn anatomy without the worry of injuring a patient. Trainees can take fluoroscopic images without exposure to radiation, which assists them in practic-

B

ing correct portal placement and access training to the joint. The simulators are a great learning tool for any hospital or surgical training centre. Training cases, expert approved and surgery specific, provide educational information and real-time feedback for trainees. Trainees can learn where to improve their surgical technique and see first-hand the consequences of surgical mistakes without the potential of harming a patient. Trainees are also able to practice on the simulators without the supervision of a senior surgeon. This frees up valuable time resources in any hospital and/or training facility. VirtaMed has an interdisciplinary background between medicine and engineering. The company has over 150 simulators throughout North American hospitals, Institutions, and training facilities. Medical societies like the American Society for Reproductive Medicine (ASRM) have been using VirtaMed simulators to improve standardized training for their surgical procedures. Similarly, medical device companies like Bayer and Smith and Nephew have been using VirtaMed simulators to promote and improve training on their devices. Helping surgeons help their trainees and subsequently their patients is the most important goal for the team at VirtaMed™. The company prides itself on pushing the current boundaries of virtual simulation and is always looking at new ways to be more innovative. Rick Hoedt, VirtaMed’s Executive Vice President for North America, is excited about the level of demand for surgical simulation in the U.S.A. and Canada and is extremely proud to be part of a company on the forefront of surgical simulation. The company along with its arthroscopy simulators also specializes in pelvic simulators for women’s and men’s health. VirtaMed hopes that its simulators will become a part of everyday surgical H training in the future. ■ Hope Sneddon is a Product Communication Specialist at VirtaMed. www.hospitalnews.com


Focus 31

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

Trillium Health

Fire saftey training

Continued from page 22 “Through our relationships with peer hospitals, we’re able to exchange strategies about managing crisis situations, like fires,� says Westwater. “By leveraging our partnerships through THEPQIC we can share our expertise while gathering new perspectives that strengthen our commitment to quality improvement.� Also advancing patient safety at Runnymede is a dedicated staff member who performs regular safety inspections at the hospital. The health and safety specialist collaborates closely with Runnymede’s management team to provide insights and recommendations related to safety, including emergency preparedness. Through patient-centred code red and code green policies and procedures,

Continued from page 26

ongoing support of staff education and implementation of enhanced safety technologies, Runnymede clearly demonstrates readiness for a fire emergency. In addition, the hospital continuously seeks opportunities for quality improvement through its partnerships. These efforts are all a reflection of the hospital’s outstanding commitment to patient safety. “You can’t plan for when a crisis will happen,� concludes Westwater, “but with an excellent emergency response strategy, you can absolutely plan to be prepared to deal with one efH fectively.� ■Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre.

Careers VIEW CAREER ADS AT:

DEADLINE FOR OCTOBER 2016 ISSUE SEPT. 27, 2016

www.hospitalnews.com To advertise please contact

Denise Hodgson

denise@hospitalnews.com 905-532-2600 ext. 2237

The launch of Code Silver was supported by a hospital-wide communication and education plan, which included outlining policies and procedures at each of THP’s three hospital sites, unit huddles and initiatives to raise awareness on the roles of individuals during a Code Silver, which included a mock exercise with THP’s senior leadership team. Similar exercises targeted at front line staff are also being developed with the assistance of other regional partH ners, such as Peel Regional Police. ■Laura Watkins is a Communications Advisor at Trillium Health Partners.

The Code Silver Trauma Team at Trillium Health Partners. POSITION

DMS Full-Time and/or Part-Time

FACULTY MEMBER

CNIH is currently seeking a Full Time and/or Part Time faculty member to join the Diagnostic Medical Sonography program. SUMMARY STATEMENT The position of a faculty member at CNIH requires a dynamic and energetic professional with a strong desire to inspire the sonographers of tomorrow. Faculty members are expected to demonstrate strong leadership skills, excellent sonography skills, and a passion for education. Faculty members interface primarily with students, faculty, administration, and student support services but they also represent CNIH to clinical staff. RESPONSIBILITIES/DUTIES i Prepare and present course outlines, course schedules, lectures, labs, assignments, and exams. i Teach students the essential concepts, procedures, and principles behind the Sonography Canada NCP as designated by the curriculum. i Use a variety of instructional techniques to promote learning and personal development. i Evaluate student progress and facilitate student achievement. i Manage the classroom and labs to the benefit of all learners. i Provide ongoing support, guidance, and advice to students informally and formally as a faculty advisor. i Attend Faculty Team Meetings. i Assist in program reviews and other committees and meetings.

i Complete administrative tasks as assigned. i Participate in ongoing professional development in the fields of education and ultrasound. RELATIONSHIPS i Reports to the Program Director. i Interacts internally with the faculty team, Student Services, and Finance Administration. i Interacts externally with clinical staff, as required. PREFERRED QUALIFICATIONS i Current registration with Sonography Canada. i Certification in Generalist Sonography with Sonography Canada. i Certification in Vascular Sonography with the American Registry of Diagnostic Medical Sonographers. i Two year’s relevant experience as a Registered Sonographer. i Certificate in Adult Education. i Demonstrated excellence in communication skills, a working knowledge of word processing and spreadsheet applications, well developed interpersonal and organizational skills. APPLICATIONS For further information about this vacancy and to pursue this career opportunity, please contact Melissa Kingston, Campus Director at mkingston@cnih.ca

Saint Elizabeth is a national health care provider that has been opening the door to new possibilities and care experiences for more than a century. 5HFRJQL]HG DV &DQDGD¡V ODUJHVW VRFLDO HQWHUSULVH ZH HPSOR\  SHRSOH DQG YLVLW  FOLHQWV HYHU\ GD\ 7KURXJK WKH 6DLQW (OL]DEHWK 5HVHDUFK&HQWUHRXU+HDOWK&DUHHU&ROOHJHVRXUFRPPLWPHQWWRSHUVRQ DQG IDPLO\ FHQWHUHG FDUH DQG WKH 6DLQW (OL]DEHWK )RXQGDWLRQ ZH DUH helping to make the future of health care brighter and stronger. Learn more at www.saintelizabeth.comRUÀQGXVRQ7ZLWWHUDW@StElizabethSEHC.

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SEPTEMBER 2016 HOSPITAL NEWS


32 Focus

EMERGENCY SERVICES/TRAUMA/EMERGENCY PREPAREDNESS/INFECTION CONTROL

AccuVein AV400

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www.hospitalnews.com

Hospital News 2016 September Edition  

Focus: Emergency Services, Critical Care, Emergency Preparedness and Infection Control. Special Focus: Online Education

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