HEALTH ACHIEVE SUPPLEMENT See page H1
FOCUS IN THIS ISSUE
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Developments in patient-safety practices. New treatment approaches to mental health and addiction. An overview of current research initiatives.
OCTOBER 2016 EDITION | VOLUME 29 | ISSUE 10
INSIDE Safe Medication ................................. 17 Evidence Matters ...............................22 From the CEOâ€™s desk .........................23 Nursing Pulse .....................................25 Trends in Transformation................... 27 Careers ............................................... 27
opioid misuse Safe prescribing Story on page 16
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
New outreach program serves clients with complex
health and social support needs By Sheryl Gray evin Hornbrook is an RN on a mission. Today, he’s off in search of “Joe,” a resident of Vancouver’s Downtown Eastside (DTES) who can often be found on the streets near Oppenheimer Park. Once found, Joe tells Kevin he needs somewhere to stay, and Kevin initiates a housing referral. As they talk, Kevin notices an infected area on Joe’s leg, makes an assessment, and connects with a physician for some antibiotics. With today’s mission accomplished, Joe is on his way, and Kevin continues down the street in search of other clients. “We find the opportunity to engage with clients, even if it’s just to assist someone to get some more cell phone minutes. Once an immediate need is met, we might be able to connect to assist with health or social support issues,” says Kevin. “The team is out looking all the time, finding clients and making those connections.” Kevin is part of the new Intensive Case Management Team (ICMT) working out of the DTES. The ICMT provides a true
The Intensive Case Management Team.
A new START at home for substance use clients
Addiction doesn’t discriminate, so why should we? By Sheryl Gray ddiction affects all walks of life…people with families, jobs, disabilities…it’s not always possible for people to enter into a residential treatment program away from home. For some, accessibility is an issue. For others, the associated stigma of “going to detox” keeps them from seeking help.
Detox isn’t a place, it’s a process.
The START program is a new twoweek, in-home detox program for Vancouver residents, aimed at people who need help to stop or stabilize their substance use. The program is completed at home, with no wait required: Clients can begin their detox journey within 24 hours of referral. The START team provides same-day or next-day intake for new referrals (professional or self-made). The first step is a visit to the program’s office, at a local Community Health Centre. Each client receives a thorough assessment by a nurse and doctor, and also has a home assessment completed to ensure a stable and supported environment is available. For the first five days of the program, a START nurse visits twice daily to monitor the detox process. During the second week, connections are made to other resources that will be essential to the client’s unique recovery process. “Medication-based treatment alone is not holistic care for addictions. Psychosocial, emotional and spiritual care are at HOSPITAL NEWS OCTOBER 2016
The Substance use Treatment and Response Team (START). least as important as the medical care,” says Dr. John Álvarez de Lorenzana, physician with the START program. “Clients who come to START will encounter service providers who are trained in a trauma-informed approach, and receive supported, compassionate care. We have the fortunate advantage of being part of the larger Vancouver Coastal Health network, with direct access to many medical and mental health care programs.” Dr. Álvarez de Lorenzana believes that addiction is becoming more accepted and understood as a chronic disease, a piece of treatment that’s been absent in the past. Medications, such as Suboxone – which
is considered a safer opioid replacement than methadone – play an important role in harm reduction and engagement in recovery activities and daily functioning. This helps people stabilize over time, which allows them to turn their focus to healing the other areas of their life from where the addiction stems. The initial medical detox process is really just the beginning of the journey, and provides a foundation for the hard work which must H follow for recovery. ■ Sheryl Gray is a Communications Specialist at Vancouver Coastal Health.
team outreach service to DTES residents who have moderate to severe substance use needs. The team includes a physician, nurse practitioner, nurses, social worker and healthcare worker, and soon, peers, who work together to meet the health and social needs of clients who have difficulty accessing traditional healthcare services. ICMTs are part of the British Columbia Ministry of Health’s defined continuum of care, with the goal to “improve health, social functioning, and access to care,” as described in their 2014 Model of Care Standards and Guidelines. Vancouver Coastal Health (VCH) has embraced the opportunity to meet clients literally where they are, whether in a park, a shelter, or their own home. The work of the ICMT is well-aligned with the goals and objectives of the Second Generation Strategy. The team is in its early days, working first with clients referred through the emergency department Familiar Faces cohort and VCH’s DTES services. Staff work to not only find the clients, but to build rapport and create the space required to provide health intervention and connections to social supports.
No goal is too small for the team, as every interaction builds relationships with the hope of eventual stabilization and connection to longer-term services “We approach people with no judgement, and over time, this opens up a space to interact. With the various mental health and substance use issues, people’s lives can be quite chaotic, and we hope our connection with them will provide access to the services they desperately need,” says Lara Ellison, Social Worker with the ICMT. “Our relationships with clients are nontransactional; at times, we just ask, ‘What can we do for you?’” All team members have a strong understanding of the impact of trauma and practice through the lens of harm reduction. Services are brought to the client wherever they are, and goals are their own: no goal is too small for the team, as every interaction builds relationships with the hope of eventual stabilization and connection to longer-term services (e.g. through a Community Health Centre). The stigma for DTES residents related to substance use, mental health issues and poverty remains, but the team moves forward, with the intention of social justice and the understanding of the inequities caused by past trauma in people’s lives. Smadar Levinson, ICMT Team Leader, explains: “I see stories of resiliency above it all. The people we serve have incredible passion. They are the ones holding onto the hope to continue to look for better lives for H themselves.” ■ Sheryl Gray is a Communications Specialist at Vancouver Coastal Health. www.hospitalnews.com
unique needs of youth with mental health issues Researchers from Western University and Lawson Health Research Institute recognize that adolescents with emerging mental health concerns require a different treatment framework than adults. A new study published in the journal Community Mental Health examined the unique experiences of youth attending London’s innovative First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre. FEMAP is a first of its kind in Canada, featuring an open door model inviting young adults affected by mood and anxiety concerns to self-refer. The program ensures that young adults receive the care they need, without having to be referred by a doctor. A team of researchers led by Dr. Elizabeth Osuch, Associate Professor in the department of Psychiatry at Western’s Schulich School of Medicine & Dentistry and a Lawson Researcher, looked at what youth find most helpful and what they find most challenging about the treatment process with the aim of using this information to help further tailor the program to address these unique needs. The study found that youth identified talking/therapy and medication as the most beneficial to their recovery, but also identified both of these as being challenging aspects of the treatment process as well. “That’s a very rich finding; that the exact thing that is most difficult is also the most helpful,” says Osuch. “It cuts both ways. It is a challenge, but it is also where your power is.” Osuch suggests that this finding demonstrates FEMAP’s success in providing a program with combined psychotherapy and prescribed medication.
The study found that youth identified talking/ therapy and medication as the most beneficial to their recovery Interestingly, they also found a significant difference in the language young females and males used to describe the treatment process. Females in the study identified “talking” as the most helpful for them in their recovery, while males identified “therapy” as most helpful. Osuch suggests this information may aid clinicians in choosing appropriate language when speaking to youth about their treatment. “If you are speaking to a young male patient, you might not want to say ‘we are going to talk’ you might want to say ‘we are going to engage in therapy.’” The study also found that the youth identified “personal accountability” as one of the most challenging aspects of their recovery. “This is an important finding because it can help clinicians prepare young people before they enter treatment to help them understand that they have to take an active role in their own recovery instead of thinking that it is something that is passively done to them,” says Summerhurst. “They play a big role in their H own recovery.” ■ www.hospitalnews.com
Mental health care
costing Canadian economy billions
Depression and anxiety cost the Canadian economy at least $32.3 billion a year and $17.3 billion a year, respectively, in foregone GDP due to lost productivity, according to a new report from The Conference Board of Canada’s Canadian Alliance for Sustainable Health Care. “A large proportion of working Canadians have unmet mental healthcare needs that prevent them from performing to their utmost and our report shows this has serious consequences for the Canadian economy,” says Louis Thériault, Vice-President, Public Policy, The Conference Board of Canada. “Improving treatment of mental illness among working Canadians would offer significant benefits for individuals, businesses, society and the economy.”
• Almost a quarter of Canadians living with a mental illness are unable to work because of their symptoms. • Employers can improve the treatment of anxiety and/or depression among
If all employees living with depression/ anxiety had access to better treatments and supports, then workplace functioning would improve significantly. employed Canadians by facilitating access to evidence-based benefits, programs and supports. In Canada, it is estimated that mental illness can affect workplace functioning. If all employees living with depression/ anxiety had access to better treatments and supports, then workplace functioning would improve significantly. Mental illness can also prevent some people from entering the workforce. If all these Canadians had access to better treatments and supports, the economy may see up to 352,000 Canadians with depression/anxiety enter the workforce as fully functional employees each year until 2035. Taken together, this could
potentially boost Canada’s economy by up to $32.3 billion a year from improved treatment of depression and $17.3 billion a year from anxiety treatment. Employees in services-producing industries feel they have the greatest need for mental healthcare. About 2.5 million employees in the services sector feel some sort of mental healthcare is required. Industries that have the highest proportion of employees with unmet mental health needs, include: • administrative support and waste management (44.4 per cent) • accommodation and food services (43.8 per cent); and • professional, and scientific and technical services (42.9 per cent). Organizations can improve the treatment of anxiety and/or depression among employed Canadians by facilitating access to evidence-based benefits, programs and supports. Improved prevention strategies, both for new and recurrent onset of mental illness are also needed, along with effective return to H work programs. ■
Canada needs a seniors strategy A new report by the Canadian Medical Association (CMA) shows that many seniors are falling through cracks in terms of accessing care and services due to a lack of a national approach and strategy. The report, The State of Seniors Health Care in Canada, demonstrates the need for a pan-Canadian strategy to address the health needs of Canada’s growing senior population. “In terms of health system performance, we know that few provinces report on health system indicators related to seniors care, such as access to home care and specialty care, such as geriatric psychiatry. Frankly, that is unacceptable in 2016,” says Dr. Granger Avery, CMA President. “We believe a common vision for action and improvements in how seniors care is measured and delivered across the country is required now.” The report, produced by the CMA, contends that improvements in seniors care require the following elements: • increased focus on healthy aging; • improved integration of health and social services; • appropriate and timely care; and • support for family and other caregivers. “Make no mistake about this. There is an urgent need to remake healthcare in this country to meet the needs of today’s aging population,” adds Dr. Avery. “Improving how we care for seniors will benefit all Canadians today and tomorrow.” The CMA has identified seniors care as a top public policy priority for governments in Canada. This call to action is supported by over 36,000 Canadians through CMA’s Demand a Plan campaign. To spur action, the CMA has made several recommendations targeted toward improving seniors care, including increased
support for home care and caregivers, as well as increasing provincial and territorial governments’ capacity to respond effectively to the needs of an aging population. Key facts supporting the need for better seniors care • The aging Canadian population is expected to result in 277,000 new cases of cancer in 2030; • The number of Canadians living with
dementia is expected to rise 66 per cent in the next 15 years; • The risk of dementia doubles every ﬁve years after the age of 65; • By 2041, seniors will have the highest rate of mental illness in Canada; • Nearly three in 10 Canadians now care for a loved one, and the number of seniors expected to need help or care will H double in the next 30 years. ■
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Opioid crisis should be top of federal health agenda By Tara Gomes
undreds of codeine tablets stolen from the medicine cabinet of an elderly person living alone in a rural community. Hydromorphone tablets being distributed at weddings and high school parties. Fentanyl patches being cut up and sold for a profit on the street. This is the reality of the opioid crisis in Canada today – these drugs are pervasive in every population, urban and rural, young and old, rich and poor. Hydromorphone, codeine and fentanyl are just three in a long list of prescription opioid painkillers that are being prescribed in enormous amounts across Canada to treat everything from dental to post-surgical pain. In fact, Canada and the U.S. have the undesirable status of having the highest per capita volume of opioids dispensed in the world. And the problem is that, while we expect prescription medications to help people, these drugs are killing people at an alarming rate. Two people die from an opioid overdose every day in Ontario, and over 14,000 died in 2014 in the U.S. Most alarming is the fact that our youth are being so greatly impacted by this epidemic. One of every eight deaths in Ontario among young adults is related to an opioid overdose. Currently, our approach in Canada has been for individual jurisdictions to tackle the problem themselves. For example, BC is currently grappling with a massive influx of fentanyl that led to 238 deaths in the first half of this year, and has led their chief health officer to declare a public health emergency. In Ontario, the approach has been to introduce numerous prescribing policies and a prescription monitoring program over the past several years as part of their Narcotics Strategy. Just last month, the Ontario Public Drug Program an-
ADVISORY BOARD Cindy Woods,
Senior Communications Officer The Scarborough Hospital,
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
Although Ontario’s policy will impact less than three per cent of all palliative care patients in the province, it highlights the complexity of policy-making in this field, and the need to engage with clinicians throughout this process to achieve a balance between access to opioids where clinically appropriate, and avoidance of patient harm. In March of this year, Health Canada made sweeping changes to the availability of naloxone – a drug that can be used to reverse the effects of opioid overdoses – by allowing it to be sold overthe-counter at community pharmacies. More broad availability of this product will no doubt save lives; however, at over $30 for an injectable naloxone kit (and over $100 for two doses of the newer nasal spray form), it is likely cost prohibitive for many people struggling with opioid addiction. Although some provinces are now providing naloxone free of charge, the approach to improving naloxone access
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across the country has been inconsistent and raises legitimate concerns about its actual impact on overdose deaths among those most in need. It is clear that policy-makers in several of the hardest hit provinces across Canada have taken steps to address opioid addiction and overdose. But is it enough? Unfortunately, in the absence of national data on opioid prescribing and overdoses, we have no way to capture the scope of this national crisis, and to identify policy changes most likely to affect real change. Instead, we will continue to rely on fragmented data reported by individual research groups in a small number of provinces. This lack of national surveillance and monitoring of one of Canada’s most significant public health issues needs to be addressed immediately. The federal government has recently prioritized an examination of the opioid crisis at the national level, with an opioid summit scheduled for this fall. This national leadership is long overdue, but will also require an ongoing commitment from healthcare providers, policymakers, data custodians and researchers from across the country to work together to ensure that we learn from each other’s successes and failures and avoid replicating mistakes of the past. The current rate of opioid prescribing in this country is clearly unsustainable. Change is possible, but only with strong federal leadership, appropriate engagement and education of clinicians, and a commitment to provide patients with access to non-pharmaceutical pain management alternatives and addiction H services. ■ Tara Gomes is an expert with EvidenceNetwork.ca, an epidemiologist and Scientist at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences.
Dr. Cory Ross,
B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON
Ontario Hospital Association
HOSPITAL NEWS OCTOBER 2016
Canada and the U.S. have the undesirable status of having the highest per capita volume of opioids dispensed in the world.
ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO
nounced that they will be delisting high strength formulations of opioids in January of next year. When used only once or twice daily, these opioids have been shown to triple your risk of dying of an opioid overdose; however their delisting has still generated considerable debate in the clinical community, particularly related to its impact on palliative care patients who use high doses of opioids to manage pain at end of life.
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PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Helping families navigate mental illness By Amber Daugherty teve Hagey describes the period of time before his wife was admitted to St. Joseph’s Health Centre’s Mental Health and Addictions program as “constant stress and high tension.” For months he juggled the daily commitments of work and providing an income for his family, being home so he could get his two young sons off to school, while remaining emotionally supportive and patient to his wife who was experiencing something that he just could not understand. The personal turning point for Steve came after his wife found help in our mental health program and when he was introduced to the Family Navigation Program – a resource available to family members of patients living with mental illness. After spending so much energy taking care of everyone else, Steve finally felt like he had somewhere he could turn to. “The benefit was just knowing that there was support for the person on the other side of the hospital bed,” says Steve. “They provided an experienced voice in mental health that helped me understand how the hospital was trying to treat my wife so that I had a better sense of (her) recovery.” With over 60,000 visits to our Mental Health and Addictions programs in the past year, we see many family members – including parents, grandparents and siblings – supporting their family members as they go through what can be an incredibly difficult time. And while patients are being treated, family members often experience symptoms of confusion, sadness and frustration. That’s where the Family Navigation Program helps bridge the gap.
Working with family members enables them to support their loved ones at home and reduce the need for emergency services. Our program matches family members with social workers experienced in mental health who provide that educational voice to explain the complexities of what’s happening with their loved one as they go through their care journey. The social workers guide families through the hospital process and in some cases, even sit in on meetings with the patient’s healthcare team to be a part of the conversation. The program is a partnership between St. Joseph’s Health Centre and the Family Outreach and Response Program and, in addition to providing information and education, offers family counselling, family support groups and connections to resources for continued ongoing support. “Families are going through a tremendous amount when their loved ones are being treated,” says Dr. Jose Silveira, Chief of Psychiatry. “While patients are receivwww.hospitalnews.com
ing medical support, their family members need to be taken care of too.” “Working with family members enables them to support their loved ones at home and reduce the need for emergency services,” he says. “As families gain a better understanding of mental health and responding to crises, they understand what resources are needed and how to handle those situations.” It’s been a year since Steve’s wife returned home after spending a month with St. Joe’s and he’s grateful for the Family Navigation Program’s support. “Mental health is difficult for anyone but if you’re new to the situation, I think it’s incredibly difficult to bear the emotional weight on your own,” he says. “This program’s accessibility and support was incredibly helpful when we were at our very H difficult time.” ■ Amber Daugherty is a Communications Coordinator at St. Joseph’s Health Centre.
Steve Hagey participated in the Family Navigation Program – a resource available to family members of patients living with mental illness.
The role of accreditation in improving patient safety By Geneviève Brisson
ver the past decade, healthcare organizations across the country have been grappling with the concept of patient- and family-centred care. This effort reached a crescendo in last fall’s Better Together campaign from the Canadian Foundation for Healthcare Improvement, which called on hospitals to begin the process of implementing a family presence policy as a practical step towards delivering a better patient experience. So now, more than ever, there is an appreciation for putting patients and families at the centre of the healthcare system. Patient- and family-centred care is no longer a trend; it is the new normal. Accreditation Canada recognizes the unique role of accreditation in putting patients first and improving the safety of healthcare for all Canadians; in fact, patient safety is an essential component of the Qmentum accreditation program. Accreditation Canada provides a robust quality improvement and safety program that reaches beyond hospitals to organizations across the continuum of care, including long-term care homes as well as residential care and home care services. The accreditation process embeds patient safety within its quality dimensions, standards of excellence, performance measures, reports, and accreditation decisions. In 2003, Accreditation Canada released its first patient safety strategy, which included the development of Re-
quired Organizational Practices (ROPs). ROPs are evidence-informed practices that organizations must have in place to enhance patient safety and minimize risk. Building on this work, the second phase of the strategy came out in 2007. It outlined an increased focus on safety in the accreditation standards, including the addition of safety-specific performance measures, and the development of patient safety knowledge transfer tools by Accreditation Canada.
Patient- and familycentred care is no longer a trend; it is the new normal. The third phase of the patient safety strategy was released in 2012. Key actions included strengthening the accreditation program, and developing and maintaining partnerships to contribute to the spread of safety and quality across the healthcare system. One of these partnerships is embodied in the National Patient Safety Consortium. Created by the Canadian Patient Safety Institute in 2014, the Consortium brings together over 40 organizations, including national patient safety and quality organizations, provincial and territorial quality and patient safety councils, government representatives, health
professional associations, and patient groups. Its goal is to advance patient safety across the country by identifying specific actions for improvement and driving an action plan – Forward with Patient Safety: Commitment through Action – for safer healthcare. Accreditation Canada is proud to support the activities of the Consortium. Last year, Accreditation Canada conducted a national consultation, asking for input and direction from stakeholders across the country on the development of the fourth phase of its patient safety strategy. The need to improve safety at care transitions, to focus on patient- and family-centred care, to increase transparency in order to help make care safer, to report on patient outcomes and experiences, and to embrace a systems approach to patient safety all emerged as key themes. This input is being used to inform the future direction and strategy at Accreditation Canada. As a proud contributor to Forward with Four, Accreditation Canada would like to encourage everyone to participate in Canadian Patient Safety Week from October 24-28, 2016. Join the patient safety conversation on Twitter using #asklistentalk, and let’s continue to improve patient safety and quality in the H healthcare system together. ■ Geneviève Brisson is a Communications Specialist at Accreditation Canada. OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
The Mood Walks initiative at RVC is one of 40 Mood Walks programs across Ontario
Empowering youth to walk towards wellness
A new partnership between Parks Canada and Rouge Valley Health System helps those with mental illness By Jane Kitchen hannon O’Reilly knows what can lift her mood – heading outside for a walk in the woods. Diagnosed with psychosis in August 2013, the 21-year-old has just completed her participation in the first Mood Walks program at the Rouge Valley Centenary (RVC) hospital campus in Scarborough. Launched in May, the program is part of Rouge Valley’s outpatient mental health services for youth between the ages of 13 and 23. The Mood Walks program with Rouge Valley consisted of a series of 10 guided hikes: half through Morningside Park, right behind RVC; and half through the Rouge National Urban Park in Toronto. Stephanie Francois, RVC social worker with the First Intervention Treatment Team (FITT) program, says that the young participants who may have anxiety, depression and psychosis see many benefits to their mental and physical health. “The program allows them to connect with other people and to nature,” she says. “The walks are led by guides from Parks Canada, so participants learn more about the natural environment around them, while being in a safe place in which to socialize.”
Shannon O’Reilly enjoys the trail in Morningside Park, thanks to her participation in the Mood Walks program, a joint initiative by Parks Canada and Rouge Valley Health System.
O’Reilly agrees. “I felt super safe,” she says about her participation in the program. “I didn’t feel like I was just a patient. I wasn’t thinking about my mental health or my issues, or anything else in my life. The things we started to talk about in nature helped us to heal. We leave our negativity in the forest.” O’Reilly has been a patient in the FITT program for three years, and graduated from it last month. FITT runs out of the Shoniker Clinic at RVC, a child and adolescent outpatient mental health clinic. It has been providing mental health services to youth in Scarborough and west Durham for over 40 years. The clinic receives approximately 1,700 referrals, and records over 13,000 office visits, per year. “Being diagnosed with psychosis was the hardest thing I’ve ever been through in my life,” says O’Reilly, “But Stephanie and the Shoniker Clinic team really helped me, with medications, and programs on offer such as yoga. Mood Walks was the cherry on top.” Even though the program is over, O’Reilly’s involvement with Mood Walks is not. Continued on page 12
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Linking young diabetes patients with mental health supports By Ania Basiukiewicz iabetes mellitus, often referred to as Type 1 or juvenile diabetes, is the second most common chronic illness faced by children and youth. Research indicates that depression is three times higher in adolescents with Type 1 diabetes, yet when it comes to treating youth with diabetes, there is often no standard process in place to help identify mental health and quality of life issues they may be struggling with. As a result, young patients and families often do not have the opportunity to discuss this important aspect of treatment with their primary care providers, which poses a strong risk of leaving these issues unnoticed and untreated. Trillium Health Partners in Mississauga sees nearly 600 young diabetes patients every year, and has launched a pilot program aiming to help treat young diabetes patients with co-occurring depression more holistically by blending physical and mental health goals right at the start of treatment. The pilot is supported by the Medical Psychiatry Alliance (MPA), a collaborative partnership between Trillium Health Partners, The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children (SickKids), and the University of Toronto. The MPA is dedicated to transforming care for Ontarians living with coexisting physical and mental health conditions. It is known that 20 to 40 per cent of children and youth with medical conditions have mental health concerns, but delivering the level of care these patients need can be challenging for healthcare providers. Trillium Health Partners’ new pilot program aims to improve the quality of care and life for young diabetes patients who are at increased risk for depression.
Trillium Health Partners’ Interprofessional Paediatric Diabetes Education Team. At their initial visit to Trillium Health Partners’ Paediatric Diabetes Education Program (PDEP), patients and families complete a quality of life questionnaire that helps their care team identify appropriate support. Questions aim to assess how teens may be feeling about their weight and body, how their diabetes impacts their experience at school and their social activities, relationships with friends and family, what they consider to be most difficult about living with diabetes, and how their condition affects their general mood. “As a nurse in the Paediatric Diabetes Clinic, I have had the privilege of working with youth with diabetes. Coping with diabetes is stressful, and often impacts every aspect of our young patients’ lives. I have seen how challenging the struggles of diabetes can be – the daily tasks needed to manage their condition can be not only physically exhausting, but can also overwhelm even the most resilient young
patients. The most common challenges happen not because our young patients don’t know how to manage their blood sugars, but rather because they are unable to manage the mental and emotional burnout that is so often a part of living with diabetes. Successfully managing diabetes is so much more than simply checking blood sugar and taking insulin – it is also about the supportive mental health strategies that help my young patients cope with their condition. Integration of timely mental health supports into our program can truly make a difference,” says Elaine Wilson, Registered Nurse, Trillium Health Partners’ Paediatric Diabetes Clinic. Through the innovative partnership with SickKids’ TeleLink Mental Health Program, Trillium Health Partners’ young diabetes patients displaying significant mental health symptoms are promptly linked to a psychiatric consultation by video conference. In this way, the new pilot
program helps our PDEP interprofessional team provide holistic care to our patients and families at a level of integration not previously achieved. “The MPA has a unique opportunity to more fully address the physical and emotional needs of teens with co-existing physical and mental health problems in more depth, and determine more innovative ways of meeting those needs. At Trillium Health Partners, we are excited to partner with SickKids on this innovative new program integrating medical and mental healthcare for our adolescents with diabetes. Together, we can all work toward improving health outcomes and quality of life for these youth and their families,” says Dr. Ian Zenlea, Physician Co-lead Medical Psychiatry Alliance Child & Youth Project. “Our goal at Trillium Health Partners is to provide more holistic care to young patients facing the challenges of living with diabetes,” says Daphne Lok, Social Worker, Trillium Health Partners’ Paediatric Diabetes Clinic. “I’m excited to see mental health supports being integrated into the direct care setting through the use of easy to understand questionnaires. I feel this approach serves the youths’ mental and emotional needs in a more immediate and relevant way. I believe that ultimately, treating the whole person enables our patients to live their lives fully and with an understanding that every aspect of their life is important, not just the medical diagnosis. Seeing children and youth living well with their diabetes is the ultimate reward for the work that our team does,” she says. With 5,000 patient visits annually, Trillium Health Partners’ Paediatric Diabetes Clinic is among the largest in Ontario and the first to trial this new innovative model of including quality of life screening as part of the treatment standard for all young diabetes patients between 13 and 18 years old. The pilot program began in September 2016 and runs to 2017 at its Mississauga Hospital site, with plans to expand in the H near future. ■ Ania Basiukiewicz is a communications advisor at Trillium Health Partners
HOSPITAL NEWS OCTOBER 2016
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
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OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Are you ready for the next evolution in patient safety and quality improvement? By Jason Thompson or more than 10 years, the Canadian Patient Safety Institute has provided healthcare providers, largely those working on the frontline in acute care settings, with the tools and resources they need to provide safer care for their patients. While a bottom-up approach to quality improvement and patient safety was a revolutionary concept 10 years ago, it is not sufficient on its own to sustain measurable change over time; ongoing support is required from organizational leaders. In addition, patients and families must be positioned as full partners in care.
Every year 200,000 patients acquire an infection they did not have before they entered the hospital.
As Bob Dylan crooned, the times, they are a changin’… and now we need to change along with it. When it comes to patient safety, there are three big questions everyone should be asking themselves. How do I prevent harm? How can I respond when harm happens? How can I learn from harm that’s already happened?
Considering the prevalence of harm in ely care, these are questions that desperately need answering: ri• In 2012-13, Canadian seniors experied enced more than 84,000 fall-related dy hospitalizations, according to a study afrom Accreditation Canada and the Can nadian Institute for Health Information and CPSI. h • A 2013 report from the Public Health Agency of Canada indicates that everyy year 200,000 patients acquire an infection they did not have before they entered the hospital. • A 2012 study on the economics of patient safety found that the cost of preventable harm in acute care is more than $396 million a year. The Canadian Patient Safety Institute is answering those questions with an initiative called SHIFT to Safety – the new source for patient safety tools and resources in Canada. Whether you’re a member of the public, a healthcare provider or a healthcare leader, we have tools and resources specifically for you. Last year, the Canadian Patient Safenty Institute conducted an exhaustive consultation process with both its users and staff to better understand the need going forward. While patients, family members, providers and leaders each had their own primary needs, what we heard can be distilled into three themes. There is a fear of speaking up and a clearly identified desire to have opportunities for safe dialogue that would promote patient safety. There is also a lack of com-
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munication as people within the healthcare system look for more ways to connect and breakdown the silos and complexity of healthcare. Finally, there is too much work. Providers required assistance with team training and problem solving skills, they cannot and will not adopt another patient safety ‘solution’ which layers on complexity and procedure. The goal of SHIFT to Safety, is to not only simplify the search for the latest and greatest in quality improvement tools and resources, but to facilitate providers, healthcare leaders, and patients and families coming together as a team for a common goal: successful care outcomes and zero preventable harm. SHIFT to Safety takes these three distinct target audiences and addresses their simplest needs. By understanding those needs, we’re able to tailor current and future offerings specifically to these audiences, and package it in a way that is easily understandable and accessible. SHIFT to Safety and all of it’s tools and resources can be found online at www. SHIFTtoSafety.com. When users visit our mobile friendly site, they will be able to filter content based on whether they are a member of the public, a provider or a leader. This will make it easy to see only the tools and resources specifically designed with their needs in mind. Additional content is coming for the public, providers and leaders and you can expect a steady flow of new material over the course of the next 12 months and H beyond. ■ Jason Thompson works in communications at The Canadian Patient Safety Institute.
Tools and resources currently available or coming soon for healthcare providers at SHIFTtoSafety.com include: TeamSTEPPS TeamSTEPPS, developed by the United States Department of Defense and the Agency for Healthcare Research and Quality, Healthcar improves safety and transforms culture in healthcare through better teamwork, b ccommunication, leadership, situational le awareness, and mutual a support. TeamSTEPPS su is an evidence-based teamwork system that te optimizes patient care by op improving communication im and teamwork skills among healthcare am professionals, including prof frontline staff. It includes fron a co comprehensive set of read ready-to-use materials and a training curriculum to int integrate teamwork princ principles into a variety of settings. settin Choos Choosing Wisely When it comes to medical more isn’t always tests, m better. More than two-thirds of diagnos diagnoses can be determined medical history alone, by med without needing any tests. Choosing Wisely Canada helps patients engage in conversations with healthcare providers about unnecessary tests, treatments, and procedures, to make smart and effective medical choices. Canadian Patient Engagement Network Achieving safe healthcare for all Canadians requires everyone’s involvement. CPSI offers patients and families, patient advisors, healthcare providers, leaders, and organizations a place to connect in real time so they can share, learn and help others. The Canadian Patient Engagement Network is an open, public, and safe space; a community for anyone passionate about patient engagement or patient-centred care. It helps build individual and system capacity for effective patient engagement towards one common goal: safe healthcare for all Canadians. Patient Safety and Incident Management Toolkit - When a patient’s safety is compromised, or even if someone just comes close to having an incident, you need to know you are taking the right measures to address it, now and in the future. CPSI provides you with practical strategies and resources to manage incidents effectively and keep your patients safe. This integrated toolkit considers the needs and concerns of patients and their families, and how to properly engage them throughout the process. www.hospitalnews.com
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
First-ever database for Canadians living with incurable form of cancer By: Dr. Chris Venner
ast month, the Myeloma Canada Research Network (MCRN) announced the launch of the Canadian Multiple Myeloma Database. This is the first-ever patient database for this specific form of cancer. The goal of this nationwide, multi-centre initiative is to inform clinical practitioners and improve research, clinical trial development and health policies for Canadian multiple myeloma patients. Multiple myeloma is one of the deadliest types of cancer in Canada. The Canadian Cancer Society estimates that over 2,700 new cases are diagnosed each year. While great advances have been made, the vast majority of patients will die because of their cancer. The disease remains manageable but incurable. Apart from being a burden to patients and their families, the disease is a massive burden on the healthcare system. Multiple myeloma often requires in-clinic/ in-hospital treatment as the disease goes through the typical waxing and waning course. The goal of the Canadian Multiple Myeloma Database is to capture relevant data and work towards optimizing care of those living with the disease. The MCRN is looking to gain a better understanding of how people are living with multiple myeloma throughout its entire course. The network wants to understand how patients are ac-
cessing the healthcare system, how available treatments are being used, and how access to therapies differs across Canada. Additionally, we hope to bridge the gap with our basic science and translational science colleagues, bringing the highly skilled and experienced laboratory expertise to the bedside. Much of the current literature and clinical trial data available is from the United States or Europe and is not always reflective of the Canadian experience, especially with regards to drug access. The patient evidence captured through this database will help inform our current Canadian benchmarks on successes with available drugs. It will help physicians observe how Canada’s healthcare system is set up to manage this specific disease. Importantly, it will help inform where we need to go in the future. Disease prevalence is another important aspect of this database. Although we can estimate the number of new diagnoses each year, we have a harder time estimating how many patients live with the disease. In combination with the Canadian Cancer Registry, electronic hospital records and pharmacy record keeping, we believe we’ll be able to identify and track the vast majority of multiple myeloma patients moving forward much more robustly and with a focus on outcomes relevant specific to myeloma.
Another unique aspect of this database is its development in concert with multiple myeloma patients. Often, disease databases are developed by healthcare providers (HCPs) and researchers with the goal of helping improve patient outcomes. The MCRN has utilized its strong relationship with Myeloma Canada and its co-founder and chairman, Aldo Del Col, to ensure that patient voices were involved in its development every step of the way. The database is overseen by a steering committee that includes Myeloma Canada patient group members. As such, the database is designed to achieve academic goals while constantly gaining insights into what multiple myeloma patients actually want to know, not just what physicians think they want to know. The Princess Margaret Cancer Centre in Toronto was paramount in the development of the database and will serve as the centre of operations. With Myeloma Canada being located in several cities across the country, we needed a home base hospital with the size and leadership, including Dr. Donna Reece, hematology and oncology researcher and Medical Lead for the Myeloma Unit at the Princess Margaret Cancer Centre, that could serve as the lynch pin for this database. The cancer centre will oversee everything in the way of data storage, in-
formational technology (IT) support and infrastructure developments. However, this is not to take away from the involvement of participating investigators representing all the major myeloma treatment centres across the country. Without their involvement a national perspective would never be gained. For those affected by multiple myeloma, speak to your physician to learn more about being part of this initiative. For more information on multiple myeloma including: local support groups, awareness initiatives, advocacy work and the latest research, please visit: www.myeloma.ca This database is the result of collaborative partnerships between both public and private organizations. This includes Myeloma Canada, the Bloom Chair for Myeloma Research at Princess Margaret Cancer Centre, University Health Network (UHN), MCRN centres across Canada and pharmaceutical partners: Takeda Canada Inc., Janssen Canada and Celgene Canada without whose support this H project would never have been realized. ■ Dr. Chris Venner is the clinical lead for the Malignant Hematology Program at the Cross Cancer Institute in Edmonton, Alberta and is a board member of Myeloma Canada.
OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Collaborate, communicate and educate:
Moving beyond blame to safety By Steven Cassel and Sandra Kagoma afety is a priority for all hospitals. Provincial legislation and government bodies mandate that hospitals properly train staff, implement safe practices, use safe equipment and medical procedures, maintain sterile environments and report on a selection of patient safety indicators – to name a few. Even with this, adverse patient events can arise. The Brant Community Healthcare System (BCHS) took action to implement a full Patient Safety Program two years ago commencing with two major initiatives. The first initiative arose from the patient safety culture survey. The BCHS identified a gap in communication between frontline staff and the Senior Leadership Team (SLT) with respect to patient safety. To understand and address this gap, BCHS launched a comprehensive patient safety walkabout initiative during the 2015 Patient Safety Week that included senior leaders. A common misconception is that patient safety is about reminding people to be more careful, but patient safety isn’t about cautioning healthcare staff to be more careful. In fact, healthcare professionals are some of the most careful people on earth. Improving patient safety is about changing the culture in healthcare from one of blame to one where we examine our systems from beginning to end to reduce the opportunities for mistakes. It’s not about who caused the incident but what caused the incident. Guided by this philosophy the BCHS Patient Safety SLT Walkabouts were designed and implemented as a tool for lead-
Senior leadership and Patient Experience & Quality Outcomes team members discuss safety concerns with staff within the BCHS Critical Care Unit. ers to visibly demonstrate patient safety as a high organizational priority, and learn from direct care providers and physicians about near misses, errors and hazards that compromise patient safety at the point of care. During an hour-long prescheduled visit a member of the Patient Experience and Quality Outcomes team partners with a member of senior leadership to discuss with care providers and physicians the issues that have caused or could cause harm to patients. Concerns raised during these conversations are recorded, entered into a database and addressed by Group Leads, with results reported back to staff. This
assures care providers and physicians that concerns raised are heard and addressed, which assists in closing the communication gap between staff and SLT. This past summer while on an SLT walkabout through the Oncology department, two patients receiving chemotherapy treatments recognized that patient safety was being discussed with senior leadership and staff. These patients also wanted to share their safety concerns regarding poor visibility in the small oncology treatment rooms, which could hinder care providers from responding to issues the patients may encounter. This provided a patient perspective that is needed when addressing safety. These interactions with patients allowed BCHS to incorporate the patient’s voice in future walkabouts – completing the communication loop within the full circle of care. Reports of these walkabouts are made available to everyone in the organization through the BCHS Intranet. Everyone is encouraged to discuss patient safety to break down communication barriers and
move away from a culture of blame, towards a just culture. During the 2016 Patient Safety Week, BCHS Board members will also participate in these walkabouts. This brings another level of leadership into the safety conversation, reinforces that the concerns of frontline staff and patients are being heard and further enhances the role of the BCHS Board on patient safety. The second initiative is a customized patient safety education program for frontline staff, leadership and physicians – conducted on-site by BCHS Patient Safety and Professional Practice Leaders. This includes the seven steps to patient safety: • Promote and build a patient safety culture; • Report BCHS patient safety concerns/adverse events through Riskpro software; • All staff and physicians will support and lead patient safety; • Establish a framework that recognizes costs of failure and benefits of reliability; • Involve patients; • Learn and share safety lessons; and • Implement solutions to prevent harm. To date BCHS has educated nearly 500 of the approximately 1,800 frontline staff, leadership and physicians. This in-house BCHS program has received encouraging reviews from staff and senior leadership as seen by the evaluation results, as well as participation and engagement of staff. Over the next year BCHS aims to measure objective outcomes that could be tied to the implementation of the program – such as medication errors and falls. The BCHS is happy to share their program with other hospitals to increase patient safety, improving channels of communication throughout hospitals, and switching from a culture of blame to a just H culture. ■ Steven Cassel is Patient Safety & Professional Practice Leader) and Sandra Kagoma is Value Stream Leader, Patient Experience & Quality Outcomes at Brant Community Healthcare System.
Continued from page 6
Walking towards wellness She is looking forward to continuing as a peer mentor in the program. Meanwhile, she has built up a support system to carry her forward. “Through the walks, I met people I consider to be friends and I will text them now. And, I can be of assistance to the people I’ve met, who are maybe starting out on their wellness journey.” The Mood Walks initiative at RVC is one of 40 Mood Walks programs across Ontario that are sponsored by the Canadian Mental Health Association, the provincial government, Ontario Parks and Hike Ontario. Rouge Valley’s mental health program is appreciative of the new partnership with Parks Canada for this initiative. HOSPITAL NEWS OCTOBER 2016
Says Francois: “Parks Canada has been gracious, offering their time, looking after busing, and donating incentives for the participants.” “Parks Canada was amazing,” says O’Reilly. “They always gave us a memento, like a water bottle or a key chain, something to show our families. They treated us so well!” Mood Walks has inspired her to get outside on her own, and with her boyfriend and family. “If there’s a tree, let’s go,” she jokes. “Nature, air to breathe, a path, it makes you feel better. H And, it’s good for your health.” ■ Jane Kitchen is Communications Specialist at RVHS. www.hospitalnews.com
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Treating the whole person to fight mental illness By Sebastian Dobosz t St. Josephâ€™s Healthcare Hamilton, innovation and research directly shape the care that patients receive every day. Pioneering comprehensive treatments for mood disorders gives clinicians new ways to engage patients diagnosed with depression or bipolar disorder. By using running, recreation and art as forms of therapy, researchers and mental health professionals improve patientsâ€™ quality of life and help them to reintegrate into their community. Nearly one in 10 Canadians will experience a mood disorder in their lifetime. Common mood disorders such as depression and bipolar disorder can lower a personâ€™s quality of life and make everyday tasks challenging. â€œThe two major treatment options for mood disorders are cognitive-behavioural therapy and pharmacological interventions,â€? says Sharon Simons, Manager of Mood Disorders at St. Josephâ€™s Healthcare Hamilton. â€œRecently however, weâ€™ve started to look at other forms of treatment that not only work to treat mood disorders, but also improve the patientsâ€™ quality of life and reintegrate them into their communities.â€? One example of these initiatives is Team Unbreakable. Team Unbreakable began as a pilot study to determine the effects of running therapy on mood disorders. For twelve weeks, participants aged 16-25 took part in a running group twice a week. The initial success of this program has led to its expansion as a clinical intervention. Now, running therapy is offered as a treatment option to patients enrolled in the mood disorders program.
â€œMuch like with running or recreation therapy, insights gained by art therapy participants can help them progress in other forms of therapy that they receive.â€?
â€œPreliminary evaluation of the program is promisingâ€?, says Dr. Margaret McKinnon, Psychologist and Co-Academic Head of the Mood Disorders Program at St. Josephâ€™s Healthcare Hamilton. â€œWe are currently analyzing our findings in relation to the efficacy of this approach in a chronic, tertiary care setting. In other words, our research asks whether this approach is effective in the treatment-resistant, severely ill patients with multiple co-morbidities that we serve.â€? Similar to Team Unbreakable, St. Josephâ€™s Healthcare Hamilton is currently testing recreation therapy as a treatment for mood disorders. Participants take part in one of three retreats per year that rely on teamwork to overcome physical challenges. Depending on the season, participants can find themselves ice-climbing and snowshoeing, or horseback riding and walking high ropes. â€œThe idea is that the participants will take what they learn from facing these challenges together and apply them to the www.hospitalnews.com
Dr. Margaret McKinnon (left) and the Team Unbreakable running group. real world,â€? says Jeff Whattam, recreation therapist at St. Josephâ€™s Healthcare Hamilton. â€œHaving debriefing sessions between the activities helps participants to talk about their experiences and how they are feeling throughout the retreat.â€? While running and recreation therapy encourage participants to explore physical challenges, art therapy encourages them to explore their creativity. Participants work with an art therapist to express their thoughts and feelings in visual forms. â€œArt therapy helps patients to communicate their inner feelings,â€? says Sharon Simons. â€œMuch like with running or recreation therapy, insights gained by art therapy participants can help them progress in other forms of therapy that they receive.â€? Evaluating these new treatment approaches through research will give mental health professionals new ways to engage with and treat patients. â€œThe Mood Disorders Program places clear emphasis on the evaluation and ongoing improvement of care initiatives,â€? says Dr. McKinnon. â€œOur success with Team Unbreakable is illustrative in that our research seeks not only to validate this treatment approach but also to identify areas for improvement and growth.â€? In order to foster a culture where patients are treated whole, the mood disorders program at St. Josephâ€™s Healthcare Hamilton combines professionals from a number of areas to deliver holistic care. Patients interact with psychologists and psychiatrists, but also with occupational therapists, pharmacists, research staff, social workers, dieticians, and more. A collaborative care team allows the program to treat patientsâ€™ illnesses, as well as help them to function better in their daily lives. It also allows for innovative care practices to be tested through research and become a part of practice. Treating the whole person means caring for all aspects of a personâ€™s health. Combining medical and mental health care allows patients to receive treatment across the spectrum of care.
Combining existing practices with innovative new treatments allows patient care at St. Josephâ€™s Healthcare Hamilton to grow and evolve according to patientsâ€™ needs. â€œEverything we do is a partnership with our patients,â€? says Sharon Simons. â€œIf we
can treat their illness and make a positive H difference in their lives, we succeed.â€? â– Sebastian Dobosz is a Research Communications Officer at St. Josephâ€™s Healthcare Hamilton
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OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Gardening as therapy By Lindsay Smylie Smith
ary says she thought gardening would be ‘too difficult’. Mary, a mental health patient at the North Bay Regional Health Centre (NBRHC), was approached by another Mary, Mary Chamberlain who is a Recreational Therapist in NBRHC’s Mental Health & Law Division, about taking part in a new Horticultural program. “I thought I wouldn’t know how to do it – it would be too complicated,” Mary says. “But Mary [Chamberlain] taught me how easy it is.”
When you participate in growing your own fruits and vegetables, you are more likely to eat four or more servings a day.
Gardening as therapy
Chamberlain says a need was identified at the hospital to address healthy eating, healthy food choices and exercise. “Horticulture therapy is one way to promote healthy eating and exercise within our hospital,” she says. Research shows gardening is good for mental health, wellbeing and the reduction of stress and depression. “We also know that when you participate in growing your own fruits and vegetables, you are more likely to eat four or more servings a day.” Chamberlain leads a small group of patients who meet regularly to garden both at the Health Centre and in the community. “Our group started by planting seedlings in February or March,” Chamberlain says. “We talked together about what we wanted our gardens to look like, what work we needed to do. Then when the snow melted we saw what we had to do and got started.” Together the patients planted vegetables in the six raised beds and flowers in the ground outside. Mary planted pumpkin, green pepper, and zucchini seeds. “She [Mary Chamberlain] had to teach me how to do this because I had never
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(above) Mark and Mary Chamberlain together in their Heritage Gardener Volunteer shirts take a break from cleaning up the NBRHC garden along North Bay’s waterfront. (right) The group gathered to make a meal from the vegetables they grew in their gardens. gardened before. I had to learn that we have to water the plants every other day – and sing to them,” Mary says with a laugh. “The only other plants I had before were artificial plants in my apartment.” Chamberlain says the patients in the program got very involved in the process and were excited to watch their seedlings grow. “As soon as I would come onto the unit, patients are eagerly asking me about gardening, they are interested in seeing the progress of what they’ve done; what they’ve grown.” This enthusiasm even translated into after hour ‘assignments’. “Because we’ve had such a hot, dry, summer, I had asked some of the patients if they would water at night on their own off unit privileges which are authorized by the clinical team,” Chamberlain says. “We knew that watering in the afternoon in the full sun was just burning the plants and the water was evaporating.” Chamberlain says a patient volunteered and came out each night at 7:00 pm to water the garden. This kind of team effort led to gardens that were flourishing by mid-July.
Owl Lodge Garden
Owl Lodge, a general secure 16-bed co-ed unit in NBRHC’s Mental Health and the Law program, boasts another of the hospitals patient-led gardens. Brett Nesbitt, a Registered Practical Nurse, says patients put a lot of work to get the garden ready this year after years of not being used. “This year when we started the garden again there was nothing but weeds. We started very late in the growing season – the garden didn’t get planted until
the third week of June,”” Nesbitt says. “It was probably 30 hours of work to clean it all up and get planted.’ Nesbitt says the majority of the plants and items used on the unit came from staff donations, as well as donations from the horticulture centre here in the hospital. “Every day we are out here with one or two patients – weeding, watering, cleaning, picking vegetables, eating them.” One of the patients who took part in the garden on Owl Lodge is Michel. Michel says gardening is his favourite activity, and takes particular pride in the tomatoes, corn and squash he has watched grow. “I just put the seeds in, and what we see here now is unbelievable,” Michel says, gesturing to the garden behind him. He says he enjoys gardening when he has a chance because he gets to spend time outdoors, and the vegetables they grow are healthy and affordable. “I think if I am discharged from here I would come back and continue with the garden even if I wasn’t paid. I would volunteer there.”
Partnership with North Bay Heritage Gardeners
As the weeks went by and the workload became less for the garden at the Health Centre, Chamberlain says they looked to use the skills to help give back to the community. “That’s where our partnership started with the North Bay Heritage Gardeners,” Chamberlain explains. The North Bay Heritage Gardeners is the volunteer group responsible for the maintenance of the vast amount of beautiful gardens along North Bay’s waterfront. The group designated a portion as the ‘hospital’ garden, and every other week
in the summer Chamberlain and a group of patients travel there to take care of the area. “The skills our patients have learned here, we are incorporating into the community while also giving back to the City of North Bay,” Chamberlain says. Mark is one of the patients who actively participated in the garden at both the Health Centre and at the waterfront. He says he enjoys the time he has been able to spend gardening and would like to expand the offerings they have at the waterfront. “I’d love to be able to plant some flowers to bring some colour down here and beautify the space,” he says.
As the summer drew to a close, Mark was one of the patients who gathered to prepare themselves a lunch with the actual fruits [veggies] of their labour. The group made a pasta dish-made from zucchini ‘noodles’ – with a tomato sauce and salad filled with greens, cucumbers, tomatoes and peppers. “We want to show that is doesn’t have to be difficult or expensive to grow your own food,” Chamberlain says. “We’ve grown things in tuna cans, old margarine containers, anything we have available. It’s just so nice for the patients to have the experience of growing their own food and having a delicious and nutritious lunch – and to know they can do this for themselves even upon discharge. They don’t need farmland or acreage to grow healthy H foods for themselves.” ■ Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre www.hospitalnews.com
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- DR. EDWARD CHOW, Director of Education, Department of Radiation Oncology and Chair of Rapid Response Radiotherapy Program, Sunnybrook Odette Cancer Centre, University of Toronto
Advertising a job is free and easy. Contact us today. firstname.lastname@example.org | 877-928-4473 uwaterloo.ca/hire/hn HOSPITAL NEWS OCTOBER 2016
» BENEFIT from the fresh ideas and ready-to-learn attitude of our co-op students » PARTICIPATE in Waterloo’s world-renowned co-op program with more than 19,000+ students » HIRE CO-OP from over 120 co-op programs including our many double-degree Business programs
Smart technology: the transformation of health care By Warren DiClemente he world is constantly being transformed by smart technology, and for an industry as important and complex as healthcare, finding ways to integrate that technology into the system is critical. That’s because embracing technological innovation is an important way to improve patient care and safety while reducing the cost of healthcare. Harry P. Pappas, Founder and CEO of the Intelligent Health Association (IHA), and HealthAchieve 2016 partner, agrees. As a global technology centric organization whose sole purpose is to help drive the “evolution to the digital healthcare revolution™,” the IHA promotes the adoption and implementation of new technologies in the health eco-system. “There is a direct link between wearable medical technology that can help both patients and clinicians monitor vital signs and symptoms, and improved health,” states Pappas. “Smart technologies are having a huge impact on consumer health and wellness habits.” In fact, the development of new health
1 2 3 4 5
care apps has empowered patients in new and important ways. All a patient needs is a smartphone to effectively monitor things like weight, blood pressure, heart rate, pulse and fitness levels. There are even apps that prompt patients to take medication at a specified time, and those that will track food intake, blood sugar, and even menstrual cycles. When this data is transmitted to a primary caregiver, it allows the physician to eavesdrop on the progress of their patient, creating a broader picture of the patient’s day-to-day health. “It’s making us all more aware of what we need to do to be healthier, to reduce cancer and heart disease risks, and to take better care of ourselves. Smart technology is putting us in control of our own health in a way never before possible,” says Pappas. 3D printing is perhaps one of the most revolutionary new technologies. It’s currently in its infancy, but tremendous strides have been made in the development of regenerative tissue and the print-
ing of anattomical pieces. A Acco Ac cco cord rdii rd According to Pappas, he ap pli pl lic icat ati tions ions ooff th thi is technology will is the applications this be truly transformational, taking the guesswork out of surgeries like hip replacement, and providing medical teams with precise information and customized prosthetics and implants to help improve patient care. It’s not just interesting to know that these new technologies exist; the key is to make sure we are embracing intelligent health technology and using it to its fullest potential in our hospitals. The Ontario Hospital Association (OHA) believes the best way to achieve that end is through education. Ensuring that decision makers understand the benefits of new technologies, both from a care and a cost-saving perspective, is crucial.
At HealthAchieve 2016, the OHA’s annual signature conference and exhibition, we will be hosting the first ever Intelligent Health Association Track featuring speakers who will address the full spectrum of intelligent health opportunities in Canada. This, coupled with the Intelligent Health Pavilion, will raise awareness and educate the health care industry on the many applications of smart technology – and the incredible ways it can help H us survive and thrive. ■ Warren DiClemente is the Chief Operating Officer and Vice President, Educational Services at Ontario Hospital Association (OHA). The OHA’s signature conference and exhibition, HealthAchieve will run Nov. 7 to 9, 2016 at the Metro Toronto Convention Centre.
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» Hire from the largest co-op program in the world with over 19,000 participating students and thousands of alumni » Access to talent from over 120 programs of study across a wide breadth of academic disciplines
» Join the other global industry leaders who hire Waterloo students consistently, year after year » Our reputation extends globally, with students and alumni working in more than 65 countries
» Straightforward and simple process reﬁned over 50+ years of experience » A dedicated team of representatives will help you every step of the way
Freshness and versatility
» Youthful Waterloo minds are connected to current technology and bring a fresh perspective » Comprehensive job-skill development courses prepare students for seamless integration into any workplace
BOARDS Published quarterly, Boards provides a refreshing collection of success stories, trend articles, interviews, and news on topical issues, governance initiatives, resources and educational programs related to the evolving role of board members in the health care and not-for-proﬁt sectors.
IN THIS ISSUE 10 Secrets Directors Don’t Know About Minutes
OFFICIAL PUBLICATION OF THE GOVERNANCE CENTRE OF EXCELLENCE
Unleash an Entrepreneurial Mindset to Transform the Ontario Health System
SEPTEMBER 2016 ISSUE 16
p8 Professional Guidance Through the Board Mentorship Program
Driving Change Through Board Diversity p1
Four Steps for Health Care Board Directors to Engage in Social Media
p12 The GCE Interview
p15 From the Secretary’s Desk
p17 Welcome on Board
p23 Upcoming Events
p30 Calendar of Events
To get the latest issue of Boards and to subscribe to upcoming issues visit www.thegce.ca/Boards
Year-round availability and affordability » Cost-effective and timely recruiting method » Co-op students begin work in January, May, or September for four months or longer, depending on their program » Alumni and graduating students are available year-round
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OCTOBER 2016 HOSPITAL NEWS
How to cope:
Making the workplace psychologically safe By Bill Howatt et’s paint a picture: Jack and Jill are 44-year-old health professionals with 20 years’ of service. Raised in stable and healthy homes in the same neighbourhood, these two old friends played together as children, went to the same high school, and even had similar academic success, both in secondary school and at university where they studied nursing together. Their fates seemingly ever entwined, Jack and Jill ended up working at the same hospital, on the same floor, with the same manager. Obviously since they work in the same place, they experience similar pressures and demands, and have the same employee support systems at their disposal. Given how similar their paths have been all their lives, one would assume that these two old chums are identical. However, the way they see their jobs – and how those jobs impact their lives – is quite different. Jack is experiencing a lot of stress and anxiety, and blames his job for the prob-
lems in his life both at work and at home. His job performance has slipped, and he and his manager are having regular conversations about his performance and the fact that he is becoming short with patients and staff. After work, Jack is spending less time with his family and more time alone. He’s sleeping more, is less active, and is taking poor care of his health. His wife has even mentioned to Jill that Jack seems depressed. Jill has been supportive of Jack and is encouraging him to see an employee and family assistance representative to find out what coping skills he can learn that might make a difference in the way he handles the stress at work. While Jack is struggling, Jill, on the other hand, is thriving. She’s productive and healthy both at work and at home, and she’s enjoying her work under the exact same conditions as Jack. Since their roles are identical, the difference lies in their
Short on time and travel dollars? Cutting edge learning is just a click away! Did you know, the Ontario Hospital Association (OHA) offers more than 60 live webcasts per year? With a variety of health-related topics to choose from, the content you need and want is now more accessible than ever. Plus, if you can’t make time for the live event, you can always watch the on-demand version at your convenience!
coping skills. The Globe and Mail’s Your Life at Work study found that employees’ coping skills can help predict health, engagement, and productivity. In an effort to mitigate the risk of poor mental health, today many employers are using the 13 Psychological Health and Safety (PHS) Factors to explore what they can do better to improve psychological health and safety in the workplace. The 13 PHS factors outline key areas where organizations can improve both environment and policies in order to reduce stress on workers and keep them healthier. An employer can develop a psychologically safe workplace by creating mental health policies.
By 2030, the world is expected to lose 12-billion workdays a year due to anxiety and depression, so the stakes are incredibly high.
LEARN MORE oha.com/webcasts
By 2030, the world is expected to lose 12-billion workdays a year due to anxiety and depression, so the stakes are incredibly high. The story of Jack and Jill demonstrates why employee coping skills and capabilities need to be part of the conversation. Ultimately, building a psychologically healthy workplace depends on a two-way accountHOSPITAL NEWS OCTOBER 2016
ability model. Both employers and employees have a role in promoting and creating psychologically safe workplaces. Employees must own their physical and mental health, personal relationships, and financial health. Employers, on the other hand, can train managers, and can provide employee and family assistance programs, trauma management, coping skills, and health and wellness programming. The biggest difference between Jack and Jill isn’t what their employer is doing; it’s their perception of what is within their control. Jack blames his environment and won’t take responsibility for his actions and choices. The Globe and Mail and Morneau Shepell have created the Employee Recommended Workplace Award. It’s designed to facilitate health, engagement, and productivity through creating a two-way accountability model. Employers are responsible for ensuring that their employees have the best mental health support possible by creating appropriate policies, procedures, and programs; and by removing barriers and risks (e.g., bullying and unsafe workplaces) that can jeopardize mental health. But in the end, every employee’s mental health depends upon what they do for themselves, such as getting professional support, developing an action plan to learn to cope better, and taking responsibility for their choices and actions. It’s a lesson that our Jack hasn’t learned, H but everyone else can and should. ■ Bill Howatt is the Chief Research and Development Officer for Workforce Productivity, Morneau Shepell, and has over 25 years’ experience in strategic HR, mental health and addictions, and leadership. Bill will be speaking about Building Psychologically Safe Workplaces on November 8 at HealthAchieve in Toronto. Learn more at www.healthachieve.com www.hospitalnews.com
Team spirit: By Dr. Ivan Joseph ost people tend to think that a successful team is the one that brings home the biggest trophy. But it’s a mistake to focus solely on the outcome of a season of play, because some of the most successful and high-performing teams don’t bring home the big prize. Look at the Chicago Bulls of the 1980s. They struggled for a decade; slowly building a strong team that came close, but never quite grabbed the title. However, by 1989 they had a direction and a star player around which to focus the franchise. After that winless period of team building, they went on to win three consecutive championships in the early 90s. The Bulls didn’t magically generate that dream team in one season. They were a high-performing team long before that NBA Championship threepeat. What they had in common with every other high-performing team, both in sports and in business, was a clear pursuit of their goals, an unrelenting passion, and enticing roles and responsibilities for each member of the team. There are four key tools for team excellence that any team can use to achieve greatness: grit, focus, cohesion, and talent for the task.
Grit is all about letting people fail, because the learning is in the failure. So often people quit when they fail. They want immediate fulfillment, so they move on to another job or another task or another team altogether when they don’t get that instant win. But failure is part of learning how to succeed. Success comes from toil and perseverance – and from praising the effort, offering constructive feedback, and motivating team members to get back up on that horse and try again.
There are four key tools for team excellence that any team can use to achieve greatness: grit, focus, cohesion, and talent for the task.
Focus is a twofold tool for team excellence. First, you have to focus on your goal. Write it down and know exactly what it is you want to achieve. Then pay attention to the distractions that divert your atten-
Leadership tools for excellence
tion away from your goal. What you focus on is what you get, after all, so make sure you’re not spending your time focusing on the wrong things and forgetting what your goal was in the first place. You can’t be good at everything, and if you’re too broadly focused your energy is going to be spread too thin. Look for physiological symptoms of this kind of stress. You may have trouble sleeping, get headaches, or have stomach issues when your fingers are in too many pots. Cohesion is all about connecting the people in your team and building strong relationships so that they want to work well together, and always strive to support and understand each other. Everyone has something that others do that makes them feel appreciated. Figure out what that something is for each of your team members, then make a point of making them feel valued and understood in a way you know they’ll respond to. We often focus on external customers and customer service but forget to focus on the internal stakeholders – the ones who are doing the important work every single day. We need to think about how to build them up by being very intentional about the relationships we have with our team members. You are more invested in strong, positive relationships, and you are more motivated to work hard for a team
that you feel likes and appreciates you. For a team member, talent for the task is about focusing on your strengths and finding your place to shine. You need to stop beating yourself up for the faults you perceive you have, and focus on what you can do well to help the team succeed. If you’re the team leader or manager, talent for the task is about figuring out how to support the strengths you see in your team members. Ask yourself if you can capitalize on those strengths. Sometimes the answer is no, because not everyone is a good fit for a team no matter what their strengths are, but more often than not the answer is yes. Praise your team members for what they can do, and for what they do well. High-performing teams aren’t built overnight. It can take four to five years to build the kind of team culture that supports championship-winning success. Stay the course and invest in the long H term. ■ Dr. Ivan Joseph, Director of Athletics, Ryerson University and an awardwinning coach, educator and organizational leader who has brought about cultural transformation. He will be speaking about Leadership Tools for Team Excellence on November 7 at HealthAchieve in Toronto. Learn more at www.healthachieve.com.
ONE DAY YOUR PATIENT COULD NEED AN MRI AFTER AGE 65, THE LIKELIHOOD OF NEEDING AN MRI DOUBLES. Òñ" !"äïòñèÌäñäçìäñöøñçèõúèñ÷!'ðìïïìòñÖÛÒèûäðöÝëä÷đöúëüìñ" !!úèïäøñæëèç÷ëèĤõö÷ÖÛÒ conditional pacemaker in Canada. We didn’t stop there. We did the same for our neurostimulator in 2013, our ìñöèõ÷äåïèæäõçìäæðòñì÷òõìñ" !$äñçòøõìðóïäñ÷äåïèæäõçìòùèõ÷èõçèĤåõìïïä÷òõ¤ÒÌÍ¥ìñ" !%Ìòñöøï÷÷ëè conditions of use with your physician. Now, more Canadians with these medical devices can access an MRI. Learn how we’re taking healthcare Further, Together at Medtronic.ca.
OCTOBER 2016 HOSPITAL NEWS
and the evolution of the healthcare industry
By Linda Nazareth he world is aging; people are living much longer than ever before and not dying at birth. These are good things, of course, but it does explain why there are different economic opportunities and challenges at play during this particular point in history. Economorpics is a term I coined for when the economy morphs from one thing into another. The forces at work when this occurs are many and varied, but include a shift in population and demographics, the reshuffling of power and power distribution, the changing roles of women, and other parts of the world getting stronger while North America regroups. We are moving into a barbell state where there are opportunities on the top and bottom of the pyramid, but not so much in the middle. The middle class is getting squeezed, and there’s evidence of this in the way some brands are marketing to their consumers. Proctor & Gamble used to advertise detergent based on its ability to give you whiter whites, but recently they began advertising based
on price point. It’s a huge shift that happened because people are more aware of personal economic security since the financial crisis of 2007-09, and they are more apt to have a strict household budget than they did before. The healthcare industry is not immune to the effects of economorphing. It will be hit by just about every change that also impacts the broader economy. We know about the demographic challenges, and in fact the healthcare sector is already dealing with the issues of an aging population – something that’s only going to become more acute as time passes. But there are other challenges on the horizon for healthcare. Attracting and retaining new staff, fighting for government financing and putting it in the right places, creating the right human resource policies, and motivating a fragmented and freelance workforce will also test and strain the system. The good news is that there are also exciting opportunities for healthcare. New technologies, particularly telemedicine, are improving patient care and clinical outcomes. Do you remember Watson, the robot that did so well on Jeopardy a
few years ago? It’s now diagnosing cases in hospital. But these sorts of advances obviously come at a cost and present complicated implementation issues. At the end of the day, healthcare is an example of a large, complex business. Every part of it needs to be managed properly, and its finances need to be watched particularly carefully, especially during a challenging financial market situation. How can the healthcare industry be on the right side of change? The key is to accept that change is a given, and that the business model that exists today is not the one that might work in ten years or five years or even one year from now. I always encourage organizations to do a SWOT
analysis: establish where you want to be, look at the parameters, and think about your strengths, weaknesses, opportunities and threats. Our healthcare system has incredible strengths and a plethora of opportunities to be mined – but in order to be on the right side of change it must also address its weaknesses and threats. Now is a good H time to do just that. ■
Linda Nazareth, Senior Fellow for Economics and Population Change, The Macdonald-Laurier Institute is an international economist and trends expert and author of Economorphics: The Trends Turning Today into Tomorrow. Linda will be speaking on November 8 at HealthAchieve in Toronto. Learn more at www.healthachieve.com.
It’s Your Education Grab a Front Row Seat Ever dozed through a monotone lecture in a dusty lecture hall? No more. Education should be engaging, interactive, and facilitated by industry thought leaders. You’ll want to get a front row seat for these programs. The Ontario Hospital Association (OHA) offers 50+ certificate courses to help health care professionals acquire the knowledge and skills necessary to face the challenges of today’s health care climate. These programs help more than 1,400 professionals from the industry, including front-line staff, human resources, emerging leaders and more.
Great Minds Meet Here Welcome to Your Next OHA Conference Think of the last time you felt truly inspired. Imagine if you could multiply that productive energy by 100. Or even 1000. There’s nothing more invigorating than a room bursting with great ideas and energy for change. The Ontario Hospital Association’s (OHA) conferences are designed with this in mind. Built by members and for members, our conferences offer participants an opportunity to share leading practices and information about industry-wide issues and trends.
HOSPITAL NEWS OCTOBER 2016
A Critical Look at Mobile Health Apps PracticalApps.ca, a new website to help healthcare providers advise patients about mobile apps, has been launched by the Ontario Telemedicine Network (OTN). The site reviews mobile apps for chronic conditions like migraines, hypertension, diabetes, low back pain and insomnia. “PracticalApps.ca takes a critical look at mobile health apps. We know patients are willing to use technology, just as they shop or bank online. But we also know there are about 165,000 health-relatIHETTWSYXXLIVIƹWE]W*H'VS[R483ƶWGLMIJI\IGYXMZISǽGIV “Only three per cent have been created by healthcare organizations. How do you know which to recommend? We think providers will welcome reviews that rate apps for clinical validity, usability, privacy and security, accessibility, safety and reliability.” PracticalApps.ca is collaboration between OTN and the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV). Dr. Payal Agarwal, a family physician and innovation fellow at WIHV, created the evaluation framework. “Patients are already using health apps,” Dr. Agarwal says. “As primary care providers we need to know more about which ones QIIXGIVXEMRGVMXIVMEJSVIǺIGXMZIRIWWWSXLEX[IGERSǺIVFIXXIV guidance.” For chronic illness, “this is especially important as one of the main goals is to help patients self-manage their condition. The ‘right’ app can play a key role in motivating patients to track their symptoms, share information and can even change behaviour.”
Your one-stop resource for trusted clinical app reviews Visit PracticalApps.ca today
8LIǻVWX PracticalApps.ca review looked at four migraine apps. New reviews, each focused on one chronic condition, are published bimonthly. Visit PracticalApps.ca today
PROTECTING WHAT MATTERS MOST Whether physical or digital, storing, scanning, backing up or recovering and securely archiving your Healthcare information in the Cloud, WE’VE GOT YOU COVERED. For all of your Health Information Lifecycle Management needs, visit us at booth #1724, 1726 at HealthAchieve
OCTOBER 2016 HOSPITAL NEWS
2016 HealthAchieve 2016 November 7â€“9, Metro Toronto Convention Centre healthachieve.com
Remember the Last Time You Felt Inspired? We do. From November 7-9, youâ€™ll have the opportunity to be educated and energized by a lineup of compelling speakers.
The Healing Power of Music with SĂŠan McCann
How to Mobilize 100,000 People into Saving Lives during Times of Natural Disasters with Dr. Verna Yiu
Monday, November 7 at 7:30 a.m.
Monday, November 7 at 1:30 p.m.
OfďŹ cial Opening
Presence: Brining Your Boldest Self to Your Biggest Challenges with Amy Cuddy
Rethinking Health Care for the Age of Distributed Trust with Don Tapscott
Monday, November 7 at 10:00 a.m.
Monday, November 7 at 3:30 p.m.
Your Employees are Key to Your Success. Your staff represents more than 60% of your total costs. And studies show that an engaged and empowered staff has a positive, measurable impact on the quality of care your patients receive. These are two strong reasons to invest in tools that will help you unlock the value of this most strategic asset. Hospitals that have invested in comprehensive workforce management VROXWLRQVDUHUHDSLQJEHQHÂżWVDFURVVWKHLURUJDQL]DWLRQV â€˘ Increased transparency, compliance, and employee satisfactionÂąWKDQNVWRFHQWUDOL]HGDXWRPDWHGVFKHGXOLQJDQG self-service tools that empower employees
healthscape â€“ A Better View Check out healthscape.ca, the website offering a broad range of health care news and information, helping you navigate the fascinating and complex landscape of Ontarioâ€™s ever-changing health care system. Subscribe for healthscape email updates at oha.com/stayinformed
â€˘ Reduced payroll errors and payroll processing time â€“ thanks to automated, accurate timekeeping â€˘ Improved attendance policy compliance and measurable savings â€“ thanks to real-time, actionable attendance reporting Learn more about how Kronos can help you unlock the value of FRPSUHKHQVLYHZRUNIRUFHPDQDJHPHQWLQ\RXURUJDQL]DWLRQ
Visit Kronos at booth 1005 at HealthAchieve 2016. Not going to HealthAchieve? Weâ€™ll come to you. Visit Kronos.ca or call 1 800 225 1561 to request an appointment with an account executive and receive your complimentary information package, complete with examples of measurable results achieved by some of your peers.
HOSPITAL NEWS OCTOBER 2016
Small Rural and Northern Health Care
Economorphics: The Trends Turning Today into Tomorrow with Linda Nazareth
Bridging the Health Care Gaps: Our Journey so far with Christine Elliott
Tuesday, November 8 at 8:45 a.m.
Tuesday, November 8 at 1:00 p.m.
An Up Close and In Person Conversation with Howie Mandel
Being Canadian: What Makes Canada Unique with Robert Cohen
Tuesday, November 8 at 10:00 a.m.
Wednesday, November 9 at 9:30 a.m.
TIME & ATTENDANCE
HR & PAYROLL
WORKFORCE MANAGEMENT OPTIMIZED EFFICIENT OPERATIONS
Actionable reporting boosts productivity, creates savings
Transparency and self-service tools empower employees
Engaged employees create more positive patient outcomes
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110 Matheson Blvd West, Suite 320 | Mississauga, ON L5R 4G7 Tel: 905 568 0101 | Fax: 905 568 8510
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OCTOBER 2016 HOSPITAL NEWS
HealthAchieve 2016 November 7–9, Metro Toronto Convention Centre healthachieve.com
Discover the Latest Innovations in Health Care Technology To raise awareness and educate health care professionals on the many applications of technology within the health care setting, HealthAchieve and the Intelligent Health Association are pleased to introduce the Intelligent Health Pavilion™ and a one-day seminar.
Intelligent Health Pavilion™ November 7 & 8, 2016 Metro Toronto Convention Centre, Exhibit Floor As our world continues to be transformed by digital health, we’re introducing the i-HOME™ and Wearable Technology Zone to this year’s Pavilion. Through the hospital, i-HOME™ and wearable technology setting, you will see how technology is improving patient care and safety while reducing costs.
The Future of Health Care is in the Digital Home November 7, 2016 Intercontinental Toronto, Ballroom B For the ﬁrst time in HealthAchieve history, we’re pleased to offer the opportunity to attend a full-day program on the Monday of the event focused entirely on the future of digital health in the home. This seminar will explore the impact of technology on the delivery of health care services, operational considerations, the value of leveraging big data and much more.
Learn more at healthachieve.com
Empower Yourself and Your Staff with Online Training Modules
You’re a People Leader. Maximize workforce and organizational effectiveness.
From Accessible Customer Service Standards 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.
Working with our members to identify and address emerging trends and challenges, our educational offerings are specifically tailored to support human resources professionals in implementing leading HR practices. Topics Include:
LEARN MORE oha.com/onlinemodules
• • • • • •
Employee Relations and Accommodation Attendance Management and Return to Work Social Media use in the Workplace Navigating Difﬁcult Conversations Addictions in the Workplace And much more
LEARN MORE oha.com/HReducation
HOSPITAL NEWS OCTOBER 2016
A seismic shift:
turning sick care into well care with technology By Natasa Sokolovich, JD, MSHCP, Executive Director, Telemedicine, UPMC s the Executive Director of Telemedicine for University of Pittsburg Medical Centre (UMPC), I am an advocate for telemedicine as a tool to improve access to care, quality of care, and the sustainability of healthcare systems. Advances in technology, including telemedicine, are the pillars of future healthcare delivery. To put it simply, we are looking at ways to keep people out of hospital by making the system more about well care than sick care. This shift can be made with telemedicine. When you look at what we should be doing to keep people well and empowered, and not just treating them when they’re sick, technology provides the tools and resources from cradle to grave. We need to change our understanding of healthcare and look at it as a health and wellness journey. Current technology allows us to deploy fitness devices like FitBit that help people monitor and track their physical activity and sleep quality, for example. But that same technology can also give health care providers an understanding of each individual patient so they can push the right information and provide truly individualized care throughout a patient’s lifetime.
We are looking at ways to keep people out of hospital by making the system more about well care than sick care. Once a female patient reaches her childbearing years, for example, it’s possible to customize the kind of information she receives to include fertility and pregnancy-related content. It’s about providing wellness tools, yes, but also integrating life journey tools into the mix. And with the right customized information, patients can take ownership of their health and proactively be a part of their overall health journey. From a healthcare provider perspective, technology enables upstream intervenwww.hospitalnews.com
tion. They can be aware of changes in a patient’s health as those changes are happening, monitor habits like movement and caloric intake, and intervene before anything becomes problematic. If you look at published data for initial clinical use cases, particularly for Telestroke, a UPMC initiative, it’s clear that new technologies are delivering promised benefits by improving clinical outcomes and having a positive impact on quality of life. In some cases we see a full recovery because important intervention happened much faster than it otherwise would have, thanks to Telestroke. Technology also shows promise in the evolution of behavioural health, particularly in patients who need ongoing counseling and can take advantage of virtual care. Essentially, technology is an opportunity for providers to come back into the patient home. Remote monitoring, which is particularly useful for patients with chronic diseases, helps prevent unnecessary hospitalization, and makes checking in with a doctor much more convenient for patients who no longer have to take time off work. It’s touch through technology. We know it works; we just need hospitals and other healthcare providers to ensure that new technologies are integrated into their organizations. The only way to do that is make it part of the overall core mission. If your mission is to provide the best quality care and patient experience, for example, it should include the technology available to achieve that end. The key is to look for the areas of biggest impact and determine what will work best for your organization. It’s not a onesize-fits-all situation. Instead, create a logical adoption model that works for your hospital based on its needs and demographics. Perhaps it becomes a receiver of technology, implementing technology that allows for mobile carts and equipment, for example. Or perhaps your organization becomes a full tech hub. Whatever the case, it has to be part of your mission and it has to come from the top down. You need a focused effort and a group of leaders dedicated to making it happen. The implementation of technol-
ogy is far too important to become a sidebar project given to someone with dozens of other pressing responsibilities. For patients, and the health of the system itself, technology must be a priority. On November 7th I will co-chair a fullday seminar at HealthAchieve entitled The Future of Health Care is in the Digital Home, designed to look at the integration of virtual care into the home and its
impact on overall health and well-being across the care continuum. It’s an exciting opportunity to look at innovation, but also an important chance to explore the value of virtual care and the ways it can be seamlessly integrated into our models of care to streamline and improve the care H patients receive. ■ Learn more at www.healthachieve.com.
Our Goal is the same as yours. To eliminate preventable safety events. We offer timely educational programs that will give you the tools you need to develop or revise your own patient safety program that meets the current Accreditation Canada standards, among many others. Topics Include: • Patient Safety Series on Infection Control, Outbreaks, Drugs and Preventing Harm • Quality Improvement Plans • Effective Process Management • Chronic Disease Management • And much more
LEARN MORE oha.com/ patientsafetyeducation
OCTOBER 2016 HOSPITAL NEWS
HealthAchieve 2016 November 7–9, Metro Toronto Convention Centre healthachieve.com
What to Expect at Canada’s Best Trade Show A visit to HealthAchieve wouldn’t be complete without scheduling ample time to visit its award-winning exhibit ﬂoor – which was recently awarded with “Best Trade Show” at the 19th Annual Canadian Event Industry Awards. So, aside from the close to 300 exhibitors showcasing the latest innovations in health care, what makes this trade show so unique – or, let’s say, the best in Canada?
HealthAchieve Go — Mobile Scavenger Hunt
Intelligent Health Pavilion™ Last year we focused on the future of hospitals and showcased North America’s ﬁrst-fully digital hospital, Humber River Hospital. Now, as our world continues to transform by digital health, we’re expanding on the Pavilion with the introduction of the i-HOME™ and Wearable Technology Demonstration Zone. Through the hospital, i-HOME™ and wearable technology setting, you will see ﬁrst-hand how technology is helping to improve patient care and safety while reducing costs.
Healthy Green Promenade Come and see what is growing in the future of health care. It’s about green space, peace of mind, easy growing, smart solutions and local food contributing to a healthy lifestyle, demonstrating a best practice combination at HealthAchieve. Take in some “green” and come visit the Healing Garden while participating in scheduled “talk to the expert” sessions.
Get set to learn, play (and win!) with our HealthAchieve Go scavenger hunt game on our mobile app! Pick from a list of exciting tasks as you compete with your fellow delegates for a chance to win cool prizes valued at more than $500 each donated by participating exhibitors. Visit the app store and type in HA2016 to download the app today!
Passport Lucky Draw HealthAchieve Show Management is once again conducting the Passport Lucky Draw on the exhibit ﬂoor. Delegates are encouraged to visit 12 speciﬁc exhibitors for a chance to win incredible prizes all worth more than $500 donated by participating exhibitors.
Choose Your Dream Destination Contest! You could win a travel package worth $5,000, sponsored by Desjardins Insurance. All you need to do is ﬁll out the ballot on your Passport, return it to Desjardins Insurance at Booth 1717 for your chance to win. The winner will be announced on Tuesday, November 8.
Book Store and Book Signing Several HealthAchieve keynote speakers’ books will be available for purchase at the book store located on the exhibit ﬂoor. We will be offering special onsite pricing for books so come prepared to take advantage of the special offers and get your booked signed by some of the authors!
Communications Café Join us in this designated lounge space in Booth 1118 that will offer complimentary beverages and snacks, charging stations, a social media wall and a photo booth for your to connect, recharge and relax while at HealthAchieve.
Complimentary Products and Services Delegates can look forward to the following complimentary services: • Ask the expert: medical cosmetics and nutritionist consultation • Mobile device charging stations • Water, beverages and healthy snacks • Flu shot clinic • Seated massage • BMI assessment • Water intake assessment • Caffeine intake assessment • Tim Hortons coffee (November 8 only)
Learn more at healthachieve.com
HOSPITAL NEWS OCTOBER 2016
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Better research: Better results By Jill Hatchette and Sandy Pagotto
r. Patrick McGrath, VP Research and Innovation, IWK Health Centre and Nova Scotia Health Authority asked a simple question: “Why are we not providing our staff with easily accessible research support?” Easier said than done. Up until 2012, IWK staff had few options on how to learn about doing research. All they had was access to a 10-week-long research course and some traditional workshops that targeted specific parts of the research process. Comprehensive but unwieldly, these resources were infrequently delivered and were really an “all or nothing” approach to education. Indeed, as heard in the comments of one staff physician who took this course, one-size doesn’t fit all: The solution? – “Comprehensive Research Education Online™, or – “creo” for short. With an already strong commitment to research culture at IWK, Pat McGrath and his team set out to address this issue. They believed as a result of their efforts, the research conducted at IWK would not only be methodologically sound, it would be more relevant and understandable and that the end result would better meet the needs of health centre staff, trainees and decision makers. creo™ is part of Dr. Pat McGrath’s legacy in healthcare. In fact, in June, 2016 Dr. McGrath received the inaugural Legacy of Leadership Award awarded by HealthCareCAN. While creo™ addressed the question of providing easily accessible research support for IWK; it didn’t stop there. In 2015, creo™ became available nationally through a partnership between IWK and HealthCareCAN.
“….we need to work together – researchers and decision-makers - and we need to provide the necessary support.” Dr. Patrick McGrath Increasing creo™’s power and value is its simple, easily digestible format that is applicable to anyone across the continuum of healthcare. From those at the front lines to those at the executive level, creo™ eliminates the barriers that exist within the traditional classroom/workshop model. Self-directed learning with access to experts is available 24/7 wherever and whenever needed for topics that cover the entire range of the research process, including knowledge translation. Truthfully, there is no lack of research being conducted; in fact, there are 2.5M new scientific articles published every year. Yet, despite all the time, money and energy spent on research, much of it ends in “Valleys of Death.”; where overlooked, under-referenced, semi-relevant research goes to die. As a result, many innovators www.hospitalnews.com
will argue that there is enough evidence out there to implement change and improve healthcare, it’s simply a matter of doing it. Locally, the IWK Health Centre and Nova Scotia Health Authority have seen great success with the use of creo as a research support tool. Not only has creo™ provided the extra support required by researchers, it has also contributed to expanding the research culture by engaging
decision-makers in the research process. The results are research projects that are supported and produce feasible and sustainable change to improve health service delivery and patient outcomes. “Creo recognizes not only the importance, but the value of connecting health professionals and learners to enhance their knowledge, expertise and understanding of the research process,” says Tracy Kitch, President and CEO of the
IWK Health Centre. “As a collaborative research education tool, creo will help the IWK and other institutions to foster a culH ture of evidence-based practice.” ■ Jill Hatchette is a Consulting Scientist with Research Services at the IWK Health Centre in Halifax Nova Scotia and Sandy Pagotto is the Director of Management and Leadership Education at HealthCareCAN.
THOMSON, ROGERS celebrates its 80th Anniversary by donating $80,000
Help us decide how to allocate our anniversary fund to organizations who have helped our personal injury clients in their journey of recovery.
Go to: thomsonrogers.com
TF: 1.888.223.0448 T: 416.868.3100 www.thomsonrogers.com OCTOBER 2016 HOSPITAL NEWS
16 Cover Story
Safe use of opioid analgesics in the hospital setting Preventing opioid-related events is a leading patient safety concern. Although there is increased focus on improper use and management of opioids in the community, the hospital setting is also where many patient safety incidents involving these drugs occur. These events take place across different settings within the hospital and involve various members of the healthcare team. The CMPA identified 36 medicallegal cases in which a patient was harmed following the administration of an opioid in hospital. In the majority of these cases (78%), peer experts criticized the care related to the incident. More than half of the patients involved in these cases died. In the cases with expert criticism, morphine was most frequently involved in an event, followed by hydromorphone and fentanyl. A few cases involved concomitant use of more than one opioid or sedative. The most common mode of administration was intravenous (IV). Breaking down the medication process by phase — assessment, ordering, dispensing, administering, and monitoring — found administering to be the most problematic phase, representing half of the cases. In some cases, more than one phase may have been involved in each event. For example, an inadequate assessment of a patient could lead to an inappropriate dose being ordered and administered to that patient. This finding speaks to the complexity of some of the cases as well as the shared responsibility of healthcare providers to prevent opioid-related events. Factors contributing to patient harm after opiod administration in hospital Provider factors • poor clinical judgment and inadequate training • mishandling of available dosage forms (e.g. crushing time-released tablet) • failure to consider patient risk factors: • advanced or young age • comorbidities (e.g. obstructive sleep apnea) • opioid naivety • concurrent use of other opioids or medications with sedative effects (e.g. benzodiazepines) System factors • equipment issues • lack of, inadequate, or unclear protocols and processes for: • epidural opiate treatment • patient assessment and monitoring • naloxone administration HOSPITAL NEWS OCTOBER 2016
Tackling the misuse of opioids:
Safe prescribing By Dr. Gordon Wallace hysicians in Canada are navigating difficult waters when it comes to the safe prescribing of opioid medications such as morphine, hydromorphone, oxycodone and fentanyl, and would be well advised to exercise caution in providing care for patients suffering from acute and chronic pain. The medical community today understands that opioid medications are much more addictive than previously recognized. Tolerance to opioids is common, and physical dependence can occur in patients who take these drugs regularly for even a short period of time. Because of their addictive nature, opioids are also aggressively sought through the medical system by drug users who have no conditions that require pain management. As a consequence, we are in the midst of a crisis related to opioid addiction and abuse that the healthcare community is struggling to address. Canada ranks second only to the United States in the per capita consumption of prescription opioids. In 2015, physicians in this country wrote enough opioid prescriptions for one out of every two Canadians.
Opioids, if used for chronic pain, should be one part of a comprehensive and well-defined treatment plan. To be sure, this is not an easy matter for physicians to manage. Many Canadians suffer from chronic pain and there is a scarcity of proper pain management services in many communities. Traditional pain relievers such as acetaminophen and nonsteroidal anti-inflammatory drugs may not work adequately. As a result, well-meaning doctors who are trying to help patients reduce their pain may prescribe opioid drugs or escalate dosages and inadvertently support addiction. A small number of patients who are suffering from addiction may seek out multiple doctors to acquire opioids. Demanding or sometimes threatening behaviour towards physicians and prescription fraud can further complicate matters. Yet it is in the interest of patients and physicians to find ways to ensure the safe and effective prescribing of opioid medications. At the Canadian Medical Protective Association (CMPA), we have observed that opioid prescribing is leading to increased medical-legal difficulties for doctors. Between 2010 and 2015, there were 151 medical-legal cases involving allegations of patient harm related to opioid prescribing. These cases mostly involved opioids prescribed for chronic pain. Most often physicians were criticized for their failure to assess patients appropriately for indications related to opioids. Inadequate assessments typically occurred at initiation, prescrip-
tion renewal, and when increasing dosages. Also, the prescribing of opioids at the same time as other medications such as benzodiazepines and psychotropic medications has resulted in an increased rate of over sedation, respiratory failure and death.
Ensuring the proper use of opioid medications
While governments, medical regulatory authorities (Colleges), and law enforcement are becoming increasingly aware of the growing misuse of opioids, and are working to address the issue, physicians in all areas of medicine have an important role to play in reducing the harm caused by these medications. At the CMPA, we provide information and suggestions on the steps that physicians can take to properly use opioid medications. Taking these steps can help to ensure the proper care of patients, and also mitigate the risks posed to doctors in terms of legal actions, College complaints and reputational damage. Safeguards include the following: 1. Seek updated information on opioids: Physicians should regularly seek up-todate information about opioid medications and non-medication pain relief options, including treatment indications, medication interactions and adverse effects. Stay current to allow you to take the right steps for a patient and comply with recognized clinical practice guidelines. 2. Perform careful and detailed patient assessments: Taking time to carefully and thoroughly assess a patient is always advisable. But this can be especially valuable in cases of chronic pain. Physicians should take a detailed history of the patient, obtain past medical records, and speak with other doctors who have treated the patient. Be mindful of other medications the patient is taking, any history of substance abuse, and any mental health conditions. This kind of detailed assessment will help determine whether an opioid medication would be beneficial to the patient. 3. Develop a well-defined treatment plan: Opioids, if used for chronic pain, should be one part of a comprehensive and well-defined treatment plan. Consider offering opioids on a trial basis and have a strategy to discontinue opioid therapy for cases where pain does not improve. 4. Obtain informed consent from patients: Given the risks involved in prescribing opioid drugs – both for the patient and the attending physician – it is important that the patient’s informed consent be obtained. Doctors should seek informed consent after they have had a fulsome discussion with the patient of the risks and benefits of pain management treatment using opioids. It is also good practice to warn patients to avoid driving or operating machinery while taking opioids. Document carefully all medication-related discussions, including informed consent discussions,
and treatment decisions in the medical record. Ensure a copy of any treatment agreement signed by the patient is also retained in the medical record. 5. Conduct regular reassessments of patients taking opioids: Again, physicians should not consider their job done once they have written a prescription for a pharmaceutical. Patients who are taking opioid medications should be monitored and reassessed on a regular basis. How is the patient’s pain? Have the opioids helped? Can the dosage be reduced or discontinued? Are there pain management alternatives? Asking these questions and evaluating the patient on an ongoing basis are critical steps in the process. 6. Consult with other physicians or healthcare providers: Communication at every step of the process is important, and not just with the patient. Effective communication with other physicians, pharmacists and healthcare providers can help to better control a patient’s pain or manage addiction should it occur. Doctors who administer opioids should never feel they need to operate in a silo. Involving the full spectrum of care can be beneficial to the patient and physician.
The Canadian Medical Protective Association has published several articles on the safe prescribing of opioid medications, all of which can be found on our organization’s website (www.cmpa-acpm.ca). These include “Opioid prescribing for chronic non-cancer pain;” “Preventing the misuse of opioids;” “The challenges of relieving chronic pain with opioids;” and “Adverse events: Physician-prescribed opioids.” These resource materials have been published between 2009 and today, and provide helpful guidance to physicians on the issues they may encounter with opioids, as well as steps that can be taken to protect themselves. The U.S. Centers for Disease Control and Prevention’s (CDC) 2016 recommendations on the use of opioids in treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care also contains beneficial information. Additionally, physicians may want to consult the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (currently being updated) which is available on the McMaster University website. This resource outlines approaches for initiating and monitoring opioid therapy, ways to manage opioid addiction, steps to reduce prescription fraud, and how to work collaboratively with pharmacists. Physicians with questions about opioid prescribing or managing medications can also consult their regulatory College, a pharmacist, or review information from the Institute for Safe Medication Practices (ISMP Canada). Continued on page 17 www.hospitalnews.com
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH Continued from page 16
Working together to tackle opioid misuse
While physicians are a key part of the solution to opioid prescription abuse, other organizations are accountable too. Federal, provincial and territorial governments can provide increased funding for research. Communities need more consistent access to effective pain management and addiction resources. Healthcare monitoring systems are required to allow physicians to easily understand the amount of opioid medications patients are taking, and which other providers may be prescribing. Regulators should look at outliers in practice and support these providers to help them develop better prescribing patterns. Medical schools and professional development organizations should include more training on pain management and safe opioid prescribing practices. And pharmacists should work more closely with physicians to manage opioid prescriptions. Patients are encouraged to also take an active interest in their medical care and pain management. Patients should discuss the advantages and disadvantages of opioid medications with their doctor, as well as alternatives to these powerful pharmaceuticals. Physicians can support these discussions by referring to reputable online information. Ongoing communication among all parties involved – physicians, pharmacists other healthcare professionals, patients and families – is key to the safe and H effective use of opioid medications. ■ Dr. Gordon Wallace, FRCPC is Managing Director of Safe Medical Care at the Canadian Medical Protective Association. Strategies to support appropriate use and monitoring For front-line care providers Consider the patient’s relevant medical and medication history, including previous opioid use (e.g. naivety); co-morbid conditions (e.g. sleep apnea); and factors (e.g. age) that may require additional consideration when prescribing opioids. Review and verify the medication concentration, dosage (dose calculation), rate of administration, and route of administration before prescribing. For children, calculate individual doses based on the child’s weight or body surface area and condition. Consider whether non-medication analgesia options are appropriate or adjunctive, and whether non-opioid analgesics should be prescribed. Ensure the patient with a high risk of respiratory depression is appropriately monitored for adequate vital signs, respiratory status, pulse oximetry, and level of consciousness. For healthcare leaders Encourage regular reviews and updates of policies and processes for the administration and monitoring of opioids. Periodically evaluate adherence to such policies and quality improvement activities. Making opioid use safer in the hospital setting requires strategies to safeguard patients from opioidrelated harm and must involve all members of the healthcare team. www.hospitalnews.com
Fentanyl patches can be deadly By Joyce Tsang, Matthew Chan, Steven Lam, and Certina Ho
entanyl is a highly potent long-acting opioid that is used broadly as an analgesic. The fentanyl transdermal system (i.e. skin patch) is highly effective, and is only used in the management of chronic pain. However, there are unique characteristics of the patches that need to be taken into consideration in order for them to be used safely. Failure to do so may result in overdoses which can have fatal consequences, especially for opioid naïve users. ISMP Canada conducted this multiincident analysis to examine medication incidents involving fentanyl patches that are commonly encountered within the community setting. Incidents were retrieved from ISMP Canada’s Community Pharmacy Incident Reporting (CPhIR) program from the period between January 2010 and January 2016. A total of three main themes were identified by this analysis.
This theme is related to the drug property of fentanyl or how it works, which includes the following subthemes: (1) dosing interval; (2 drug-drug
interactions; (3) Rate of absorption; and (4) its effects on opioid naïve users. Although considerations of pharmacological properties apply for all drugs, fentanyl is unique with its constant rate of absorption and long dosing interval. Hence, a fentanyl patch is expected to be applied for 72 hours; yet, most patients attribute a typical pain medication as lasting only for a few hours that can be used only when required. (Table 1)
Opioid-dose conversion refers to the process of calculating the appropriate dose of fentanyl to prescribe. To initiate fentanyl therapy safely, patients must first have prior use of other opioid analgesics in order to reduce the risk of adverse effects, such as, respiratory depression. Converting the doses between the myriad of opioid formulations can have significant safety implications if performed incorrectly. (Table 2)
Finally, product design represents the physical limitations as to how the medication is commercially available. This re-
fers to the fixed dosage of fentanyl and its supply of 5 patches per box. A combination of multiple or, sometimes, different patches may be required to achieve the prescribed doses. (Table 3)
Safety recommendations can target different stages of the medication-use process rather than a specific potential contributing factor. These recommendations provide a good transition point to align with the recent fentanyl legislation in Ontario (http://www.ontla.on.ca/web/ bills/bills_detail.do?locale=en&Intrane t=&BillID=3059). Many regions have already adapted a “patch-for-patch” program to create safer fentanyl practices, where patients with a prescription for fentanyl would only be provided with new fentanyl patches when they return H the used patches. (Table 4) ■ Joyce Tsang is an Analyst at the Institute for Safe Medication Practices Canada (ISMP Canada); Matthew Chan 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. Pharmacological Properties Subtheme
Potential Contributing Factors of Medication Incidents
Lack of knowledge or awareness of the unique dosing interval of fentanyl transdermal patches in pain management. Lack of a clinical decision support system to alert the prescriber and/or pharmacist for potential DDI and/or other contraindications. Fentanyl patch is a controlled delivery system designed to release a steady amount of medication at a constant rate in mcg/hour. Unlike most other pain medications, fentanyl transdermal patch is used consistently with a strict dosing regimen and direction of use rather than on an “as needed” basis. Lack of knowledge or awareness of the proper indication for the use of fentanyl patches.
Drug-drug interaction (DDI) Constant rate of absorption
Effects on opioid naïve users
TABLE 2. Opioid-Dose Conversion Potential Contributing Factors of Medication Incidents Lack of familiarity or access to equianalgesic or opioid-dose conversion tables for pain management. TABLE 3. Product Design Subtheme Supplied in a box of 5 patches Fixed dosage
Potential Contributing Factors of Medication Incidents Confirmation bias (mix up of the number of boxes and the number of patches prescribed). Prescribed doses may require combination of multiple or different patches.
TABLE 4. Recommendations Medication-use process Prescribing Order Entry Therapeutic Check Medication Dispensing Patient Counselling Monitor/Follow-up
Recommendations Use a standardized fentanyl prescribing guideline or protocol. Include or have access to an equianalgesic conversion table. Adhere to the physician’s specific written instructions. Include “return used patch(es) to pharmacy” or adopt the “patch-for-patch” program. Assess patient on appropriate indication and dose of fentanyl, potential drug-drug interactions, contraindications, state of opioid-naïve, and use of maintenance or breakthrough pain medications, etc. Double check the number of patches to be dispensed. Ensure all patch strengths dispensed add up to the prescribed dose. Educate patient on the appropriate indication and administration of a fentanyl patch, signs and symptoms of an overdose, and accessibility of naloxone (an antidote to fentanyl). Initiate a patch-for-patch partnership with patients. Ensure patients return used patches to pharmacy for safe disposal. OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
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Connect with delegates on the tradeshow floor
HEALTH ACHIEVE SUPPLEMENT See page H1
FOCUS IN THIS ISSUE
AL HEALTH PATIENT SAFETY/ MENT RCH AND ADDICTION/RESEA
t afety practices. New treatmen Developments in patient-s and addiction. An overview approaches to mental health s. of current research initiative
................... 17 Safe Medication .............. .................22 Evidence Matters ..............
...........23 From the CEO’s desk .............. .........25 Nursing Pulse ............................ ................... 27 Trends in Transformation ................... 27 Careers ............................
10 | N | VOLUM E 29 ISSUE OCTOBER 2016 EDITIO
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Safe prescribing Story on page 16
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HOSPITAL NEWS OCTOBER 2016
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Digital Health Week:
A national conversation to #ThinkDigitalHealth By Dan Strasbourg anada Health Infoway is part of The Better Health Together community of more than 40 healthcare organizations inviting Canadians to be a part of Digital Health Week from November 14 – 20, 2016. The week-long celebration of the benefits of digital health brings together Canadians, clinicians, governments, associations and industry partners for a national conversation about digital health. As part of the week, the Better Health Together organizations, along with patient partners, are coming together to examine how digital health technology is being used by Canadians and their healthcare providers to help shape a future of healthier Canadians. A key area of focus this year will be on how technology is transforming the patient experience. For example, some virtual care solutions enable patients to be discharged from hospital sooner, while others help avoid hospitalization in the first place. In the end, they all help support patient empowerment and improved outcomes. “Research shows that when Canadians have access to their health information, it enables them to be more active partners in their care and wellness,” says Shelagh Maloney, Vice-President, Consumer Health, Communications and Evaluation Services, Canada Health Infoway. “That’s important, because three-quarters of patients who have this access report having more
knowledge of their condition, being more confident in the care they receive and having more informed discussions with their care providers.” Canadians’ appetites for digital health is evident in recent studies that reveal their use of digital solutions to book appointments, request prescription renewals, view their health information or consult with their doctor online has more than doubled in the past two years. A recent study reveals 82 per cent of Telehomecare patients report less need to visit an emergency department, while 88 per cent report a positive overall experience. “Digital health solutions are modernizing our health system and saving Canadians’ time,” says Maloney. “From patients and caregivers living with chronic illnesses to busy parents sandwiched between their children and their parents, digital health helps people manage and improve health and outcomes. That’s worth celebrating! How is digital health working for you? Add your voice to the conversation and find out more about what digital health means for you, your patients and your family. Join in via #ThinkDigitalHealth or learn more at www.betterhealthtogether. ca, where you will find out more about interactive learning events in which you can H participate. ■ Dan Strasbourg is Director, Media Relations at Canada Health Infoway.
Join the conversation!
Digital Health Week and Canadian hospitals From bar codes that ensure patients get the correct medication to clinical decision support tools to hospital information systems, digital health is an integral part of Canadian hospitals. It helps provide authorized staff with timely information about a patient and also supports accurate communication between staff members, as well as with patients and families. The Better Health Together community wants you to join the conversation about your experience with digital health. Here are some examples of recent digital health advances that may be making an impact: • Keeping you connected. Some hospitals offer patient portals or other tools to keep you and your family connected through your care journey with access to information such as lab results and appointment notes. • Providing critical information during emergencies. Electronic health records can speak for you when you can’t. With provincial/ territorial electronic health record systems, your medical information is in the hands of your emergency care team, when and where it matters most. • Enabling faster diagnoses. 99 per cent of diagnostic imaging in hospitals is now digital. This enables faster diagnoses and treatment of patients. In fact, these digital health systems have been shown to increase productivity by 30-40 per cent.
• Helping care teams make the right decisions. Computerized order entry and other decision support tools help staff make the right decisions based on up-todate clinical evidence as well as best practice recommendations, providing better, safer care. • Improving patient outcomes. Electronic medical records and other digital technologies have the potential to improve patient outcomes by alerting clinicians to preventable drug interactions, and by helping hospitals identify and track infections, medication errors and other adverse events. • Virtual consultations. Telehealth and e-visits enable your care team to consult with specialists regardless of their location, increasing access to care even from some of the most remote communities.
What has been your experience? Between November 14 and November 20, #ThinkDigitalHealth and share your story about how digital health is making a difference in your hospital.
OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
From research to care: Five years of Canadian “firsts” pave the way for decades of medical advancement By Claire Samuelson
n 1922, Canadian researchers Drs. Charles Best and Frederick Banting discovered insulin as a treatment for diabetes. In 1950, Toronto physicians Bill Bigelow, John Callaghan and John Hopps developed the first artificial pacemaker to be used in open heart surgery. In 1961, the scientific world was in awe of Drs. James Till and Ernest McCulloch who made an incredible discovery that later enabled the first bone marrow transplant: the identification of blood forming stem cells. Since the dawn of modern medicine, scientists at Canada’s research hospitals have made countless life-saving discoveries and international, national and
Changes coming to B.C. cancer treatment system
July 21, 2016 British Columbia is the first province to implement Oncopanel genomic screening for cancer patients, but it won’t be the last, and the list of treatable mutations will continue to grow and become more robust as each patient’s information is added to the database. Agencies across Canada are also working together to discuss the accelerated clinical trials of off-label treatments with pharmaceutical companies.
Vancouver Coastal Health sets new guidelines for treatment of opioid addiction
November 3, 2015 Vancouver Coastal Health has established a “first-of-its-kind” guideline in the treatment of opioid addiction, recommending that doctors use an alternative to methadone as a first line treatment. The nine recommendations are aimed at improving physicians’ knowledge of treatment options in light of ongoing challenges with methadone and opioid overdoses linked to fentanyl and oxycodone.
Results of world’s first study on new treatment for heroin addiction
April 6, 2016 The results of a ground-breaking research project have revealed an effective new treatment tool for chronic heroin addiction: hydromorphone, a licensed and widely-available pain medication. Led by a team of researchers from Providence Health Care, this is the first and only clinical trial of its kind in the world. The research study found hydromorphone to be as effective as pharmaceutical-grade prescription heroin, providing a licensed alternative to treat severe opioid use disorder.
Unveiling B.C.’s first digital mammography vehicle
February 24, 2015 British Columbia’s first mobile digital mammography vehicle has been unveiled by the province’s Health Minister. The breast cancer screening vehicle is first of three mobile units intended to reach rural areas, in an attempt to transition away from analog mammography. 10 per cent of HOSPITAL NEWS OCTOBER 2016
all screening mammograms in British Columbia are performed by the mobile fleet.
Spinal Cord Injury Program at HSC Winnipeg first in Canada to receive accreditation
August 10, 2016 The Spinal Cord Injury Program at Winnipeg’s Health Sciences Centre is one of the first in Canada to be accredited under new standards. The interdisciplinary team at the Centre provides specialized trauma, orthopedic and rehabilitative care, among many other services, to approximately 50 to 60 people with spinal cord injuries each year. The program recently underwent review, achieving unprecedented ratings of 99 and 100 per cent.
Women’s College unveils Toronto’s first [high-tech] outpatient hospital
June 12, 2013 Women’s College Hospital has unveiled Toronto’s first outpatient clinic. The contemporary facility is a significant milestone in the province’s plan to transition health care out of hospitals and into home and community settings, where patients are more comfortable and are less at risk of exposure to harmful infection. Designed to allow patients to return home as quickly as possible, there are no in-patient beds, and surgery patients only stay up to 18 hours.
Medicine as Unique as You
November 12, 2014 A team at the University Health Network has developed a genetic test that identifies which men are at highest risk for prostate cancer recurrence. The test could revolutionize the way the disease is treated by helping to identify men that require more aggressive treatments while preventing the over-treatment of those who don’t.
Local researcher examines new way to capture images of brain for Alzheimer’s disease
June 15, 2016 A researcher at the Thunder Bay Regional Research Institute has discovered a more effective way to study the brain while treating Alzheimer’s disease. The goal of
local “firsts” that translate ground-breaking research into innovations in care. These breakthroughs have transformed countless lives and facilitated decades of research into many complex and life-threatening conditions such as heart disease, diabetes, cancer, and respiratory disease. These healthcare and research “firsts”, which appear in reputable print media, are tracked through HealthCareCAN’s award-winning tool, Innovation Sensation, a searchable database that highlights innovative breakthroughs from Canada’s research hospitals. We encourage you to visit www.healthcarecan.ca to view thousands of other healthcare and research “firsts”, and pick your favourites.
the research is to provide a more accurate measurement of the brain function in Alzheimer’s patients using hyperpolarized xenon. It is believed that when patients inhale hyperpolarized xenon gas, researchers will be able to take a clearer picture of the brain when using an MRI machine. This study will be the first large scale clinical trial in the world using hyperpolarized gas to take an image of the brain.
Toronto hospital becomes world’s first to treat brain tumour with non-invasive procedure
November 9, 2015 Scientists at Sunnybrook Health Sciences Centre are the first in the world to use focused ultrasound to breach the blood-brain barrier of a patient with brain cancer precisely and noninvasively. They used focused ultrasound, pioneered by a Sunnybrook Research Institute scientist, to deliver chemotherapy directly to the brain tumour. They are poised to launch another world first: evaluating this technology for patients with Alzheimer’s disease.
North American first in children: SickKids doctors destroy bone tumour using incisionless surgery
August 6, 2014 The Hospital for Sick Children is the first facility in North America to perform a specialized procedure that uses ultrasound and MRI to destroy a bone tumour without piercing the skin. In collaboration with Sunnybrook Health Sciences Centre, physicians used an MRI to guide high-intensity ultrasound waves to destroy a benign bone tumour called osteoid osteoma. The 16-year-old child experienced excruciating pain for a year prior to the procedure, and is now pain-free.
World first in imaging technology developed at Lawson
December 8, 2015 Researchers at Lawson Health Research Institute, in collaboration with Ceresensa Inc., produced the first commercial imaging product available in the world for PET/ MRI scanners. The novel PET-transparent MRI head coil provides unparalleled images to advance the study, diagnosis and
treatment of a wide range of diseases. At St. Joseph’s, the coil is being used for research on schizophrenia and depressive disorders, Alzheimer’s disease, dementia, and the study of brain damage resulting from chronic dialysis.
Researchers produce first widely protective vaccine against chlamydia
July 21, 2016 Canadian researchers have developed the first widely protective vaccine against chlamydia, a common STI that is mostly asymptomatic but impacts millions of people around the world each year and can result in infertility. Performed at St. Joseph Healthcare Hamilton’s Research Institute, the study would be the best way to treat the infection, and may prevent or eliminate its damaging reproductive consequences.
Where’s Zika going next? Maybe China, India, or Nigeria
September 1, 2016 In January 2016, before the World Health Organization declared Zika virus a public health emergency, Dr. Kamran Khan published a letter in The Lancet highlighting the potential for this emerging virus to spread rapidly across the Americas. In that analysis, southern Florida was identified as one of the highest risk areas for viral introduction and local spread, which was ultimately borne out last month. As health officials scramble to understand the mosquito-borne virus, Dr. Khan, an infectious disease specialist and scientist at St. Michael’s Hospital, is using big data to develop models to anticipate where and when an outbreak is most likely to occur in the world.
The Royal gets NATO’s first research chair in military mental health
December 11, 2014 The Royal Ottawa Health Care Group will become home to NATO’s first research chair in military mental health. Col. Rakesh Jetly, senior psychiatrist with the Canadian Armed Forces and Mental Health Adviser to the Surgeon General, says that there is work to be done on research that will translate into new treatments for those with PTSD. Canada and www.hospitalnews.com
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH its NATO partners will work together to share and amplify research in this everimportant area.
Ottawa Hospital launches world’s first clinical trial of double-virus cancer treatment
July 10, 2015 Researchers at The Ottawa Hospital have launched a clinical trial that seeks to use two viruses to attack the cancer cells of patients with advanced tumours. The clinical trial, a joint effort between The Ottawa Hospital, the Children’s Hospital of Eastern Ontario and McMaster University, is the first in the world to use one virus to directly kill cancer cells and another to stimulate the patient’s own immune system to fight the cancer. Combining these two approaches could dramatically increase the chances of success.
Blood test identifies women at risk of preterm delivery
June 24, 2016 Researchers at the Lunenfeld-Tanenbaum Research Institute have developed a blood test that detects if a pregnant woman is at risk of delivering her baby prematurely. With an 86 per cent accuracy rate, the new test is more accurate than any existing procedure. This test is important as buys physicians time to implement measures to help prevent a pre-term delivery.
Since the dawn of modern medicine, scientists at Canada’s research hospitals have made countless life-saving discoveries Montfort recognized for integrating midwives into hospital
May 31, 2015 Hôpital Montfort is believed to be the first hospital in North America to officially give midwives privileges to conduct births without transferring care to an obstetrician, although a medical team is available if needed. The hospital promotes a holistic approach to maternity care, encouraging communication between family doctors, obstetricians, midwives, and nurses.
World first in prostate cancer treatment at LHSC
April 24, 2013 Researchers at London Health Sciences Center and Lawson Health Research Institute now offer a minimally invasive treatment option for patients with localized prostate cancer. The world first treatment utilizes a new device that uses thermal ultrasound therapy with real-time MRI guidance to destroy cancer cells in the prostate gland. Physicians have an improved view that allows the whole prostate gland to be treated in one session and with greater accuracy. www.hospitalnews.com
KGH team performs a North American first in endoscopy
December 19, 2012 The Endoscopy team at Kingston General Hospital has successfully performed the first endoscopic procedure in North America using a biodegradable esophageal stent. Esophageal stents are used to improve the quality of life for patients who find it difficult or impossible to swallow due to a narrowing of the esophagus. The device is a revolutionary tool that could dramatically improve the lives of many.
World’s first concussion research centre
July 2, 2014 Holland Bloorview Kids Rehabilitation Hospital is home to a new Concussion Clinic focused on children and youth with persistent and long-lasting concussions. The Concussion Clinic is one of the world’s first research institutes to focus on paediatric concussions and will be the first of its kind in Ontario dedicated to children who are affected by ongoing concussion symptoms.
Safe place for sick kids in Sudbury
August 25, 2016 A Health Sciences North acute care centre will soon be offering a comfortable, safe space for families whose children are ill. Located at Ramsey Lake Health Centre, the first Ronald McDonald House Family Room in Northern Ontario will be ideally situated in a spot between the paediatrics and neonatal wards at the hospital.
New procedure at Hamilton’s Juravinski centre cuts chemo wait time
November 24, 2014 The Juravinski Hospital and Cancer Centre is the first Canadian hospital to adopt a new procedure that has improved care for chemotherapy patients. The procedure uses new technology to ensure accurate placement of a peripherally inserted central catheter (PICC) which delivers chemotherapy medication through a large vessel near the heart. The procedure has drastically cut wait times for chemotherapy patients.
Canadian researchers unravel the underlying biology of rare childhood disorders
June 6, 2014 A nationwide research team, led at CHEO, used exome sequencing technology to study a wide range of rare childhood genetic disorders including neurodegenerative conditions and those that affect multiple systems in the body. The team solved 146 disorders, including the identification of 67 novel genes that had never been associated with a rare disease before.
In a Canadian first, family practice offers genetic testing with CAMH to predict which psychiatric meds work best
January 30, 2013 The Centre for Addiction and Mental Health (CAMH) is the first Canadian hospital to offer genetic testing to predict
how patients will respond to psychiatric medications, and the first to deliver these tests in primary care. Results show which medications will be effective for a patient, and which ones will not work or may cause side effects. The test is now available in the community through the IMPACT study. CAMH also has the first Canadian patent on a gene that predicts antipsychoticinduced side effects (weight gain), which is under study in a randomized controlled trial of pharmacogenetics testing.
New network aims to wean seniors off inappropriate prescription drugs
February 26, 2016 Scientists at the Bruyère Research Institute have developed the first ever deprescribing guidelines. Currently, there are many prescribing guidelines that tell you when to begin taking a drug, but none address when it might be appropriate to stop taking it. The aim of the project is to reduce unnecessary and inappropriate medication use in older patients by 50 percent by 2020.
Mental stimulation may offset impact of poor diet on cognition
July 25, 2016 Researchers at Baycrest in Toronto have demonstrated for the first time that a lifetime history of mental stimulation and high cognitive reserve can partially offset the neurocognitive disadvantages associated with consuming a poor diet. This new study suggests that mental stimulation may help offset the cognitive decline associated with a traditionally “Western” style diet, heavy on red meat, processed foods, sugary drinks, and baked goods.
Genetic discovery about childhood blindness paves the way for new treatments
January 12, 2015 Researchers at the Montreal Children’s Hospital of the McGill University Health Centre have discovered a new gene that is critical for vision. This breakthrough opens up new treatment avenues for children and adults suffering from retinal degenerative diseases.
Revolutionary surgery for lung cancer
July 11, 2016 The University of Montreal Hospital Research Centre (CRCHUM) is launching a major international clinical trial to test a minimally invasive and safer surgical approach for patients with lung cancer: video-assisted thoracoscopic (VATS) lobectomy with ultrasonic pulmonary artery sealing.
World first clinical study launched in patients facing a therapeutic dead end launched at CHU Sainte-Justine
October 26, 2015 A new drug combination being trialled in a groundbreaking CHU Sainte-Justine/ University of Montreal study is giving hope for survival, healing and improved quality of life to the 20 per cent of children who do not respond to standard cancer treatments. Known as DEC-GEN, it is the world’s first study involving children
Focus 21 with solid tumors or recurrent or refractory leukemia.
New research centre takes on new meaning for cancer researcher
August 22, 2016 A partnership between Vitalité Health Network, the Université de Moncton, and others, New Brunswick’s first hospital research centre, the New Brunswick Centre for Precision Medicine, is slated to be built by April 2018 and will be home to cutting edge biomedical, genomics and population health research.
Horizon Health eliminates visiting hours for family at hospitals
February 1, 2016 The Horizon Health Network is the first health authority in Atlantic Canada to eliminate visiting hours for family members in its hospitals. Horizon Health introduced its new Family Presence Policy recently, allowing family to visit patients staying in Horizon Health hospitals whenever they wish. The change is an attempt to recognize the importance of family in a patients healing process.
IWK Health Centre home to unique imaging room
December 14, 2015 The IWK Health Centre in Halifax, Nova Scotia is home to a one-of-a-kind imaging room, equipped with a unique technology – the first of its kind in Canada. The digital imaging machine is unique as it combines a nuclear medicine camera and a standard CT camera. Obtaining simultaneous images of function from the nuclear medicine camera, and anatomy from the CT camera affords health professionals vastly improved diagnostic capabilities.
Halifax doctors aim to perform Canada’s first face transplant
July 9, 2012 A group of Halifax doctors aim to make Halifax a prime destination for face transplants. Patients that would be potential candidates would include those with trauma-related injuries and burns. If everything goes as planned, Canada’s first face transplant could be performed within one year.
Newfoundland health board launches end-of-life planning program
May 12, 2016 Soon, Newfoundland patients will be asked to think more about their final days when they arrive for treatment at Eastern Heath hospitals. In a new policy, patients will be asked to consider what type of procedures they want performed, and which they do not, while in the last stages of their lives. The program is optional, and patients will not be forced to make advanced decisions. It is the first time Eastern Health has undertaken a broad regional strategy of promoting these types of important conversations. ■ H Claire Samuelson, MA (Bioethics) is Policy Analyst, Research and Innovation at HealthCareCAN, The national voice of Canada’s healthcare organizations. OCTOBER 2016 HOSPITAL NEWS
22 Evidence Matters
New smoking cessation strategy: HSNRI Scientist receives funding for smoking vaccine By Maggie Frampton ntario has higher rates of smoking than the provincial and national average. Over 45,000 Canadians die from smoking related diseases each year. There is an undeniable link between smoking and cancer, heart and lung diseases. Dr. Hoang-Thanh Le, Scientist at Health Sciences North Research Institute, the research institute for Health Sciences North in Sudbury, Ontario, has received funding from the Canadian Institutes of Health Research (CIHR) for the development of an intranasal vaccine using a novel adjuvant delivery system. The vaccine is showing promising preliminary results. “Only a small group of people see long term success with the current smoking cessation options. The nicotine vaccine would be a likely option for treatment that suppresses the addiction, ” says Dr. Le. Dr. Le has been developing the vaccine since 2011 when he first received support from Grand Challenges Canada and Northern Cancer Foundation. The project involves collaborations with partners at the Centre for Addiction and Mental Health in Toronto, Health Sciences North Research Institute in Sudbury, Pasteur Institute in Ho Chi Minh City, Vietnam; and Indian Institute of Science Education and Research in Kolkata, India. Dr. Le and his team propose to develop a new vaccination strategy targeting the lungs, which offers an effective treatment that can sequester nicotine in the airways and limit its entry into the brain. Preliminary results show that levels of nicotine in the brains of vaccinated mice were four times lower than those not vaccinated. The new proposed strategy, which is easily administered through the nose, skin or under the tongue, could be able to aid people who smoke to successfully quit and also to prevent smoking. “We are very excited for Dr. Le and his research team for receiving funding from CIHR. The development of this research will help many patients in Northern Ontario and beyond,” says Dr. McElhaney, Vice President of Research & Scientific Director at Health Sciences North Research Institute. Dr. Le anticipates starting human clinical trials once all safety and efficacy testing has been concluded in animals. This vaccine would benefit patients by reducing the risk of cancers, heart disease and stroke. The vaccine will not require any needles making it more cost effective than traditional vaccines. This safe and effective approach to vaccination could be further developed for other addictions such as coH caine, heroin, and methamphetamine. ■
Skip the cold turkey By Janice Mann and Sarah Jennings uitting smoking. It’s an endeavour that strikes fear and loathing even in the bravest of hearts. And it’s no wonder. Smoking is a complicated addiction with both physical and psychological factors at play. Not only do smokers crave the nicotine found in cigarettes, they’ve also formed a lot of habits that revolve around their smoking. So it’s a major undertaking to attempt to quit. But it’s one that’s well worth the effort – even if it does usually take several tries. Although smoking is on the decline in Canada, more than 30 per cent of hospital beds are occupied by adults who are there because of health problems caused by their smoking. Smoking is a major risk factor for cancer, as well as for respiratory and cardiovascular diseases. But unlike some of the other things that put us at risk for these health problems, our smoking risk factor can be changed – by quitting. One in three of the 18 per cent of Canadians who smoke wants to quit within the next 30 days. But what is the best way to quit? It seems everyone has an opinion, but what really matters in important health decisions is knowing what the evidence says. And when healthcare decision-makers in Canada want to know what the evidence says, they turn to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. In 2010, CADTH conducted a major review of the drugs that are available to help people quit smoking, to see if they really do help. These medications, sometimes referred to as smoking cessation
HOSPITAL NEWS OCTOBER 2016
aids, include varenicline (also known by the brand name Champix) and bupropion (also known by the brand name Zyban). Varenicline is a prescription drug that affects nicotine receptors in the brain. It reduces the cravings for cigarettes and decreases the pleasure people experience from smoking. Bupropion is a prescription antidepressant. Exactly how it helps people stop smoking isn’t fully understood.
More than 30 per cent of hospital beds are occupied by adults who are there because of health problems caused by their smoking.
The review also included nicotine replacement therapy, frequently referred to as NRT. NRT delivers the nicotine that would otherwise come from tobacco use and helps relieve or prevent cravings. NRT is available without a prescription in various forms, such as a patch, gum, lozenge, or inhaler. When CADTH looked at the evidence from research, it showed that varenicline, bupropion, and NRT can all be more effective than trying to quit without using a smoking cessation aid. NRT or varenicline may double your chance of quitting, and bupropion could triple your chances of success.
Since the original review of the evidence in 2010, CADTH has conducted several rapid evidence reviews to ensure the information remains up to date. And although some smaller studies have been found that don’t show any benefit of these drugs, the bulk of the evidence continues to show that varenicline, bupropion, and NRT are all effective in helping people to quit smoking and remain smoke-free one year later. So what does all this evidence mean for smokers, their families, and their healthcare providers? It shows that using a medication to help you quit is more effective than going it alone; in other words, these drugs can help increase your chances of successfully quitting. Since the evidence also shows that NRT, varenicline, and bupropion all increase your chances of quitting, it means each person who smokes can decide which of these options best suits them and their lifestyle – one size does not have to fit all. And finally – smokers can choose to save the cold turkey for leftovers, and not feel that it’s their only strategy for quitting. If you would like more information on the CADTH evidence reviews for quitting smoking, you can find it at www. cadth.ca/smokingcessation. And if you’d like to learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: www.cadth.ca/conH tact-us/liaison-officers. ■ Janice Mann and Sarah Jennings are Knowledge Mobilization Officers at CADTH.
Maggie Frampton is a Communications Specialist at Health Sciences North. www.hospitalnews.com
From the CEO's Desk 23
Justice for all Canadians By Catherine Zahn
ince becoming the CEO of CAMH in 2009, I’ve received phone calls for mental health advice, guidance, system navigation and support at least once a week. The calls come from neighbors, friends, colleagues, and casual acquaintances. These are people who are frustrated and confused by their inability to access the healthcare system when it comes to mental health. Many compare the experience to their vastly different encounters for non-psychiatric conditions like cancer, diabetes or heart disease. They describe roadblocks across the spectrum – from primary and community care to crisis and critical care in hospitals and emergency departments. There’s something deeply unjust about this discrepancy. As we mark Mental Illness Awareness Week 2016, I don’t deny that there’s been significant progress on mental health in Canada. Honest conversations have galvanized attention across the country; people with lived experience have bravely shared their stories; innovative brain research is reaching a tipping point; novel treatments and care models are emerging. Yet, too many people are not getting the care they need. Funding levels do not match the burden of illness. Individual care providers as well as healthcare organizations are working to improve our
efficiency, to create partnerships and collaborations that enhance continuity of care and to advocate for equity of funding. Still, wait lists grow. People are in pain. Lives are lost. Today in Canada, there is a once-in-ageneration opportunity to address the gap in resources for mental healthcare. The federal Minister of Health is negotiating a renewed accord with her provincial counterparts. Under the health accord signed in 2004, Canada’s first ministers agreed to a 10-year healthcare agreement that included a commitment to improve access to five clinical procedures. It included an investment of 5.5 billion dollars for a wait time initiative that spurred provincial investments to meet specific targets and reduce wait times for patients. Mental healthcare wasn’t on the list. Canada’s hospitals and their patients cannot afford to have mental health left out of the next health accord. This is not a shell game. All aspects of the mental healthcare system – from health promotion and prevention to community care and social supports to acute and complex hospital care – are under resourced. It’s a sad state of affairs that the first point of access to the healthcare system for people with a mental illness is often a hospital emergency department. Rational and effective investment will prepare primary care clinicians and community care agen-
cies to address mental disorders early and in an evidence informed way as part of a cohesive system. The entire system must advocate for better access to mental health care across the country. As we mark Mental Illness Awareness Week, hospitals and hospital leaders are uniquely resourced to shine a light on mental health system shortcomings, and to engage our partners – including our patients, to demand parity – with passion and precision. Continued on page 27 Catherine Zahn
OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
Bringing mindfulness therapy online First-in-Canada platform increases access to mental health support for cancer patients By Lisa Cipriano ancer patients at The Scarborough Hospital (TSH) now have better access to mindfulness therapy, which reduces mood and anxiety symptoms, thanks to a new online therapy platform called iMindful. Created through a partnership between TSH and Centennial College, iMindful enables patients to access care on their own terms and on their own schedule – a welcome solution considering the unmet mental health needs of cancer patients. The program features therapist-guided mindfulness modules, group chats, meditations developed by TSH therapists, and a yoga practice developed by TSH Psychiatrist, Dr. Karen Shin. It also provides links to therapist-approved online resources like the Mental Health App Library, information on sleep hygiene, and more. Patients can even use iMindful to book video appointments with their therapist, or message their therapist using video or private chat. “We are finding new ways to empower cancer patients who may benefit from mental health support,” says Faiza KhalidKhan, Patient Care Director for TSH’s Mental Health department. “iMindful gives patients more control over their own treatment.” For therapists, the platform is a useful tool for monitoring patient engagement, evaluating the effectiveness of the program
Photo credit: Centennial College.
A picture at Centennial College’s WIMTACH Hackathon where Software Engineering Technology/Technician students were challenged to create apps that could provide low-cost health care solutions. on their patients, and analyzing metrics nial College’s Wearable, Interactive, and that help the Mental Health team tailor Mobile Technologies Access Centre in the program for patients. iMindful’s group Health (WIMTACH), where Software Enchat feature even flags trigger words typed gineering Technology/Technician students by their patients, so that therapists can de- were challenged to create apps that could liver appropriate support. provide low-cost healthcare solutions. “With iMindful, we are building on our “Centennial College has an incredible success with Internet-Assisted Cognitive groundswell of innovative thinkers who Behavioural Therapy (iCBT), which is mirror the talent and skill of those in our available to patients experiencing anxiety Mental Health department,” says Alfred and depression,” says TSH Psychiatrist Dr. Ng, Director of Innovation and PerforDavid Gratzer. “Both programs directly mance Improvement at TSH, and the support the hospital’s strategic direction, hospital’s WIMTACH lead. “With their ‘Patients as Partners.’ Our vision is to ex- expertise in healthcare technologies, it tend beyond the bricks and mortar of the made perfect sense to collaborate with our hospital, and become an e-therapy hub for neighbour.” our community.” From there, the project was approved The idea for iMindful originated at a for funding from Centennial College via two-day hackathon organized by Centen- its College and Community Innovation
grant from the Natural Sciences and Engineering Research Council of Canada. Three students were hired to further develop the concept under the guidance of Mihai Albu, WIMTACH Researcher and Professor with Centennial’s School of Engineering Technology and Applied Science (SETAS). After meeting with members of TSH’s Mental Health department to better understand patient needs, the students developed iMindful with a focus on interaction and engagement. The project was a great success: iMindful was named “Best Web Application” at Centennial’s SETAS Technology Fair in April. “Centennial College attracts a remarkable cross-section of young, brilliant minds from across the GTA and internationally, as well. We have a deep pool of talented, motivated students who work on our WIMTACH projects,” says Mihai. “I cannot emphasize enough the team spirit and the efforts of our students to exceed client expectations, as well as my own. I could not be more proud of them!” iMindful is part of TSH’s e-therapy model based on stepped care, and a referral to the program is required. Patients referred to TSH’s psycho-oncology program are triaged by a mental health registered nurse into the most appropriate level of H support, based on their level of distress. ■ Lisa Cipriano, is a Communications Officer at The Scarborough Hospital.
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Nursing Pulse 25
Healthy habits start at school Public health nurses working in schools can have a major impact on Ontario students By Daniel Punch he came to Audrey Burns’ office with a secret. She was just 14-years-old, nearly eightmonths pregnant, and scared. Her baby’s father was nowhere to be found, and she had hidden her pregnancy from her parents and peers. Burns, the public health RN for her Niagara Region high school, was the first health professional she told about her baby. In tears, the girl asked Burns what she was supposed to do. “Let’s focus on right now,” Burns told her. “Let’s see if you and your baby are okay.” Burns connected the girl with another care provider to get the proper medical examinations. She then set up a meeting with the girl’s parents, and was by her side when she told them she was pregnant. She also supported the teen as she made the decision to put her baby up for adoption, and facilitated the process. The girl and her family were grateful for Burns’ guidance. Within a week of giving birth, she was back at school with her friends. Burns counts this among the most memorable experiences of her three-decade nursing career. Helping the teen is also a concrete example of the essential role public health nurses can play in schools, and why she took the job as school nurse for Niagara Region Public Health four years ago. Burns currently works with three high schools – about 1,500 students – where she is a visible presence and key part of the school communities. “The students like having access to a nurse (at school) because that’s where they spend most of their time,” she says. “You build up that trusting, caring relationship so they come back and see you – sometimes often.” Since the early 20th century, public health nurses have been working with Ontario public schools to help students make healthy choices, access health services, and develop into healthy adults. Managing communicable diseases has traditionally been a large part of their role, but they also provide a myriad of other services, including health teaching, health promotion, one-on-one counselling, sexual health services, and addressing the social determinants of health. Budget cuts in the 1990s led to a major reduction in public health nursing services in schools, and forced some of Ontario’s 36 health units to largely abandon their school-based programming. While there has been a significant resurgence of school nursing since then, limited resources have impeded the relationship between health units and schools. Today, an Ontario public health RN can work with as many as 35 schools, meaning they are responsible for between 400 and 14,000 students. That RN may only visit certain schools once or twice a month. The level of school services also varies widely from one health unit to another. As a result, many school staff, students and their families don’t understand the role of school-based nurses, and don’t fully utilize them. Cindy Baker-Barill is past-president of the Registered Nurses’ Association of Ontario’s (RNAO) Community Health Nurses’ Initiatives Group (CHNIG), which has spent years advocating for an increased role
The Community Health Nurses’ Initiatives Group (CHNIG) Schooll Health Committee released a policy paper in 2015 called Healthy Schools, Healthy Children. en. It outlines the interest group’s recommendations for better promotion of nursing services in schools, including its call that every Ontario primary and secondary school be assigned a public health nurse as a visible presence in the school community. ity. To read the document and all of its recommendations, visit RNAO.ca/ a/ HealthySchoolsHealthyChildren
for public health nurses in schools. A 29year veteran of public health, who worked in schools from 1986 to 2000, Baker-Barill has watched the role change. “Before, you were an integral part of the school. You had relationships with staff and students in schools, and were part of ongoing discussions about health. Now, health promotion is sometimes seen by schools as additional work,” she says. The diminished role for school-based nursing runs counter to evidence about childhood development, CHNIG says. Research shows the brain continues to develop dramatically from late childhood to young adulthood, making it a crucial time to learn healthy practices and coping skills. Nurses are also needed to tackle the ongoing problem of childhood obesity. School years also encompass critical transition periods that can lead to anxiety and depression. The Mental Health Commission of Canada reported that onein-four Canadian children have mental health challenges. When a student comes to see public health nurse Doris Barkley feeling anxious, angry or depressed, she’ll often pick up her snow globe – with characters from the Disney animated film Frozen – and shake it. She points to the chaos of fluttering ‘snow’ inside. “When you’re really mad or upset, and your brain feels like this,” she explains, “…you can’t make a good decision.” Working part-time at three elementary schools in Perth County, Barkley encounters a lot of anxiety and depression. She remembers one Grade 5 student who lived in her grandparents’ custody, but wanted desperately to be back with her mother – who she only saw on scheduled visits. On good days, she was bubbly and gave Barkley a hug. On bad days, her nails were dirty and uncut, and she clearly hadn’t bathed in quite some time. “She needed someone to talk to and she did not have that (at home),” Barkley says. Principals and teachers do their best to fill that role for young students, but they often lack time and health expertise. But a public health nurse is able to offer that confidential ear, and build a therapeutic relationship. “When I call (students) down to meet with me, they generally have a big smile on their face. They know someone’s going to listen,” Barkley says.
One-on-one sessions are one aspect off O Barkley’s role. She also does health teaching with larger groups, focusing on everything from planning for the future, to dealing with stereotypes, dating and relationships. But most school health issues can’t be addressed effectively with 500 students at a time. And when a public health nurse is assigned thousands of students, CHNIG says it compromises care. Thegroup’s recommendations for improving nurse-to-student ratios are outlined in its 2015 Healthy Schools, Healthy Children policy paper. To start, they would like to ensure a public health nurse is assigned to all Ontario primary and secondary schools. The number of schools currently served by a public health nurse is difficult to determine because each health unit has a different school health model. A 2012 survey of Ontario’s 36 health units found 31 had health teams working in schools, and 15 had staff providing one-on-one services
to students. CHNIG wants school-based nurses to act as a bridge between schools, nur families, the health system, and the broadfam er ccommunity. Burns is doing that back in Niagara. She B engaged a number of organizations from eng her community for a ‘day of awareness’ on impaired driving this past spring. Statisimp tics show that one-in-four Niagara Region students has already ridden in a car with stu driver who has consumed alcohol, and ad more than 10 per cent of students who are mo licensed drivers have operated a vehicle lice within an hour of consuming marijuana. wit Burns teamed up with Ontario StuB dents Against Impaired Driving, Mothers den Against Drunk Driving (MADD) Canada, Ag and a local community health centre to hold an event at two Welland high schools. hol Each participating organization provided Eac educational materials, and the schools’ edu student councils helped set up a number stu of activities designed to raise awareness about impaired driving. The centrepiece of the day was a car, heavily damaged in a drunk driving accident, which they set up near the entrance of the schools. Students were shocked to see both ends smashed in, and a pair of men’s ice skates still hanging from the mangled trunk. “I think the visual component really struck home,” Burns recalls, adding the event is a great example of community collaboration, but it also shows the potential for public health nurses to reach students during a pivotal point in their lives. “There are all these transformations happening at this time in their lives,” Burns says. “Now’s the time to reach out to them... and embed health habits, because H they’re still learning.” ■ Daniel Punch is a staff writer for RNAO. This article was originally published in the July/August 2016 issue of Registered Nurse Journal.
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Educational & Industry Events To list your event, send information to “firstname.lastname@example.org”. 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 “email@example.com” 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 20, 2016 Health Quality Transformation Presents: Quality Matters 2016 Metro Toronto Convention Centre, Toronto Website: www.hqontario.ca Q October 24-25, 2016 CHIMA National Conference 2016 Chateau Lacombe Hotel, Edmonton AB Website: www.chima-conference.com Q October 24-26, 2016 6th Conference on Recent Advances in the Prevention and Treatment of Childhood and Adolescent Obesity, Ottawa, Ontario Website: www.interprofessional.ubc.ca Q October 27, 2016 Innovations Transforming Healthcare Environments Walter C. Mackenzie Health Sciences Centre, Edmonton AB Website: www.cchf.net 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 November 29, 2016 Leading Edge Environments Oakville Trafalgar Memorial Hospital, Oakville Website: www.cchf.net Q November 29, 2016 RSNA 2016 McCormick Place, Chicago, United States Website: www.rsna.org Q December 8–9, 2016 Data Analytics for Healthcare Toronto, Ontario Website: www.strategyinstitute.com To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS OCTOBER 2016
Meditek’s scrubEx editek is on a mission to create more desirable working environments for its clients by creating value and reducing cost, through innovative products such as scrubEx. In nearly every hospital, reducing the linen budget has become an increasing concern due to high usage and costs associated with linen loss. Despite many efforts to curve this multi-million dollar problem, the rise in scrub and linen loss continues to grow since linen and scrubs are distributed on “open linen carts” creating a “free for all” environment. At Meditek, there is a focus on bringing a solution to this problem through partnering with IPA – the worldwide leader in healthcare linen and surgical scrubs automation and the makers of scrubEx and alEx. Since 1995, IPA has committed to reduce the cost of healthcare by automating linen distribution through innovative technology and dedicated people. The first scrubEx unit was installed at Vanderbilt University Medical Center. They saw an immediate drop in usage and replacement costs and a boost in staff satisfaction as the automated dispensing system granted access to only authorized users only. “We understood the frustration behind the lack of scrub availability and the desire for hospitals to recoup costs associated with scrub usage and loss,” says Executive Vice President of Sales and Marketing, Dan Weyen. “scrubEx eliminates the unauthorized user from taking scrubs so surgeons and staff have what they need when they need it.” While many administrators consider surgical scrubs as their number one linen complaint, IPA has proven that clinician satisfaction will improve and loss minimized dramatically by simply controlling access. IPA boasts that scrubEx customers see a decrease in scrub usage by 40 per cent and a 90 per cent reduction in scrub replacement costs. “scrubEx is the most successful project we have ever installed” Kevin Peters, Director of Food and Logistics Services at The Ottawa Hospital. IPA continues to live up to its mission by continuously seeking new opportunities to improve customer experiences while reducing costs. In 2014, IPA released vendEx, a vendor software program
dedicated to helping vendors comply with hospital surgical attire policy. The program is simple. Each vendor registers via the vendEx website and purchases scrub credits. The vendor will use these credits to dispense their scrubs from scrubEx and then return them at the end of the day ensuring the vendor is following infection prevention guidelines. “In 2008, we introduced the industry to the first and only automated linen dispensing technology to control linen,” says IPA President Joe Gomes. “We had many scrubEx customers ask if we could help them with their linen loss and usage so we developed alEx. Like scrubEx, alEx is only accessible to the authorized user and communicates with our web based software providing visibility for the hospital linen staff to manage their business.” With alEx, (IPA) customers have seen a 20 per cent decrease in linen cost while improving nurse satisfaction. The latest addition to the IPA product line is the high-capacity scrub-dispensing machine - scrubXchange. Released in 2015, scrubXchange allows laundries to offer a full-service scrub rental program to their healthcare customers. “We have been partners with IPA and offering their scrubEx and alEx technology to our customers for a long time,” says David Potack, Vice President at Unitex. “We’re seeing a lot of interest from our hospital customers in the new program and are excited about the benefits scrubXchange offers.” By building a comprehensive scrub management program for hospitals, laundries are able to increase end user satisfaction, decrease costs, and build better customer relationships. Since 1995, more than 700,000 healthcare professionals use this technology with over 6,000 units installed in facilities in the US, Canada, Germany, Ireland, Korea, Saudi Arabia, and the UK making IPA the worldwide leader in healthcare linen and surgical scrubs automation. Meditek, centrally located in Winnipeg, Manitoba, provides the Canadian healthcare industry with medical equipment and services through its network of direct sales representatives. More information about Meditek can be found at H http://www.meditek.ca ■ This product feature was provided by Meditek. www.hospitalnews.com
Trends in Transformation 27
Thinking differently, leading differently By Michael Ronchka ew managers at UHN are stepping into the role with the skillset of seasoned leaders, in addition to their extensive clinical experience. They are former Lean Leads who were seconded from their clinical roles to learn to manage differently. They work alongside UHNâ€™s Lean team, a group of coaches hired from private industry for their experience implementing Toyotaâ€™s world renowned management system. Lean Leads are high performing individuals who typically spend one to two years helping frontline staff and leaders on a unit create positive change using Lean tools and change management concepts. To prepare them for the role they start with applied training in advanced problem solving, a yellow belt in Lean and ongoing coaching. â€œThis is common practice in industry,â€? says Brenda Kenefick, Director, Lean Process Improvement, UHN. â€œWe are building capacity within the organization and the best way for people to learn the Lean tools and concepts theyâ€™ll need as managers is to use them to solve problems.â€? The result of all that preparation is a new breed of managers who enter the role with the skillset and outlook they need to change the organizational culture. â€œI think of myself as a leader first in a managerâ€™s role,â€? says Sylvie Robinson, Program Manager, Toronto Rehab and former Lean Lead. â€œAs a leader I help my staff work better as a team. In my managerial role I have four main responsibilities: Setting priorities, developing processes to meet goals, continuously improving processes, and developing people by establishing a culture where they feel safe raising problems and attempting to solve them.â€? â€œI use the facilitation skills I developed as a Lead daily,â€? says Sylvie. â€œDuring discussions with the interprofessional team Iâ€™ll ask â€˜whyâ€™ many times to better understand the process, and when we canâ€™t agree on a solution I ask them to pause, step back and think differently.â€? Sylvie demonstrated the value of that approach not long after stepping into her new role. The physiotherapy team on the unit believed the rehab gymnasium wasnâ€™t large enough for them to safely treat patients. Costly renovations were being considered to solve the problem. Instead, Sylvie challenged the team to rethink how they were using the space. â€œAs a physiotherapist I had personal experience with the teamâ€™s problems,â€? says Sylvie. â€œIt gave me some insight and cred-
Sylvie Robinson, Program Manager, Toronto Rehab, leads an interprofessional team during a safety huddle. ibility that a consultant wouldnâ€™t have. I helped them define the problems they felt were due to insufficient space.â€? With a clear understanding of what needed to change in the gym, the team spent several days reorganizing and removing unnecessary equipment. They were so satisfied with the result that the $50,000 renovation was avoided. â€œWe are so happy with the support we got for this project and proud of what the team accomplished,â€? says Heather Preston, physiotherapist, musculoskeletal rehabilitation, Toronto Rehab. Leads also gain exposure to much more of the broader organization than they would in a clinical role. Fellow former Lean Lead and current manager at Toronto General Hospital, Marleine Elkhouri, says her exposure to the patient flow perspective taught her the importance of understanding processes at all stages in the patient journey. â€œWe need to talk to other departments to understand how our and their processes affect patient care so we can resolve issues as they arise,â€? says Marleine. â€œThat conversation canâ€™t be high level, weâ€™ll get together with another department and walk through a process step by step. Using that approach, solutions to complex problems often become obvious.â€? The former Lean Lead sees herself as a coach. She fosters an atmosphere where staff feel comfortable making problems transparent, then coaches them through
the circle of continuous improvement to ensure they are addressing the root cause of a problem.
â€œWhen a staff member raises a problem we start by tracking how often it happens and what causes it,â€? says Marleine. â€œI challenge them to collect data before and after we implement a solution to see if it worked. You need facts to show a gain. If the problem doesnâ€™t come back we know it was solved, and if it does we can try again. It takes longer, but itâ€™s very satisfying knowing we got it right.â€? Lean thinkers embrace the concepts of transparency and continuous improvement. The Lean Lead role has demonstrated that when leaders combine their experience with the Lean skills of facilitating, coaching and problem solving, they provide a solid foundation for organizations to deliver the safest, highest quality care possible. In short, transformation happens. If youâ€™d like to learn more contact the UHN Lean Team at firstname.lastname@example.org Trends in Transformation profiles people in action, improving healthcare at the H front lines. â– Michael Ronchka is a Communications Associate â€“ Lean Process Improvement at University Health Network.
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From the Ceoâ€™s desk Our Ministers, provincial and federal, need to hear that we are supporting the 6.7 million Canadians with mental health concerns who are indignant about waiting a year for a specialist appointment; the nearly 700,000 Ontarians with depression who are denied an evidencebased intervention like CBT that is not covered by the same system that pays for a knee replacement; the thousands of people with schizophrenia who are denied safe and supportive housing; the moms and dads who have lost children to suicide because they couldnâ€™t find services to address the suffering of their kids. www.hospitalnews.com
Picture where we could be if there had been a commitment to improving access to mental health care in the last health accord? As our Ministers of Health meet to create a new agreement, they need to hear from all of us that a failure of this relationship to include practical action for mental health care will speak volumes. Plenty of time has been spent on H strategy â€“ itâ€™s now time for action. â– Catherine Zahn, MD, FRCP(C) is President and CEO of The Centre for Addiction and Mental Health (CAMH).
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OCTOBER 2016 HOSPITAL NEWS
PATIENT SAFETY/ MENTAL HEALTH AND ADDICTION/RESEARCH
The Truth Hurts As nurses, we take part in some of the most signiﬁcant events that happen in the span of a lifetime. We see a lot we seldom talk about - moments that stay with us long after a shift has ended. But when the well-being of our patients is threatened, it’s our duty to speak out. Ontario’s healthcare system is falling short. Years of inadequate funding and cuts have left us with fewer RNs per person than any other province. Every time a Registered Nurse is cut, patients lose a skilled professional and a caring advocate. Since 2015, over 1,500 RN positions have been eliminated in Ontario. Our patients deserve the best possible care. As nurses we make a pledge to ensure just that.
HOSPITAL NEWS OCTOBER 2016
Focus: Patient Safety, Mental Health & Addiction, Research and Health Achieve Supplement.