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MEDEC Special Supplement – Showcasing The Value Of Medical Technology. FOCUS IN THIS ISSUE


Canada's Health Care Newspaper

Digital health advancements and new technology in healthcare. Programs and initiatives focused on enhancing the patient experience. SPECIAL SECTION: INFECTION CONTROL PG16

NOV. 2014 | VOLUME 27 ISSUE 11 |

INSIDE Ethics ..................................................11 From the CEO's desk..........................22 Evidence Matters ...............................28 Nursing Pulse .....................................42 Careers ............................................... 47

Gamechangers Be their advocate

Hospitals weigh in on implementing ‘flu shot or mask’ policies

Top 10 new and emerging health technologies

Story on page 30

for access to the right care

Join our diverse team of skilled Care Coordinators Be the health expert clients can rely on to lead the way through our complex health care system, identifying their unique needs, helping them understand their options, planning their care, and linking them to the right care – at home and in the community. RNs, MSWs, OTs, PTs, RDs and SLPs are invited to apply. For details, locations and staff videos, and to apply for a Care Coordinator, Nursing or other role, visit Most Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

We are committed to accommodating people with disabilities as part of our hiring process. If you have any special requirements during the recruitment process, please advise Human Resources.

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Urban telemedicine pilot improves care at withdrawal management sites across Toronto By Diana Hooper ince the late 1990s, the Ontario Telemedicine Network (OTN) has offered two-way videoconferencing to increase access to patient care and education for health care professionals and patients. However, until the implementation of the TC LHIN-funded urban telemedicine Withdrawal Management pilot project led by Toronto East General Hospital (TEGH) in partnership with UHN and St. Joseph’s Health Centre, this technology had not been used in Toronto’s withdrawal management sector. This two year pilot project is “a completely new program and use of technology in a sector that crosses many hospitals,” says Pat Larson, the program’s Nurse Practitioner. The program provides access to primary care (provided by a nurse practitioner) for five non-medical withdrawal management sites associated with three Toronto hospitals – St. Joseph’s withdrawal management service; UHN’s Ossington and Women’s Own sites; and Toronto East General Hospital’s Aboriginal program and Withdrawal Management site. After many years of experience and interest working with marginalized populations and tackling access issues, Pat knew immediately upon hearing about the TEGH-led project that she wanted to be involved in such an exciting opportunity with the potential to benefit clients and shift access at a sector level. TEGH’s Withdrawal Management service, like the other TC LHIN sites involved, has traditionally been staffed by providers with expertise in addictions and social services but no medical training. The increasing medical, withdrawalrelated and mental health complexity of clients being cared for in community settings, combined with growing Emergency


Photo credit Kevin Holm

Pat Larson, Nurse Practitioner, performing a telemedicine consult. Department (ED) usage for people with substance abuse issues, demonstrated that a new care model was needed. “Not only are the people we care for more medically

Early client satisfaction scores are high with 98.5 per cent reporting good to excellent quality of care, 93 per cent reporting timely access to the nurse practitioner and 98.5 per cent reporting increased self-management.

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complex now, but substance abuse is more complicated. There’s an explosion in substance options so more clients presenting in withdrawal management centres are in crisis,” explains Pat. With little new money available but a clear need, the idea of telemedicine was put forward as an option with the TC LHIN funding the nursing resources and facilitating equipment through the OTN program. The goal was to improve access to primary care for both clients and staff. Telemedicine has traditionally been funded to facilitate access within a specific specialty area, but in the case of withdrawal management, the funding is also being used to build capacity within the sector across the TC LHIN and to shift how the sector’s clients use ED services. The pilot funds one nurse practitioner who provides primary care to patients and consults to staff at all five sites, both in-person and through OTN. About 73 per cent of the clients seen by Pat have a feature of complexity such as medical co-morbidities, a complex withdrawal, are unattached from primary care and/or are currently homeless. Pat consults directly with patients to address medical issues, assist with system navigation and manage withdrawal. She also helps clients with mental health issues obtain support and does a lot of care coordination related to medication reconciliation. Under the direction of the Withdrawal Management Services (WMS) Steering Committee, Pat was also tasked with program development. “This is a complex project to develop and coordinate as it involves five sites, required the development of agreements, operational systems and protocols, as well as setting up OTN equipment and training staff at each site,” Pat says. An important component of the pilot has been capacity building to help nonmedical staff understand and correctly manage risks which might result when individuals with complex medical, withdraw-

al and mental health issues are in WMS care. “There were no known detailed algorithms to help non-medical staff identify and manage complex risk issues, including polysubstance use and pre-existing medical problems,” says Pat. She is working with WMS supervisors and addictions experts to develop risk assessment and management practice guidelines for staff across all sites. It is expected that this will shift how withdrawal management clients use emergency services, both by decreasing non-emergency ED usage and ensuring that those who need urgent medical intervention will be sent promptly to the ED. The technology has also facilitated other safety enhancements like weekly Virtual Rounds which are held with supervisors and staff at all sites, and OTN consults which are used to enhance access to addictions specialists and to obtain advice to help manage the care of complex clients. The pilot’s success can be attributed to many factors including that the sector had been voluntarily planning together for nearly a decade with fully functioning steering and operations committees and that TEGH stepped forward to collaboratively lead the model development, work plan and evaluation strategy for the initiative. Within this work, one of the challenges has been to design an electronic medical record (EMR) that is contiguous and accessible to the nurse practitioner from any site, as many clients use more than one program. The EMR has been implemented with TEGH as the health records custodian. Additional safety enhancements have also been realized. For example, Pat identified that the transfer of information from the ED was a concern and that to improve care and safety, “staff needed good information from the ED in a way that would be easily understood by non-medical staff.” Using OTN technology she consulted with other hospitals to look at current best practice and developed a new ED transfer form that is now being piloted. The WMS pilot will be externally evaluated to determine its success. Data is being collected to evaluate outcomes, e.g. numbers served, client complexity and types of referrals. Early client satisfaction scores are high with 98.5 per cent reporting good to excellent quality of care, 93 per cent reporting timely access to the nurse practitioner and 98.5 per cent reporting increased self-management. Pat has no doubt of the program’s success. “I believe I diverted about nine per cent of the clients I saw in the first quarter of the year from the ED,” she says. She also notes the positive response of both staff and patients who appreciate the support and availability of medical expertise. It is clear that the model can provide an opportunity to shift practice within the withdrawal management sector and has the potential to be an important component of a system that will ensure people receive the best possible treatment in the H right location. n Diana Hooper is a member of the Communications Team at Toronto East General Hospital.


Canadians missing a beat over their own health

Canadians are not any healthier than they were a decade ago, despite having much more knowledge of what makes up a healthy lifestyle, according to the first publication of a Conference Board of Canada research project that makes the case for healthy active living. "An alarming number of Canadians are moving very little, sitting too long, eating poorly, not getting enough sleep, drinking too much, and continuing to smoke," says Thy Dinh, Senior Research Associate. " Even though average life expectancy has increased, the progress made in previous decades – such as lowering smoking rates – appears to have plateaued. There is an urgent need to support Canadians in adopting healthier lifestyles and create a national culture of wellness." HIGHLIGHTS •The prevalence of several chronic conditions has risen since 2003. •Stagnant or declining levels of Canadians who lead healthy active lives are associated with increases in chronic conditions. •Almost one-third of children are overweight or obese, which increases the risk of developing conditions such as cardiovascular disease, cancer, hypertension, diabetes or depression. Even after adjusting for the aging of the population, the prevalence of several negative health conditions has risen since 2003, according to Statistics Canada. Increases include: •diabetes – 24 per cent •pain or discomfort that prevents activities – 34 per cent •self-reported mental health issues –35 per cent •obesity – 23 per cent; and •high blood pressure – eight per cent. Concerns that children are not moving enough are also mounting. Almost oneH third of children are overweight or obese. n

Canadian task force against screening for

prostate cancer The Canadian Task Force on Preventive Health Care (CTFPHC) released an updated guideline on screening for prostate cancer using the prostate specific antigen (PSA) test. Based on the balance between the possible benefits and potential harms of early diagnosis and treatment of prostate cancer, the CTFPHC recommends not screening for prostate cancer with the PSA test. Guidelines are published in the Canadian Medical Association Journal (CMAJ). "Unfortunately the PSA test is simply not an effective screening tool," says Dr. Neil Bell, member of the Task Force and chair of the guideline working group. "Almost 20 per cent of men aged 55 to 69 have at least one false-positive, approximately 17 per cent of them will have unnecessary biopsies and over half of the detected cancers are overdiagnosed, which is the detection of

New research led by the Motherisk Program at The Hospital for Sick Children (SickKids) shows for the first time that probiotics can significantly reduce colic in North American infants. The study assessed the effectiveness of Lactobacillius reuteri DSM 17938 in treating infantile colic in exclusively breastfed Canadian babies. The paper was published in The Journal of Pediatrics. An estimated five to 40 per cent of infants experience colic, typically beginning around six weeks of age, and ending at about three or four months. Babies with colic usually fuss at least three hours a day, more than three days in a week over at least three weeks, with no obvious trigger. Some research has pointed to a potential role of the intestinal microbiota, microorganisms that include “good bacteria”, which differ greatly between infants with colic and those without. Some babies with colic have also been shown to have inadequate levels of a type of good bacteria (probiotic) called lactobacilli in early infancy. At the outset of the study, the general characteristics between the probiotic

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cancers that would not have caused symptoms or death during the lifetime of the patient. False positives and overdiagnosis often lead to unnecessary treatments which can lead to impotence, incontinence, infections and other harms. Considering PSA screening results in only a 0.1 per cent reduction in death from prostate cancer, the harms associated with screening outweigh the benefits for most people." Guideline development is based on a systematic review of available literature, a broad consultation process and scientific evidence synthesis. The development of the PSA screening recommendation was led by CTFPHC members, supported by a scientific staff, the Evidence Review and Synthesis Centre (ERSC) at McMaster University and various other external stakeholders. Recommendations of the guideline include:

•For men younger than 55 years of age and 70 years of age and older, CTFPHC strongly recommends against screening for prostate cancer with the PSA test. There is no evidence that screening with PSA tests reduces mortality, whereas there is evidence of harms. •For men aged 55-69 years of age the CTFPHC does not recommend screening for prostate cancer with the PSA test. There is inconsistent evidence of small potential benefit of screening, and evidence of harms. This recommendation places a relatively low value on a small potential absolute decrease in prostate cancer mortality, and reflects concerns with false positives results, unnecessary biopsies, overdiagnosis of prostate cancer, and the harms associated with unnecessary H treatments. n

Probiotics may significantly reduce colic

MaRS HealthKick 2015 MaRS HealthKick 2015, Canada's largest health venture showcase, is expanding its business pitch competition beyond Ontario to include health startups from across the country. Building on the success of last year, HealthKick 2015 will give up to 45 health ventures the chance to pitch cutting-edge health technologies and products to a 300-person audience of leading Canadian and U.S. venture capitalists, investors, entrepreneurs, c-suite leaders and industry partners. Canadian health ventures interested in participating in the pitch competition should visit healthkick. The application period is now open, with entries due by November 24, 2014. HealthKick 2015 takes place on Thursday, May 7, 2015 at MaRS Discovery District in downtown Toronto.


Now in its second year, HealthKick offers participants exposure, networking, investment and partnering opportunities as well as the potential to win one of three $20,000 cash prizes. This funding recognizes startups with the greatest impact potential, while also providing financial support to ventures bringing their innovations to market. In addition to attending HealthKick, all selected ventures are paired with mentors and undergo a coaching program to hone their pitch presentations in the weeks leading up to the showcase. Winners from the inaugural event in 2014 include: PlantForm Corporation (Biotechnology & Pharmaceuticals); Profound Medical (Medical Devices & Diagnostics); and Newtopia H (Healthcare IT). n

group and the placebo group were similar. The median crying and fussing time for both groups was also comparable: 131 minutes per day for the probiotic group and 122 minutes per day for the placebo group. At the end of the treatment period, the probiotic group exhibited a significantly shorter duration of crying and fussing (60 minutes per day), versus the placebo group

(102 minutes per day). More than half of the probiotic group had experienced a reduction in colic symptoms by the end of the study period, with some babies showing a statistically significant improvement as early as seven days after beginning treatment. The probiotic was well tolerated, and no side-effects were reported in either H group. n

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Guest Editorial


Issues, trends and treatment of diseases specific to men and women including perinatal care and prostate health. Examining and improving quality of services through accreditation. An examination of safe and effective use of medications in hospitals and clinical pharmacology.

JANUARY 2015 ISSUE EDITORIAL DEC. 5 ADVERTISING: DISPLAY DEC. 12 CAREER DEC. 16 MONTHLY FOCUS: Professional Development/ Continuing Medical Education (CME)/Human Resources Continuing Medical Education (CME) for health care professionals. Human resource programs implemented to manage stress in the workplace and attract and retain health care staff. Health and safety issues for health care professionals. Quality work environment initiatives and outcomes. + PROFESSIONAL DEVELOPMENT SUPPLEMENT


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Let’s start seeing people with dementia for who they are. Test your attitude towards dementia at letstalkaboutdementia

One patient's experience Dear health care worker, I recently experienced a parent’s worst nightmare. One evening my nine-week old baby developed an extremely high fever. We rushed to our local community hospital and were admitted through the emergency department to the pediatric unit. We were discharged three days later thanks to the skilled doctors and nurses who cared for our precious little one. While our infant’s care and health outcomes were fantastic, our experience was less than satisfactory. I noticed some key trends that seemed to repeat themselves that shaped my experience as a patient. During my hospital stay many staff took the opportunity to bad-mouth their colleagues to me when we were alone. I am not sure if this occurred because I looked rather trust-worthy or they wanted to let me know they were more competent than their colleagues. Whatever the reason, if there was a positive purpose, it was definitely lost on me in the moment. The emergency nurses; complained about the doctor’s orders and the delay in response of the pediatric nurses. The pediatric nurses complained about the emergency room nurses inability to get an intravenous line. The pediatrician complained about orders made by the emergency doctor. Once admitted, our pediatric nurse complained about the pediatricians approach to the care of my baby. Then the pediatrician complained about the pediatric nurse’s lack of ability to obtain a urine sample. This pattern continued for the duration of our stay. At every opportunity the parent in me wanted to scream at the top of my lungs “Can everyone stop complaining about each other and look after my sick baby?” From my vantage point it seemed that everyone was so focused on their own needs and skills that they appeared completely oblivious that there was a sick baby that needed their help. At no point was it beneficial for me to know that the emergency and pediatric physicians had different opinions on what lab tests should be done on my baby. Nor

was it beneficial for nurses from each ward to openly criticize the others in my presence. In fact it was downright disappointing. This did nothing other than state to me that egos were taking priority over my daughter’s care. I cannot tell you how many times nurses told me, “I am so busy today.” I am not sure if they were telling me to excuse the fact that my daughter’s medications or vitals were not on time or maybe they were simply looking for support. Every time I heard this statement my head played my own version that sounded more like “your daughter is not a priority.” Everyone is busy. Be thankful you are busy; this means you are in-demand and in today’s tough economy, not at risk of losing your job. Do not use patients or their families as your personal confidante. I was in that hospital room to care for my infant and see her condition improve, not to hear that staff were not equipped to see this goal through. Patients and their families need to know they are your priority and your job is to care for them in an effort to restore health. Please take time to tell them this, share in positive news with them as if you are happy too, because I know you are. Use the chart, read it, write in it and refer to it. After all, this is where everything that happens should be documented. At every interaction with a physician and their students I was asked the same questions “was she premature” and “was your delivery normal.” I answered these questions the same each time, surely someone wrote this down in our chart. Answering the same questions over and over again made me feel like they were questioning my response. I started to wonder if they thought I was lying. The majority of health care workers that approached my daughter referred to her as male. I would politely correct them with her or she. My daughter spent her time in hospital wearing only a diaper. Despite no obvious gender indicator, surely somewhere in my paperwork it indicated that she was female. I began

questioning if there was a mistake on her chart due to the frequency at which staff referred to her as male. As sleep deprivation and stress took their toll I wondered what other mistakes may lurk on my baby’s paperwork. While this small slip of the tongue seems minor, it became a major cause for concern as more and more staff made the same error. Please be careful of what you say to patients and how you say it. When you are caught on such a slip up, be genuine in your apology and make a sincere effort to refrain from repeating the same mistake next time. Patients and their families need to know that you are listening and that you care about what it is they are saying. The gender error is one that left me with a sense of sloppiness and lack of focus on behalf of all who made this innocent mistake. I am a health care worker just like you (though I never let those who cared for us know this). People trust us to take care of their most precious loved ones in their most vulnerable states. This is our job and we do it with pride, but how we treat each other (especially in front of the patients) is dreadful. Patients know that healthcare is not a glamorous career choice. They know that most of us do it because we want to help sick people get well. Do your best to confirm this belief when people are in your care. Try to ask yourself, if I were a patient what I would like to hear. You are a knowledgeable person who has a lot more to talk about than the incompetency of colleagues. I am not innocent of uttering some of these statements above. However, I can assure you that I will be more conscious of what I say to patients and their families after my daughter’s hospital stay. Fellow health care workers, choose to interact with your patients in a way that instills confidence in yourself and your fellow team members. You alone have the power to positively shape the patient’s experience. Yours truly, An appreciative mother


Helen Reilly,

Bobbi Greenberg,

Barb Mildon,

Jane Adams,

Sarah Quadri Magnotta,

Senior Communications Officer The Scarborough Hospital, Scarborough, ON RN, PHD, CHE , CCHN(C) VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences Whitby, ON

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










Manager, Media and Public Relations. Mississauga Halton Community Care Access Centre Senior Writer/Communications Specialist Humber River Hospital

Dr. Cory Ross,

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

Akilah Dressekie,

Senior Communications Specialist Rouge Valley Health System





President Brainstorm Communications & Creations Toronto, ON


Publicist Health-Care Communications Toronto, ON


Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: Canadian Publications mail sales product agreement number 40065412.




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Seniors design and test new technology to By Jennifer Gillard

improve transitions of care H

Seniors in Northumberland are now using smartphones like this one to store their personal health information story, monitor/track their chronic conditions and communicate with their caregivers and healthcare providers

INTEGRATING TECHNOLOGY IN HOSPITAL PHARMACY OPERATIONS Protecting the patient’s health is the number one concern of hospitals and their pharmacies across the country. Technology, when used effectively, can reduce medication errors and improve operational efficiency in the health care system, while curtailing financial losses due to inventory, dosage and dispensing issues. In fact, the increase in the use of technology to improve safety of medication use is among the Canadian Hospital Pharmacy 2015 Goals and Objectives. Simply fixing parts of the pharmacy supply chain is not the solution. It requires a concerted effort throughout the entire process: •

• •

Decision support There is the need for collaboration and connectivity in the continuum of care to ensure best outcomes for patients and optimal use of time and human resources.

Accountability Recording and tracking of medications throughout the supply chain to ensure proper dispensing, administering, and availability of medications and to identify and eliminate diversion.

Safety By automating supply, storage, inventory and dispensing of medication, human errors and drug shortages are minimized, thereby improving patient outcomes and safety. Inefficiencies Financial losses, time spent by pharmacists and nurses checking, dispensing, ordering give rise to inefficient operations and management of time and resources.

McKesson Canada offers a suite of automation solutions that dramatically improves workflow, reduces costs and intrinsically reinforces medication safety at each step of the medication use and supply processes. Through the use of robotics, bar-code scanning automation and powerful analytic tools, McKesson Automation’s array of pharmacy solutions enhance medication ordering, dispensing, administration, charge capture and inventory management processes. The integration of technology at all stages of the hospital pharmacy supply chain, enables decision support and communication between nursing units and the hospital pharmacy, and ensures accountability. To learn more about McKesson Canada’s Hospital Automation Solutions, meet with us at HealthAchieve, booth # 1606.

Copyright © 2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.


ave you ever been asked to fill out a questionnaire about your health history only to realize… you can’t remember all the facts? It’s happened to most of us. Over the course of six, seven or even more decades, the simple facts of our own health story – the chronic conditions, surgeries, treatments and so on, can blur. As each year goes by, it gets more difficult to present an accurate summary to a new health provider. Think of the time wasted across the health care system as we repeat ourselves over and over again, or the errors that occur when we don’t get it right. Think of the added complication of trying to summarize multiple complex, chronic health conditions when you’re in crisis, in an Emergency Department, or in a physician’s office trying to communicate on behalf of a loved one, who can no longer recall the specifics of their personal health history. Thanks to funding from The Change Foundation, a group of seniors, their caregivers and a team of health care providers and social care agencies have come together in Northumberland County, one hour east of Toronto, as equal partners in Northumberland PATH (Partners Advancing Transitions in Healthcare). Through PATH, seniors, their caregivers and the agencies that support them are getting a unique opportunity to co-design and test mobile technology and an interconnected web-based portal to store and share health information. The goal: to improve transitions of care for seniors and their caregivers as they move in, out of and across the health care system. In the coming months, up to 300 Northumberland seniors will be on-board and piloting the new system developed by seniors, for seniors. More than 100 individuals involved with the PATH project came together September 29th, 2014, at the Cobourg Community Centre (CCC) for live demonstrations of the new technology tools and feedback from some of the seniors involved. The enthusiasm in the room was contagious. Seniors and caregivers talked about their role designing and testing the smartphone technology, health care providers discussed how they were incorporating the new information into their day-to-day practice, and Volunteer Transition Coaches – recruited to support seniors with the technology and with navigating through the health care system – shared their enthusiasm for the opportunity to empower seniors in such a unique and personal way. Among the displays was the new healthcare provider portal – an information highway linking participating seniors and their

healthcare providers, which went live last month – and the new smartphone application, co-designed with support from PATH partner QOC Health. "We are now at a point in the PATH project where we're seeing the results of the teams' hard work," explains Wendy Kolodziejczak, PATH Project Manager. "Local seniors involved in the pilot are now able to do what they asked us to do: store their personal health story, share their self-identified needs, monitor chronic conditions, and communicate directly with their health care provider. This is a true 'first' for Ontario, and it is really an honour to have it happening right here in Northumberland."

The PATH team has been invited to speak at more than 55 different organizations, conferences and events around Canada, to share what they’re doing in Northumberland with local seniors and caregivers. Health care providers involved in the project are able to see the relevant health information for participating seniors and use it to improve transitions of care. Said one caregiver whose husband has been directly involved: "PATH has made a big difference in our lives. It is really helpful to have all your information at your fingertips. I didn't even use a computer until a year ago, and now I can." "This project is generating a lot of interest,” confirms Wendy Kolodziejczak. “Technology is being tested in many areas of the health care sector, but most of what is happening is within an organization or a program unit. PATH is unique in that it is a community-wide effort co-designed by seniors, their caregivers and a range of agencies, and we're focusing on those difficult transition points where we know we can do better. Though it is still early days, our unique combination of smartphone technology with a secure, private online portal and Volunteer Transition Coaches to help when there are questions is already H improving care for local patients." n Jennifer Gillard is Chair of the Northumberland PATH Communications Sub Committee and Director of Communications and Community Engagement at NHH.




We’re proud

to sponsor OHA HealthAchieve 2014

Transforming health care through technology solutions • Patient flow and resource planning • Connectivity to enable care coordination and patient centered care • Integrated supply chain • Hospital pharmacy automation

Meet us Booth 1606 for demonstrations of our solutions Monday, November 3 Tuesday, November 4 9:00 a.m. to 5:00 p.m. Feature Session Tuesday, November 4 10:00 a.m. to 11:30 a.m. Room 105, 106, 107 Together for better health

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Health Links Session Tuesday, November 4 3:30 p.m. to 5:00 p.m. Room 104 ABC





First hospital in Canada with completely

paperless medical record system By Shernette Muccuth Henry dvancing care for people with a mental illness is paramount for Ontario Shores Centre for Mental Health Sciences (Ontario Shores). Having just received the prestigious HIMSS EMRAM Stage 7 award for its completely electronic medical record system, Ontario Shores uses this system to support key decision making for increased quality of care and patient safety. Ontario Shores is the first hospital in Canada and the first mental health hospital in the world to receive this recognition. Awarded to health care organizations, this designation is given for having an electronic health information system which advances the use of patient data to ultimately improve process and performance. Having a completely paperless system reduces errors of omission and ensures the care being offered is supported by evidence based standards. “Our electronic medical record system improves the delivery and quality of care that we provide and standardizes clinical documentation in an environment which is efficient, secure and collaborative,� says Karim Mamdani, President and CEO at Ontario Shores. The Stage 7 designation means that patient information documented allows for best outcomes at all times. At Ontario


Ontario Shores physicians Dr. Ilan Fischler and Dr. Tam showcase the various features of the EMR to evaluator Pate Wise, VP, HIMSS Shores, an electronic assessment is com- automatically populate with next steps potential metabolic side effects. One of the pleted when a person is admitted at the which may include the recommendation of challenges in mental health is that antipsyhospital. Within the assessment, there are appropriate nicotine replacement therapy. chotic medication may result in increased certain mandatory fields which must be Similarly, if a physician identifies that weight gain, obesity and an increased risk completed and will then guide treatment. a person will be receiving antipsychotic for diabetes. It is important that these For example, if the person being assessed medication in their documentation, the medications when prescribed are accomhas a history of smoking, when the docu- system will automatically populate with panied by the appropriate monitoring. mentation is completed, the system will a recommendation to closely monitor for Continued on page 10

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10 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/INFECTION CONTROL Patient Experience at Osler encompasses every touch-point a patient or visitor has with the hospital, and as a result, both clinical and non-clinical staff play an important role in helping Osler achieve high patient satisfaction.

Gordon Newman, Osler Patient Experience Advisor.

A comprehensive approach to enhance patient experience By Donna Harris


hen Gordon Newman was invited to join William Osler Health System’s (Osler) Patient Experience Advisory Committee, he eagerly accepted. As a former patient, Gordon knew his experiences could be used to help inform and enhance the care other patients receive at the hospital. In his role on the Committee, Gordon is one of 20 Patient Experience Advisors who provide advice and guidance on a range of topics and issues, including everything from the hospital’s welcome pamphlets and visitors’ policy, to parking and wayfinding. “I enjoy having the opportunity to be heard and to positively affect the experiences others have at the hospital,” says Newman. “Being on this committee is a great way for me to give back to the hospital that has given so much to me and my family.” Osler is one the largest community hospitals in Canada, serving a growing and ethnically diverse population of more than 1.3 million people. Patient Experience is a pillar of Osler’s service delivery, and is used as a metric to help the hospital consistently meet the varied needs of the community it serves to ensure every patient who comes through its doors has equitable access to quality healthcare. To

help achieve this, Osler focuses on creating an inclusive environment that is respectful of various cultural, religious and spiritual practices and communication needs. “The Patient Experience Advisors are integral to helping us capture the voice of the patient by ensuring their perspectives are included wherever and whenever possible,” says Susan deRyk, Joint VP, Patient Experience, Communications and Strategy, Central West Community Care Access Centre, Headwaters Health Care Centre and William Osler Health System. “Our focus is to go beyond the excellent clinical care we already deliver to ensure all interactions, in all corners of our hospitals are compassionate and patient-inspired.” Patient Experience at Osler encompasses every touch-point a patient or visitor has with the hospital, and as a result, both clinical and non-clinical staff play an important role in helping Osler achieve high patient satisfaction. Osler’s Service Excellence Call Centre plays an integral role in capturing patient feedback – contacting every inpatient within 48 hours of discharge to ask a few short questions about their stay, including how they were treated, whether they would recommend the hospital to others and if they have any suggestions for improving. The data collected from each call is stored

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in a secured hospital database and is used immediately to help better understand and evaluate each patient’s experience, celebrate success stories, and identify where staff and physicians can focus their energies to further improve the patient experience. “The information we capture through the call centre is used to inform decisions that help us ensure we are delivering care that respects the traditions, religions and culture of patients and their families,” says deRyk. “It also reminds both clinical and non-clinical staff to continue to keep patient experience top-of-mind in every interaction at our hospital.” Osler’s successful Palliative Care Skype Program, is an example of an initiative that was conceived because staff identified an opportunity to enhance the care of patients on their unit. The hospital serves a large immigrant population and sometimes patients are unable to see loved ones who live abroad because of time and financial constraints, or challenges obtaining a visa to enter Canada. This is exceptionally difficult for end-of-life patients who wish to reconnect with family members thousands of miles away. Staff from various departments worked together to create the Palliative Care Skype Program – a program that utilizes inexpensive technology to provide patients and their loved ones with an otherwise impossible connection. “It was heartbreaking to see patients die without being able to connect with their loved ones. Now, when dying mothers can see and talk to their children, or young adults with their parents, it is comforting to know that we were able to make this happen during such a difficult time in their lives,” says Gurwinder Gill, Director, Equity and Volunteer Services, and the program’s co-sponsor. Osler is pleased with the feedback the program has received and sees its success as one of many indications that staff are keeping the patient experience at H the heart of everything they do. n Donna Harris is a strategic communications partner, William Osler Health System.

Paperless medical record system Continued from page 8

An electronic record system means that once this medication is ordered by the physician, the system automatically generates suggestions for such additional monitoring. This greatly reduces any errors which may occur and enables clinical teams to proactively address any arising issues and prevent metabolic complications. “Since this system of monitoring has been instituted at Ontario Shores, adherence with the ideal recommended metabolic protocols have doubled,” indicates Dr. Ilan Fischler, Geriatric Psychiatrist and Medical Director, Clinical Informatics. The electronic system also facilitates the sharing of clinical information in a manner that supports the use of patient data to improve performance and transform clinical practices to one which is evidenced-based, ensuring that patients and families are recipients of recovery-oriented care. For example, Stage 7 at work reflects the use of clinical practice guidelines within the organization. The clinical practice guidelines developed for Schizophrenia and currently being developed for major depression allows staff to use structured templates based on evidence-based practices and the data collected from the system to inform practice and ultimately achieve quality outcomes. “Having electronic medical records also means that we can develop clinical scorecards. These are issued to each clinician monthly to determine their adherence to best practices as compared to their peers,” adds Fischler.

Having a completely paperless system reduces errors of omission and ensures the care being offered is supported by evidence based standards. One key patient safety and quality of care strategy used at Ontario Shores is the use of computerized physician order entries, where prescribed medication is entered electronically, replacing a physician’s handwritten note thus significantly reducing the risk for errors. This is also very significant in identifying any significant drug interactions or allergies the person may have. Once again, this results in reduced risk and increased safety in patient care. Offered by the Healthcare Information and Management Systems Society (HIMSS), the Stage 7 award signifies attainment of the highest level on the Electronic Medical Records Adoption Model (EMRAM). It scores hospitals in the HIMSS Analytics Database on their progress in completing 8 stages (0-7), with the goal of reaching Stage 7 – the pinnacle of an environment which is truly paperless. “Ontario Shores is truly a leader in their field in the use of electronic health records,” says John P. Hoyt, FACHE, FHIMSS, Executive Vice President, H HIMSS Analytics. n Shernette Muccuth Henry is a Communications Officer at Ontario Shores Centre for Mental Health Sciences.

Ethics 11

Flu vaccines and Ebola relief

– do we have duties to get and to give? By Kevin Reel


ver 40 years ago, philosopher and ethicist Peter Singer published an article called “Famine affluence and morality.” The piece argued that we ought to give, generously, to relief efforts in East Bengal, where people were dying “from lack of food, shelter, and medical care.” He presents a strong and unsettling case for donating our money to an extent that most of us could not easily ponder – giving up most everything beyond our own subsistence needs. I agree with Singer, though I cannot manage it myself. However, I don't believe Singer imagined that readers would act upon his argument’s conclusion fully. I believe he wanted to leave them aspiring to do so in the face of the fear of giving so much. (Check out his website ‘The Life You Can Save’ for his latest efforts to create such laudable aspirations in all of us.) Today I feel the same argument can be made with respect to Ebola relief. The bulk of the world has more or less stood by, at a convenient remove, watching (or not) as the virus has continued to wreak its havoc on distant lives. Only in recent weeks, with its sudden proximity, has much attention been paid by those of us in safely far-flung countries – but largely out of fear. And, as often happens, fear trumps fact. We have lamentable

tales of ignorance such as landlords refusing to rent apartments to people from affected countries. We have sudden calls for banning flights from those countries. We have immediate anxiety about our own physical and economic safety. We have sudden pressure for action – founded on FBEM – fear based evidence making.

Is this fear of flu vaccine any more evidence based than the irrational fears of the actual minimal risk that Ebola presents to any of us in an affluent health care system?

This is a close cousin of OBEM – opinion based evidence making. What should be apparent is that almost nobody in North America has anything whatsoever to fear at this point in time. Our exceptionally resourced health care systems leave us with all the necessary tools – as long as we use them well. (As you review IPAC procedures for flu season, remember that flu kills, too!)

What has not materialized around Ebola in many decades is the much needed immediate relief for those living through outbreaks. These needs are not complicated – beds, simple protective equipment, basic medical care, general relief supplies. Simple needs left unmet because the necessary funds are not forthcoming. Singer's 40 year old argument still needs making – there is a duty to help for the sake of relieving the pain and suffering of others...not to worry irrationally about the minimal loss of resources to ourselves. I wonder, too, if a close relative of this FBEM is not lurking behind some of the hesitation to get the annual flu vaccine. Yes, there can be reactions. Yes, a few have been reported as severe. And yes, the flu vaccine is not a surefire thing. But just how much of one’s reluctance to get the jab is based on true stories of dreadful outcomes? Is it weighed against the evidence that the flu jab is far safer than driving to work, and likely to prevent a good amount of suffering, even a few deaths (or a few hundred, maybe a few thousand, depending on the estimates you quote). Is this fear of flu vaccine any more evidence based than the irrational fears of the actual minimal risk that Ebola presents to any of us in an affluent health care system? These two fears are like rival siblings – one sees us underestimate the risks we pose to

others (when not vaccinated); the second has us overestimate the risk that others pose to us. In both cases there are two conclusions I cannot help but make – firstly, give to Ebola relief. Any major relief charity is worthy – Medicins Sans Frontieres, the Humanitarian Coalition, UNICEF to mention a few. If you don’t want to give your own funds, then give a dollop of your time – contact your MP and MPP and tell them to make sure Canada gives more than its abysmal contribution to the relief work. Give to help others, not just to save your skin. As for the vaccine, get it to protect others, if not yourself. The risks are, according to what I know, miniscule in getting the jab and far higher skipping it and giving the flu to others. If you have good evidence to the contrary, please do share it. If not, don't risk sharing the flu. In both situations we have moral duties which may require overcoming our fears. Aspire to that laudable virtue of courage – H then get and give. n Kevin Reel, MSc, OT Reg. (Ont.) is Assistant Professor and Associate Graduate Faculty Member, Department of Occupational Science and Occupational Therapy; Associate Graduate Faculty Member, Institute of Medical Science, University of Toronto.

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12 Focus


Patient as paper: Exploring the patient experience through art By Surgeon Mike Papesch FRACS Artist Emma Barnard


he project titled Patient As Paper is a surgeon and artist collaboration that investigates and demonstrates the patient experience and pathway. It encourages reflection by doctors, medical professionals and students, on what it is to be a receiver of medical care and the impact this has on people. It gives a visual voice to patients, and reflects some of the harsh realities people endure as part of their pursuit of ‘getting better’. This patient study draws to attention the degree of inevitable depersonalization that occurs when people are in hospital. “Patient as Paper” explores photographically the meanings of silent biomedical artifacts such as notes, scans, micrographs and surgeons' theatre drawings (be they on paper or skin). By inverting a patient

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and their notes, using superimposition and image-processing, photography forces a critical reflection on being a patient in the foreignness of hospitals, and on the complementarity of patients' and surgeons' visions of each other, as objects and people. Patients As People is a touring exhibition which showcases an installation of approximately fifty selected artworks created whilst working with patients of Consultant Surgeon Mike Papesch within the ENT department. A fifty-one year old busy engineer has a left sided sore throat for six months. He receives an appointment from the hospital. He lights a cigarette and thinks, worried but sure all will be okay. He goes along to clinic, and suddenly becomes a patient. A term understood by us as health care professionals, but what does it mean to him? As doctors, we understand our job; to listen, investigate, inform the patient and family, organize, guide and manage a patient through an agreed treatment pathway. We understand what being a patient means to us; that we can help, and sometimes cure a patient, within a unique trusting doctor/patient relationship. But what does this all mean to the patient? He is still an engineer, and others are relying on him for his skills. He himself is a specialist, yet all his own skills are of no value in his current crisis. He feels a loss of control, and is unsure of what his future will be. He really rather not be a patient, yet this is where he is. He is acutely and uncomfortably aware of his dependence on the health care team. The focus of this collaborative project is to focus on the patient experience. To invite the person to illustrate through

words or pictures, what it feels like to be a patient. It deliberately avoids questionnaires and provides people with a “clean slate” to express their thoughts, fears, aspirations and worries; all part of being a subject of our health care system. To reflect upon these images invites the doctor and other health care professionals to consider what the patient is expressing about their care. Some images are very literal, others less so. It is not so important that the viewer understands exactly what the patient themselves is thinking. The

challenge for us as health care providers is to allow ourselves the opportunity to reflect on these images and thereby consider, in a novel, visual and artistic way, how the patient experience can affect us all. This work does not seek answers to the patient experience, but does promote unH derstanding of it. n Mike Papesch FRACS is a Head and Neck Consultant Surgeon with Whipps Cross University Hospital, London Barts Health, NHS Trust.

Focus 13


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NOVEMBER 2014 HOSPITAL NEWS 2014-10-28 8:00 PM

14 Focus


Researchers create “black box” for use in operating rooms By Leslie Shepherd

esearchers at St. Michael’s Hospital have developed a “black box” for use in operating rooms, similar to that used in the airline industry. Dr. Teodor Grantcharov says the goal is to improve patient safety and outcomes by identifying where errors occur in the OR and teaching surgeons how to prevent them. When black boxes were introduced in the aviation industry, preventable errors dropped significantly. Dr. Grantcharov has been testing the prototype of his black box for several months in the operating rooms at St. Michael’s, where he specializes in advanced minimally invasive surgeries, such as gastric bypasses. It’s also being tested at two hospitals in Copenhagen, Denmark, with more international sites to be involved soon.


The black box is only for laparoscopic, or minimally invasive, surgeries that insert video cameras in thin plastic tubes into small incisions in the body.

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“Our journey in getting our son diagnosed was one full of anguish and uncertainties, but thanks to you, also full of hope.” Jon was referred at birth after his infant hearing screening test to receive an ABR test to verify if he indeed had a hearing loss. The ABR test required him to be in deep sleep for at least 2 hours. Our son was one of the many babies who did not sleep longer than an hour, either night or day. After five attempts at regular sleep ABR without any results, we were referred for a sedated ABR at [Canadian hospital]. At that time, he was already 6 months, which put us right at the end of the period considered early intervention for a hearing loss diagnosis. We were further told that sedated ABR would take at least another month to schedule and we were invited to do another regular sleep ABR at [Canadian hospital]. At this attempt, the audiologist only got reliable results for Jon’s right ear. Our frustration with the process was building up, as we were losing precious time in aiding our son. Read the full story here. HOSPITAL NEWS NOVEMBER 2014

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“We want to see where errors happen in surgery so that we can understand how errors lead to adverse events and develop training curricula to prevent these errors from ever happening again.” The box is about the size of a box of tissues or a thick book and it records almost everything that goes on in the OR, such as video of the surgical procedure, conversations among health care workers, room temperature and decibel levels. It works only for laparoscopic, or minimally invasive, surgeries that insert video cameras in thin plastic tubes into small incisions in the body that allow the surgeon to see what’s going on inside the patient. “We want to see where errors happen in surgery so that we can understand how errors lead to adverse events and develop training curricula to prevent these errors from ever happening again,” Dr. Grantcharov says. “It doesn’t mean that we will have perfect surgeries, because we are not perfect. But it means we will learn from our errors, which will make us safer. We will train future surgeons better because we can show them what are the most critical situations and how to avoid them.” Research has already shown that 84 per cent of errors in bypass surgery hap-

pen during the same two steps, so training has been adapted to help surgeons master those two skills. Dr. Grantcharov is looking at performance issues – something the surgeon did or didn’t do, such as apply enough force when grabbing a bowel, which might make it slip and tear. But he’s also looking at less tangible factors that can lead to errors, such as communication and team dynamics. “Say a surgeon picked up the wrong instrument. Then he got angry or frustrated and started to make technical errors. The more mistakes he made, the worse communications became.” Dr. Grantcharov’s team has done extensive research on surgical error analysis. According to this framework, an error is a minor deviation from an optimal course of action. Errors happen during each procedure; however very few lead to adverse events and go unnoticed by the surgical team. The landmark study on hospital medical errors in Canada, a 2004 paper by Ross Baker, a professor at the University of Toronto's Institute of Health Policy, Management and Evaluation, found that 7.5 per cent of patients admitted to acute care hospitals in Canada in 2000 experienced one or more adverse events, which can include everything from reactions to wrongly administered medications to bed sores, falls, infections and surgical errors. Most of these events did not result in any serious harm, the study found, but almost 37 per cent were preventable. More recent studies have shown rates of adverse events in hospital between 10 and 14 per cent. Such events cost taxpayers billions of dollars, usually in longer hospital stays. Dr. Grantcharov notes that professional athletes have coaches who point out their wrong moves and help them improve their performance. “For surgeons, we will have data that will allow better coaching and improvements and therefore better patient care,” he says. “We will reduce the risk and complications and show how to make the OR more efficient, which will also allow us to save money and do more cases.” Dr. Grantcharov hopes his black box would bring more transparency to the OR for patients and help change the “blameand-shame” culture that traditionally has made doctors and nurses reluctant to reH port mistakes. n Leslie Shepherd is Manager, Media Strategy at St. Michael's Hospital.

The black box is about the size of a box of tissues or a thick book and it records almost everything that goes on in the OR.

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Focus 15

Measuring patient experience By Gail Williams


ou’d be hard pressed to find anyone who would choose a hospital stay over a trip to Disneyland. However, as Fred Lee controversially pointed out almost a decade ago in If Disney Ran Your Hospital, there are many points of overlap when it comes to customer – or patient – experience and satisfaction. The focus on measuring and improving patient experience has grown by leaps and bounds since the early 2000s. Where does Accreditation Canada fit in this picture? As part of the accreditation process, Accreditation Canada client organizations that provide acute care services are required to administer a patient/resident experience survey at least once during the accreditation cycle and report the results. They have the option of using their own survey tools and processes, a vendor’s, or resources from Accreditation Canada. This requirement is being extended to organizations providing long-term care and corrections health services, effective January 2015. The intent is to ensure that the experiences of those who use the services are being monitored and the information is used to inform quality improvement initiatives. However, measuring patient experience is just one part of the puzzle. In the past few years, Accreditation Canada has been exploring how to go that extra step. How to help our client organizations actively and consistently improve patient experience? This led to a comprehensive shift Ontario_Health_Network_Half.indd


in focus throughout the accreditation program. In keeping with our patient safety strategy and progress in the field, and following extensive consultation, Accreditation Canada re-vamped the standards to strengthen and broaden the patient- and family-centred components. This change reflects and promotes the need for honest and real involvement by patients and families throughout the care process. Accreditation Canada’s standards and criteria address the policies, practices, and processes that need to be in place to provide safe, high-quality care. Specific and targeted patient- and family-centred care elements have been integrated throughout the majority of the standards, covering all aspects of planning, delivering, and evaluating services. The process included identifying different levels of patient engagement and collaboration that were expected, as follows: •The activity is the responsibility of the organization’s care team. Patient and family engagement is not required, but it is also not precluded. •The activity is conducted in collaboration with patients and families, defined as either: •In partnership with the client and family: The team collaborates directly with each individual client and their family to deliver care services. Clients and families are as involved as they wish to be in care delivery. or •With input from clients and families: Input from clients and families is sought

collectively through advisory committees or groups, formal surveys or focus groups, or informal day-to-day feedback, and their perspectives are used to inform service delivery. In addition, while current standards emphasize “who” is responsible for a particular action, the approach has been changed to emphasize (a) what is expected and (b) how patients and families are to be engaged. Throughout, the focus is on creating and nurturing mutually beneficial partnerships among and between the organization’s staff and the people they serve. It means working collaboratively with patients and their families to provide care that is respectful, compassionate, culturally safe, and competent, while being responsive to their needs, values, cultural backgrounds and beliefs, and preferences (adapted from the Institute for Patient- and Family-Centered Care (IPFCC) 2008 and Saskatchewan Ministry of Health 2011). As part of this process, Accreditation Canada adopted the following four values that are fundamental to this approach, as outlined by the IPFCC: 1. Dignity and respect: Listening to and honouring patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care. 2. Information sharing: Communicating and sharing complete and unbiased information with patients and families in ways

that are affirming and useful. Patients and families receive timely, complete, and accurate information so they can effectively participate in care and decision-making. 3. Partnership and participation: Encouraging and supporting patients and families to participate in care and decision making to the extent that they wish. 4. Collaboration: Collaborating with patients and families in policy and program development, implementation and evaluation, facility design, professional education, and delivery of care. The Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization's culture that impact patient perceptions across the continuum of care.” How can we create a culture where patient experience is front and centre? It’s more than smiles and sunbursts. It’s putting care providers in patients’ shoes … or their wheelchairs. It’s acknowledging and respecting how it feels to be in a health care environment, often involuntarily, when you are feeling sick, anxious, and vulnerable. We know that the changes to the accreditation program – being released in 2015 for on-site surveys starting in 2016 – may pale next to a ride on Space Mountain or a photo with Mickey. But they will provide support and direction to our client organizations as they work to truly improve patient experience across the board. And H that’s no small success. n Gail Williams is Manager, Publishing at Accreditation Canada.

NOVEMBER 2014 HOSPITAL NEWS 9/30/14 10:10 AM

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16 Special Section: Infection Control

Finalists in the hand hygiene photo contest for all health care workers in BC.

Infection control: How to educate and motivate By Helen Evans

or most health care workers, infection control is a topic that doesn’t generate much excitement. And for many healthcare workers, infection control training consists of a mere one-day module and an


annual refresher. Add to this the fact that people are time-pressured in their jobs and often feel over-messaged about infection control topics such as hand hygiene, how can we educate and remind health care workers about the importance of infection

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control without these messages getting lost in the ocean of information people already receive?

Let’s Go Viral!

The Provincial Infection Control Network of BC (PICNet) decided two years ago that they needed to overhaul the way this material is presented, as sessions where staff were simply given information about infection control were resulting in bored audiences and little uptake.

PICNet’s next challenge was to reach more people. PICNet has a provincial mandate to provide infection control resources and education to the whole of BC, but travel restrictions meant they could only visit facilities in the Vancouver area. The PICNet team set out to create an infection control educational game that would be fun, memorable, and involve hands-on activities that would encourage team-building and learning by doing. “Let’s Go Viral!”, a Family-Feud style game, was created based on specific teaching goals such as hand hygiene, personal protective equipment (PPE), risk assessment, vaccination, and modes of transmission. Questions that PICNet had been asked during previous education sessions also helped build the content. The game features a variety of types of questions to keep the participants on their toes: buzzer questions, donning/doffing PPE, a Cover Your Cough contest, and Germ CSI, to name a few.

Packaging it up

Feedback from the participants was overwhelmingly positive. “It was everything an in-service should be: it was simple, it was fun, and it was easy to remember.” “I literally could not walk down the hallway for people stopping to tell me how great the workshop was.” Given the success of the game, PICNet’s next challenge was to reach more people. PICNet has a provincial mandate to provide infection control resources and education to the whole of BC, but travel restrictions meant they could only visit facilities in the Vancouver area. So how could they make this available to the whole province? The team decided to package up the game and make it available as a kit that could be purchased or downloaded so that Infection Control Practitioners, managers, or Directors of Care could run the workshop themselves. And so game production began: PICNet produced or sourced all the game components (game cards, answer buzzers, instruction booklets) and even created an instructional video using a “train the trainer” model. The kit was a great success, with orders received from across Canada.

Evaluate and Adapt

Based on feedback from people who used the game, and from more of PICNet’s in-services, the game was changed slightly for the 2014 edition, with a greater focus on risk assessment. PICNet found that relying on people to memorize, for example, which PPE are used for which types of infection, does not promote long-term retention of knowledge. Instead, getting health care workers to think about why they do certain infection control practices will result in them approaching their work day with a fuller understanding of what practices are needed in which situations. Continued on page 20

Special Section: Infection Control 17

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18 Special Section: Infection Control


More than voluntary and less than mandatory:



T3 This is the s econd artic series exam le in a three internal comining how hospitals ap -part function be munications. Hospita proach s ls fully engag t when their employe es are ed. A well o rganized bu contribute to il comes from efficiency but true eff ding can This installm a well organized cultu ectiveness of several h ent looks at the expe re. ri o 'get a flu sh spitals implementing ences ot or wear a mask' polic ies.

What some hospitals have learned so far about implementing ‘get a flu shot or wear a mask’ policies By Yvan Marston

nated cards with a flu question on one side and a number of facts supporting the answer on the other, were used daily at morning huddles. Informal leaders were encouraged to pick a card and prompt a short discussion about the question and answer.


oluntary flu immunization campaigns in hospitals across Ontario have been robust and multifaceted but generally only capable of convincing 51 per cent of health care workers to get the shot. “Despite our best efforts, vaccination rates among health care workers continue to fall short,” says Dr. Tim Rutledge, CEO of North York General Hospital and chair of TAHSN (Toronto Academic Health Science Network) working group that studied best practices to minimize the risk of hospital transmission of influenza. “We came to the conclusion that we should adopt a mask or vaccinate policy as part of a comprehensive prevention and control program,” he says, explaining that such a policy must be seen as a component of an overall infection control plan that includes elements such as hand hygiene, discouraging ill visitors, cough etiquette as well as early identification of outbreaks. As parties continue to debate the effectiveness of both the flu shot and mask wearing as preventative measures, more health care facilities (13 in Ontario last year) are moving to bring into effect vaccination or mask policies. They are policies that unions have objected to on health information privacy and human rights grounds. Only a few flu seasons have passed with these types of prevention policies in effect. And facilities that have implemented them have undoubtedly raised their immunization rates. But at what cost to their employee relations? What practices have some of these hospitals observed to move this from being a top-down initiative to a more broadly accepted component of patient care and safety? Here are seven.

Ask staff and unions for help designing a solution

In 2007, North Bay Regional Health Centre made a decision to force the immunization issue. Employees were told that when there was significant influenza activity in the community and an increased risk to patient and staff safety, flu shots would be mandatory. Employees without flu shots would be sent home – and they could use vacation days if they didn’t want to lose pay. By 2011, its staff immunization rate was 90 per cent but the hospital also had 22 grievances related to this single issue. It had them put into abeyance and worked in tandem with its unions to address specific concerns staff had about the flu prevention policy. It was this exercise that helped the hospital rewrite its policy to distinHOSPITAL NEWS NOVEMBER 2014

Leverage your champions

guish between periods of high risk, where it would implement a get-a-flu-shot-orwear-a-mask-in-clinical-areas solution, and periods of outbreak where staff caring for patients would still be required to be immunized. “The mask was a concession,” explains Danielle Baker, NBRHC’s director of safety and risk. “Adding the option of the mask took away other risks, like the possibility of not being able to staff a unit because not everyone had gotten the flu shot. Or of having disengaged staff.”

Create a climate for thoughtful dialogue

When Bluewater Health implemented a flu shot or mask policy in 2012-2013 it communicated its intentions to the unions early on. It presented the policy to union executives with the help of the chief of professional staff and the chief of nursing. Not only did this demonstrate that it was a hospital-wide initiative, but it also meant key players were there to ask and answer questions immediately. “They had the ear of those two individuals to talk about the actual policy,” explains Colleen Cook, Bluewater’s director of HR. Most of the questions, she recalls, were about logistics. So having a surgeon there to discuss the details of a mask option, for example, gave this solution credibility.

Dig for the details that matter to staff

To address the employee dissatisfaction stemming from its initial 2007 mandatory flu shot policy, NBRHC struck a multidisciplinary committee that included representatives from the three unions along with senior team members and the chief of staff. The group drafted a list of all the issues – administrative and ethical – and teams conducted focus group work to stimulate discussions.

This helped identify 10 root causes for dissatisfaction over the policy. With a list of solutions in hand, the team reported back to its focus groups to discuss how it would address their concerns. This process is how they landed on the notion that staff wanted more choice in the matter, says Baker. Other findings included concerns over when immunization was required as well as improved access to the flu shot (night shifts, for example, lacked access to daytime clinics). NBRHC addressed the access issue by appointing nurse and paramedic champions who were trained to administer the flu shot at any time. To provide clarity around when staff should be vaccinated, NBRHC designated a specific calendar date by which staff must either get the flu shot or sign a form declining it. B.C., the first province in Canada to move to a vaccinate or mask policy uses an official coverage date (usually December 1st ), explains the province’s health officer Dr. Perry Kendall, adding that it can change depending on an outbreak and that whatever the date, it is important to start on a working day.

Make it part of the conversation

When Bluewater Health sought to build buy-in for its flu shot or mask policy, it employed a number of tactics, including the use of huddle cards, a technique it borrowed from Mt. Sinai and adapted to meet its flu campaign needs. “Vaccine hesitancy is complex and can be different for each individual,” says Meaghan Lawrence-Kreeft, a communications coordinator who worked on the project. It was important to generate peer-to-peer discussions on the topic, she explains. The huddle cards, a series of 16 lami-

Don’t underestimate the importance of peer pressure. In B.C., units where someone was championing the program had higher rates of immunization than units where you had opponents. “If you can find local champions, it can make a big difference,” says Dr. Kendall. And when it comes to more general communication, NBRHC’s staff interviews found that employees would rather hear about the flu policy from infection control than from a VP or CEO.

Know your audience

You should have clarity over your staff’s immunization status. In B.C., each regional health authority keeps its own immunization coverage data. Health care workers immunized off-site are asked to enter their vaccine status online and to keep a hard copy record in case they are asked to confirm their status. At NBRHC, employees whose immunization status is unknown to OH&S as of November 15th are required to submit a ‘Declaration of Intention’ form. Having this information serves two purposes: it allows the hospital to better plan for an outbreak by knowing exactly how many staff members are immunized, and it creates a database of employees to whom it can communicate more directly.

Make the mask or shot policy truly universal

Any hospital developing a flu prevention policy will work with a multidisciplinary team to get each group’s perspective and buy-in. With the chief of staff on board, and professional organizations and patient advocates supporting the need for flu shots, most of the hospitals’ groups are represented, except for visitors. “One of the points the unions made was that we were making staff wear masks but then visitors coming in from the community didn’t have to,” says B.C.’s Dr. Perry Kendall. So the province modified the policy to include asking visitors who were not vaccinated to either get the shot, which was made immediately available to them, or H wear a mask. n Yvan Marston is a freelance writer in Toronto.

Special Section: Infection Control 19


20 Special Section: Infection Control

Enterovirus – D68: What you need to know? By Bruce Gamage

nteroviruses cause a wide range of illness; most are associated with the common cold, but others are associated with lower respiratory tract, skin and mucous membrane, and central nervous system diseases. Enterovirus-D68 (EV-D68) is a previously rare enterovirus that can cause mild to severe illness. EV-D68 is unusual in that it is more often associated with lower respiratory illness. The virus is spread person-to-person through contact with the respiratory secretions of infected persons.


Clinicians should consider EV-D68 infections in children presenting with severe respiratory illness and report any increase or unusual clusters/ outbreaks of respiratory illness to their local public health authority. EV-D68 was first identified in 1962. It has occurred infrequently since that time, although from 2008-2010, the Centers for Disease Control and Prevention reported on six clusters of EV-D68 in the Philippines, Japan, the Netherlands, and three US states (Georgia, Pennsylvania and Arizona). The clusters appeared to be concentrated in the fall. Four of the six

Continued from page 16 outbreaks only reported infected children, one outbreak reported only infected adults and one outbreak involved both adults and children. Patients in these clusters often had new onset or worsening wheezing. Hospitalizations and admissions to intensive care units were noted and three individuals died.

Current Situation

In August 2014, several children’s hospitals in the US reported increases in children hospitalized with severe respiratory illness. EV-D68 was identified in many of these children; notably, 70 per cent of the children had a history of asthma or wheezing. Since then, over 500 cases in 43 US states and the District of Columbia have been confirmed to have respiratory illness caused by EV-D68. Although not nationally notifiable, cases of EV-D68 have also been identified in five Canadian provinces (BC, Alberta, Saskatchewan, Manitoba, and Ontario). More case reports are anticipated as diagnostic testing for EV-D68, which requires sequencing of the virus, is completed on suspect cases. On September 26, 2014, the US CDC issued a Health Advisory to clinicians reporting a cluster of polio-like illness in nine children (aged one-18 years) in Colorado. Of the eight tested specimens, six were positive for entero/rhinoviruses, of which four were confirmed as EV-D68, with two typing results pending at the time of report. As part of this advisory, the US CDC


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Infection control

requested further information on patients ≤21 years of age presenting with acute onset of focal limb weakness occurring on or after August 1, 2014, and an MRI showing spinal cord lesion largely restricted to grey matter. Since then, clusters of polio-like illness have been cited in some provinces including BC, Ontario and Alberta although information about whether these may have been associated with EV-D68 is still pending.

What do health care providers need to know?

Clinicians should consider EV-D68 infections in children presenting with severe respiratory illness and report any increase or unusual clusters/outbreaks of respiratory illness to their local public health authority. Health care providers should implement droplet and contact precautions, in addition to routine practices for patients with suspected EV-D68. Surfaces should be cleaned with a hospital-grade disinfectant with a Drug Identification Number or DIN and a label claim for non-enveloped viruses.

What can members of the public do?

Members of the public can take action to prevent the spread of this virus. Hands should be washed frequently with soap and water, or cleaned with an alcohol-based hand rub containing at least 70 per cent alcohol. As well, coughing and sneezing into your sleeve can help minimize the risk of spread of illness. Children should be kept home from school if they have coldlike symptoms. If symptoms of a lower respiratory illness develop, the child should be assessed by a health care provider, especially if the child has a history of asthma or wheezing. There is no vaccine against EVD68 like there is with polio. Sudden onset of muscle weakness or partial paralysis is very rare in children. Parents are advised to monitor their children and take them to see a doctor if a lingering cold seems to suddenly get worse or if the child suddenly develops a fever. As well, any child who suddenly develops muscle weakness or is unable to move their limbs should seek imH mediate medical care. n Bruce Gamage RN BScN CIC is the President of Infection Prevention and Control Canada (IPAC Canada)/ Prévention et contrôle des infections Canada (PCI Canada). IPAC Canada is a multidisciplinary professional association for those engaged in the practice of infection prevention and control across the continuum of care ( He is Network Manager at the Provincial Infection Control Network of British Columbia.

Hit us with your best shot!

Educating staff is one thing; motivating is another. In early 2014 PICNet, as part of the Communications sub-committees of BC’s Health Quality Networks and the Provincial Hand Hygiene Working Group combined their efforts to come up with a provincial activity for World Hand Hygiene Day. Hand cleaning compliance rates have steadily been increasing in BC, so the team decided they wanted to host an activity that would celebrate hand hygiene efforts and help build enthusiasm, rather than simply reminding health care staff to clean their hands. The group decided to run a hand hygiene photo contest for all health care workers in BC. A web page was created where staff could submit their photos, and the contest was run for five weeks. There was a grand prize for the funniest/ most creative photo, a trophy for the BC Health Authority that submitted the most photos, and weekly drawings for gift cards.

The contest won a contest

The “Clean Shots” photo contest received more than 1,000 entries, and the creativity of the photos far surpassed the judges’ expectations. The contest proved that point-of-care staff have plenty of enthusiasm, creativity, team spirit, and great ideas! Having staff showcase their efforts was a great alternative to previous “topdown” efforts for hand hygiene promotion, and it was a fun way to celebrate everyone’s efforts. In addition, the Clean Shots contest won first place in the Canadian Patient Safety Institute’s “What’s Your Hand In It?” Dragon’s Den-style competition to promote hand hygiene improvement. A survey was conducted after the contest to find out what participants thought and whether they’d like to see this again next year. There was also an increase in hand hygiene rates during that period: BC surpassed its provincial target of 80 per cent for the first time since provincial hand hygiene auditing began. The main lesson the organizing committee learned was that health care staff have lots of fantastic ideas; it just takes a good idea to harness this.

For more information

Infection control education and motivation can be made fun and accessible; it just takes some out-of-the box thinking. And if you don’t have time for that, PICNet has already boxed it up for you! For more information on the Let’s Go Viral! kit, visit the PICNet website at letsgoviral. You can also view the Clean Shots finalists finalists/. n H Helen Evans is a Communications Officer at the Provincial Infection Control Network of BC (PICNet).

Special Section: Infection Control 21

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22 From the CEO's Desk

Engaging heads, hearts and hands By Sue Denomy


ould your employees recommend your hospital as a great place to work, learn and grow? Would they say that they trust your organization? Bluewater Health is the largest public sector employer in Sarnia-Lambton. Our hospitals bring together the collective talents of over 2,500 staff, physicians and volunteers dedicated to a mission of exemplary care. Inspired People is one of our five strategic goals, compelling us to ignite passion and pride as an organization of choice in which to work, practice, volunteer and learn. Why is this important? A high level of employee engagement has a positive impact on patient satisfaction and patient outcomes. Teams perform at their best when employees are engaged and feel supported and valued in their roles. Innovation comes from individuals who feel safe bringing forth new ideas to challenge the status quo. As the health care talent pool is diminished, we must nurture a healthy, happy and engaged workplace culture to attract and retain tomorrow’s health care professionals. No workplace is without challenge and opportunity, and an engaged workforce can move through those challenges in a culture of collaboration, teamwork, support and possibility thinking. Engaged staff go above and beyond with their heads (using knowledge, skills and resources), hearts (care, caring and compassion) and hands (performing meaningful work). When I meet our organization’s newest recruits at orientation, I’m delighted to hear, “My friend who works at Bluewater Health recommended the job to me… I hear this is a great place to work!” This is important to hear and I want to hear it often, as it galvanizes our commitment to make it so.

Sue Denomy (right) is President and CEO at Bluewater Health. To evaluate if we’re meeting our Inspired People priority, we invite staff and physicians to tell us how to improve upon our work environment. Our engagement survey, facilitated every two years by National Research Corporation Canada, assesses such workenvironment factors as teamwork, an employee’s relationship with their manager, health and safety, training and development and overall job satisfaction. The tool looks at how these environmental factors influence engagement and trust.

Our journey with this particular survey tool began in 2009, and we are in our third wave of using the responses to guide continuous improvements. Each year, there are more voices reflected in the anonymous survey. The 67 per cent response rate in 2013 is our highest yet – up more than 25 per cent since 2009. Our overall engagement score is six per cent higher than the community hospital average reported in the 2013 NRCC survey results.

No workplace is without challenge and opportunity, and an engaged workforce can move through those challenges in a culture of collaboration, teamwork, support and possibility thinking. Through multiple reports, we can assess the responses through different lenses – by department, by job classification or employment status – to determine improvements that will lead to meaningful change. The most recent survey highlighted significant gains on each of our top three engagement priorities: Quality care as a goal – up 16 per cent Involvement in decisions – up 19 per cent Positive work environment – up 20 per cent Creating a healthy environment where engagement flourishes isn’t anyone’s job… it’s everyone’s job. Each department – its leader and its staff – contribute to our success. From Human Resources and Organization Development’s employee development process, executives’ purposeful rounding, Occupational Health and Safety’s wellness initiatives, to the commitment of our Healthy Workplace Team – strategies and activities are aligned and embedded to focus on our people’s


health, wellness, job satisfaction and worklife balance. The Healthy Workplace Team of frontline staff and volunteers helps to guide our employee-focused initiatives. These fortyfour energetic ambassadors form dyads with their department manager and are dedicated to inspiring and implementing interdepartmental employee engagement activities. At a recent workshop, they reviewed the most recent engagement survey results, shared insights, set priorities for the coming two years, and celebrated engagement successes within their department. It was a great day full of enthusiasm, creativity and laughter, resulting in a list of possibilities. They confirmed that communicating early, honestly and clearly contributes to employee trust, as does delivering on our promises through timely follow-up, and asking for staff input early on issues that affect them. Ambassadors also have ideas to help grow and sustain our positive results. They tell us to keep going with Lean tools and techniques, RNAO Best Practice Guidelines, and volunteer Patient Experience Partners, while maintaining patient and family-centred care at the core of all that we do. They recommend continued involvement and engagement of staff in decisions that affect their work, and everyday methods of providing employee feedback, reward and recognition. Today, Bluewater Health is committed to empowering our people to be the best they can be. To operationalize this aim, we are: • Launching a Talent Development System including an Employee Development process • Developing a plan to enable our people to work to their full scope of practice • Developing our leaders through the Bluewater Health Innovative Management Program and partnering with Lambton College on a new Board of Governors certificate program, Healthcare Management & Leadership Development • Educating and engaging our people in patient and family-centred care principles and care strategies • Continuing to formally recognize and acknowledge our people • le in Lean principles and tools, including daily huddle boards where staff generates improvement ideas. These initiatives represent our corporate response to the collective voice of the organization, heard through the engagement survey. To create a workplace where employees want to invest themselves, we need to shape a workplace culture that meets the employee’s desire for a career that fulfills their hearts, challenges their minds and is a balanced part of their lives. Engagement, and the continual improvement that it requires, is not for the faint of heart. Sustaining results becomes tougher year after year. As system challenges put new demands on organizations and their people, our role is to be watchful of the pulse of the organization and to engage staff in identifying the H most – their most – important priorities. n Sue Denomy is the President and CEO at Bluewater Health in Sarnia, Ontario.


Runnymede Healthcare Centre patient, Barbara (left) tries the hospital’s new thickened tea with Monique, speech-language pathologist.

Patient satisfaction

is served By Michael Oreskovich

atient experience surveys in Ontario consistently find a link between satisfaction with hospital food and overall patient satisfaction. Comprised of different backgrounds, cultures and ages, patients have varied needs and expectations. One priority shared by all of them though, is high-quality hospital food. Runnymede Healthcare Centre is committed to ongoing quality improvement and is always looking for initiatives and processes that can be implemented to better meet the needs of our patients’ including their dietary requests.


Responding to patient needs

Patients and their families communicate food preferences through their regular interactions with the hospital’s diet technicians and clinical dietitians. Feedback is also given to a Menu Committee that was created in early 2013, and is comprised of a dietitian, speech-language pathologist, food services representative and a patient representative. The committee reviews menus prior to their launch, tests recipes and provides input into new food products and recipes. Involving patients in the decision-making process is an important function of the committee which evaluates the new food recommendations based on a variety of criteria such as patient safety, nutritional value, feasibility, flavour and appearance. If the suggestion satisfies all criteria, it’s incorporated into the hospital’s menu.

What patient satisfaction looks like

Today’s patients are more conscious than ever about the positive impact that good nutrition can have on health and recovery. In many cases low sodium or low fat menu options are valued highly by patients, especially those who are living with chronic conditions such as heart disease or diabetes. Alternatively, patients may prefer to continue eating foods they enjoyed prior to being admitted to the hospital. In these cases, Runnymede’s dietitians balance a patient’s request with his/her clinical needs. If a patient can safely tolerate a more indulgent diet, the request will be accommodated. In cases where such a diet

is considered to be a health risk, a more clinically-appropriate compromise will be suggested. Placing patients at the centre of the decision-making process ensures that their voice is heard and their needs are being met, promoting patient satisfaction and an enhanced patient experience.

Ongoing process improvement

Like nearly one-third of Runnymede patients, Barbara Hopkins has difficulty swallowing and requires a modified diet that includes thickened beverages. Born in Britain, Barbara used to enjoy her tea time ritual every day, but since her stroke over two years ago and subsequent admission to Runnymede for rehabilitation, she has not been able to have a cup of tea. Patients identified Runnymede’s selection of thickened hot beverages in their quality improvement wish list for the hospital. In response, the Menu Committee developed a more enjoyable alternative for patients with swallowing difficulties, like Barbara. After trying a number of flavoured formulas, the committee proposed an innovative solution: brewing real coffee and tea, and then mixing in the prescribed amount of thickener. The result not only tastes better, but the mixture can be custom-formulated to best suit each patient’s therapeutic needs. The new thickened hot beverage program will be implemented across the hospital in the coming months, following the roll-out of education for staff. However, a recent pilot project gave Barbara the opportunity to try a sample of the new thickened tea. The experience not only allowed her to regain a lost link to her past, but it also significantly enhanced her patient experience. By maintaining feedback processes that take patient preferences on board, hospitals can better promote quality improvement and enhance patient satisfaction. Runnymede’s example shows that restoring some of life’s simplest pleasures can go a long way toward enriching the patient H experience. n Michael Oreskovich is a communications assistant at Runnymede Healthcare Centre.

Focus 23


Health Information Management Health Services Management

Certificate Programs Health Informatics Health Services Management Health Studies NOVEMBER 2014 HOSPITAL NEWS

24 Focus


Baycrest enhances patient safety with new portal

All direct care staff can access vital safety data in real-time By Amanda Paterson ne of the main barriers to enhancing patient safety is the failure to learn from safety incidents. Baycrest Health Sciences has launched a Patient Safety Portal – a central web-based access point to collect, analyze and learn from patient safety incidents. Built to meet Baycrest’s unique needs as a long-term care facility and complex continuing care hospital, the technology enables staff to compare and analyze incidents by rate, type and location within the organization. Historically, management teams have had access to safety data, but that information has not been accessible by all those involved in client care. “We recognized that client safety involves every staff member here. Our goal was to create a one-stop shop in which all staff can access real-time safety information,” says Shadan Fallahi, patient safety officer and risk manager. “By making all those involved in


point of care better informed about incidents and the best strategies to mitigate future incidents, we can make each patient experience a safer one.” Since its launch in early September, the portal has received more than 3000 visits, indicating that many Baycrest staff are eager to access current safety data. “We acknowledge that in a health care environment, there is inherent risk. We can mitigate that risk by enabling all staff to confront safety issues head on,” says Fallahi. The portal is hosted on Microsoft SharePoint and draws data from both Meditech and the Safety Event Reporting System (SERS). “This new access to safety information is empowering for direct care staff,” says Andrew Pigou, manager, informatics and PMO, eHealth. “With this transparent approach, clinical leaders can now deliberate on important patient safety issues with live data at their fingertips,

Marie Jane Lopez Torres, R.N. navigates the Patient Safety Portal with hands-on training from Andrew Pigou and Shadan Fallahi. to direct the focus of their conversations and guide next steps.” Features of the Patient Safety Portal: • Easy-to-understand graphs and charts populated with real-time safety data • Recent case studies and recommendations based on actual and potential patient safety incidents • External resources including ISMP Medication Safety Alerts, annual recommendations from the Geriatric and Long Term Care Review Committee from the Office of the Chief Coroner and information on the most recent hazard alerts,

product recalls and product notifications. • Client safety stories shared by clients, staff, volunteers and students to illustrate patient safety experiences, helping staff connect real patients to the safety data being monitored. Moving forward, the team plans to enhance the portal’s function by allowing comments, interpretation and action planning with a new interactive workflow H process. n Amanda Paterson is a Public Affairs Specialist at Baycrest Health Sciences.


MOMENT THAT MATTERS. Another adventure. And the technology to help keep them healthy for many more. Health information has the power to change the quality of our lives, and we’re working hard to improve healthcare across generations. When clinicians have access to complete patient information from the entire care continuum, everyone benefits. Enhanced analysis. Increased insight. Informed decisions. And that adds up to a better quality of life for everyone.

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MEDTECH Focus on MEDEC members making a difference in Canadian Healthcare


Canada’s Medical Technology Companies


MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Reduce costly reinterventions to save money. Experience the long-term savings provided by the only drug-eluting SFA stent in Canada.



1. Burket M. The economic impact of restenosis and the economics of drug elution. Presented at: Vascular Interventional Advances (VIVA) 2011; October 18-21, 2011; Las Vegas, Nevada. 2. De Cock E, Sapoval M, Julia P, et al. A budget impact model for paclitaxeleluting stent in femoropopliteal disease in France.Cardiovasc Intervent Radiol. 2013;36(2):362-370. © COOK 2014



Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014



Industry is made up of a few large companies and a large number of small and medium-sized companies.


Generally based on biomedical engineering, and developed through mechanical, electrical and/ or materials engineering to develop a product that permanently or temporarily replaces the function of the body. Comprised of a wide cross-section of technologies, including mechanical, electrical, and materials-based engineering, as well as biotechnology and other sciences. Designed and developed in the health care field with clinicians, to perform certain functions .based on quality, safety and effectiveness.

Product Development

Due to a high rate of innovation, there is a short product life cycle and investment recovery period (typically 18 months on the market). The majority of new products typically bring added functions or clinical value based on incremental improvements, or are invented based on health care needs.

A letter from MEDEC President: elcome to the first MEDEC MedTech supplement in Hospital News. We are thrilled to have this opportunity to showcase some of the many benefits that medical technology offers to patients, as well as the health care system. We’ll also highlight some exciting initiatives that are taking place in our industry and share some ideas about how we believe we can collaboratively work together to increase the adoption of innovative medical technologies into the Canadian health care system for the benefit of patients, clinicians and the system as a whole. For those of you who aren’t familiar with MEDEC, let me provide an introduction to our association and the medical technology industry in Canada.


This supplement will highlight some exciting initiatives that are taking place in our industry and share some ideas about how we believe we can collaboratively work together to increase the adoption of innovative medical technologies into the Canadian health care system For more than 40 years, MEDEC, as the association representing Canada’s medical technology companies, has been working in partnership with health care providers, patients and governments to contribute to better health and more sustainable healthcare for Canadians.

MEDEC members are creating implantable devices, surgical tools, diagnostic technologies and many more innovations that are improving the lives of patients in Canada and around the world every day. These technologies are leading to earlier and more accurate diagnoses, less invasive procedures (meaning faster recoveries and reduced hospital stays), improved treatment options and reduced wait times to name just a few of the benefits. In addition to improving health outcomes, these technologies bring great value – making important contributions to ensure the sustainability of Canada’s health care system. Through the ongoing research and development of innovative products, Canada’s medical technology industry contributes significantly to the effectiveness and efficiency of the health care system and to the wellbeing of Canadians, while helping to drive a vitally important sector of our economy – providing well-paying jobs to over 35,000 Canadians. And we know Canada’s medical technology industry could do even more. Despite the often substantial barriers to getting technologies adopted into the Canadian healthcare system, recent initiatives like the federal government’s Advisory Panel on Health care Innovation and the Ontario Health Innovation Council, as well as other initiatives with healthcare providers, are showcasing that governments and healthcare partners across the country are recognizing the immense potential that the medical technology industry offers. We hope you enjoy the information provided in this supplement and look forward to our continued collaboration with our partners in the health care system for the benefit of patients. Sincerely, Brian Lewis, President & CEO, MEDEC

Feedback from clinicians and users can be shared with product engineer to improve design and best practices. High cost for distribution, training and education, and often a requirement to provide service and maintenance for (for high-tech devices).

Regulation in Canada

Risk-based pre-market approval/licensing of individual product. Licensing requirements vary according to risk classification of product within the Medical Devices Bureau at Health Canada.

How can Zilver® PTX® reduce costs? Bare-metal stents and angioplasty are suboptimal. Lesions in the superficial femoral artery (SFA) are difficult to treat. Oneyear restenosis rates can be as high as 67% for percutaneous transluminal angioplasty (PTA)1 and nearly 40% for bare-metal stents (BMS)2, which often lead to reinterventions. But there are downsides to reinterventions. SFA reinterventions can place extra burdens on patients, physicians, and facilities. These procedures consume more time, radiation, and contrast, and often require devices that can increase equipment costs by 270% over the original intervention.3 And these reinterventions can spark a cascade of further reinterventions.3 That’s why drug elution is the solution. In a randomized controlled trial, Zilver® PTX® showed a clear drug effect at four years by reducing reintervention rates 45% compared with standard care4, which consists of optimal PTA and BMS. By reducing reinterventions, this drug effect benefits patients, physicians, and facilities. 1. Refer to the Instructions for Use (IFU) for full prescribing information, including indications, contraindications, warnings, precautions, and clinical data. 2. Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-1888. 3. Burket M. The economic impact of restenosis and the economics of drug elution. Presented at: Vascular Interventional Advances (VIVA) 2011; October 18-21, 2011; Las Vegas, Nevada. 4. Ansel G: The Zilver PTX randomized trial of paclitaxel-eluting stents for femoropopliteal disease: 4-year results. Presented at: Vascular Interventional Advances (VIVA) 2013; October 8-11, 2013; Las Vegas, Nevada.



MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

What hospitals need to know about Bill 21 By Tania Haas he under-dosing of chemotherapy drugs discovered earlier this year at four Ontario hospitals and one in New Brunswick has resulted in a new bill that, if passed as proposed, could drastically change how Ontario hospital pharmacies operate. The Ontario Ministry of Health and Long Term Care (MOHLTC) introduced Bill 21, Safeguarding Health Care Integrity Act, 2014 this past summer. It’s a multipronged bill addressing the province’s voluntary blood donor system and new reporting and information sharing requirements for health profession colleges. It also proposes to extend the Ontario College of Pharmacists’ (OCP) authority to conduct regular inspections of hospital pharmacies to ensure new standards are being met. In the same way, the OCP oversees community pharmacies and drug preparation premises, Bill 21 would allow the College to approve hospital pharmacy licensing; and ensure that legislative changes to the Drug and Pharmacies Regulation Act are being followed. In anticipation of Bill 21 passing, the OCP’s website posted a version of Registrar Marshall Moleschi’s presentation on Bill 117 (Bill 21’s precursor). Inherent in the bill are a series of requirements that define exactly how a hospital pharmacy, its personnel and its tools shall be expected to work and operate. “The OCP is going to create the rules and procedures for accreditation; for mandatory criteria observed in inspection;


how hospital pharmacists will be judged,” explains Jake Thiessen, Ph.D., the investigator appointed by the MOHLTC less than a month after the under-dosing was recognized. His report, “A Review of the Oncology Under-Dosing Incident” outlines perceived causes and offered 12 recommendations to prevent similar incidents. Thiessen says the new bill fairly reflects the intent of his investigation’s findings. “Former patterns and practices will need

to be modified,” says Thiessen. “It’s all in the best interests of the patient.” According to Thiessen’s report, a total of 1,202 patients, including 40 children, received lower than intended doses of the chemotherapy drugs cyclophosphamide and gemcitabine. The incidents were initially discovered on March 20, 2013. By March 27, the hospitals had quarantined questionable products. Thiessen concluded that a series of omissions led to the under-dosing. His

investigation focused on the dose preparation of the two drugs, specifically the drug dilution stage. He concluded that an “inferior process” did not clearly indicate a final concentration. Products without adequate labeling added to the lack of clarity. Finally, hospital pharmacies made some incorrect assumptions about the products, which were then individualized and distributed to patients. Continued on page M6

Timeline: From oncology under-dosing incident to Bill 21 2013 March 20-27 Instances of under-dosing and mixed dosages of chemotherapy drugs in Ontario and New Brunswick discovered April 15 The Ontario MOHLTC appoints an independent investigator, Jake Thiessen, Ph.D., to conduct a review to determine the causes of the under-dosing and to provide recommendations to prevent future incidents of this nature July 12 “A Review of the Oncology Under-Dosing Incident” presented to the MOHLTC, including

12 recommendations for operational, personnel and procedure change; six of which relate to pharmacies. August 7 Dr. Thiessen’s report released to the public October Draft legislation known as Bill 117 introduced to the legislature. It provides the Ontario College of Pharmacists with the authority to license and inspect Ontario hospital pharmacies 2014 Spring OCP Registrar Marshall Moleschi’s Bill 117

information presentation is available online Legislature dissolves. “Bill 117: Enhancing Patient Care and Pharmacy Safety” does not pass before the dissolution. July 2014 Bill 117 legislation reintroduced without changes as Bill 21, schedule B of the proposed Safeguarding Health Care Integrity Act August to December 2014 In anticipation of the Bill 21 passing the Ontario College of Pharmacists (OCP) is: • developing the accreditation process for hospital pharmacies

• developing hospital pharmacy inspection criteria • adapting its drug preparation premises guidelines to hospitals • visiting hospitals on a volunteer basis October to December Legislation expected to pass December The OCP is set to pilot the draft inspection criteria 2015 OCP set to have visited all hospital pharmacies by the end of 2015 2015/2016 Legislation expected to be enacted

Increased collaboration sparks new ideas. And new opportunities. Our mission to alleviate pain, restore health and extend life, written more than 50 years ago by our founder Earl Bakken, has never wavered. Not even in the face of today’s challenging healthcare environment.

Innovating for life. HOSPITAL NEWS NOVEMBER 2014

UC201100972j EN © 2014 Medtronic, Inc. All Rights Reserved.

We’ve been at your side for decades, providing the most advanced, life-changing medical devices. Now let’s take the next step. Let’s build on our partnership to optimize healthcare delivery and access for your patients.

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014


Increasing the adoption of innovation ne of the biggest challenges facing the medical device industry in Canada is the slow pace of the adoption of innovation within the health care system. This is important because not only do new innovations have the capability to improve the lives and health outcomes of patients, but they can also enable smarter, more efficient healthcare which contributes to the sustainability of our health care system – a goal of governments and health care providers across the country. At the same time, we know that it is a time of transformation in healthcare, as providers and policymakers adapt to the health care needs of an aging population, while managing with scarce financial resources. With that focus in mind, MEDEC aims to work collaboratively with governments and other health partners on strategies to support the transformation the health care system. We are working to fulfill this goal through a number of channels, with one very important avenue being the Ontario Medical Technology Working Group. The Ontario government established the Medical Technology Working Group in the summer of 2013 to provide ongo-


ing policy advice to government and develop/propose strategic directions and initiatives relating to our industry. The Ontario Medical Technology Working Group consists of a number of representatives from industry, government and academia, and MEDEC is well-represented by a number of member companies, as well as MEDEC President and CEO Brian Lewis and VP Government Affairs, Nicole Dekort. The goals of the working group are to: 1. Maximize the industry’s contribution to high quality and sustainable healthcare; 2. Create a strong medical technology business environment in Ontario to ensure its continued growth and advance prosperity in Canada; 3. Position Ontario as a global leader in life sciences and a destination of choice for medical technology investment and development. Following the establishment of the Working Group, a few months later – in No-

vember 2013, the Ontario government launched the Ontario Health Innovation Council (OHIC). This 15 person council of health care leaders was created to accel-

erate the adoption of new technologies in our health care system and support the growth and competitiveness of Ontario’s health technology sector. Knowing that OHIC was going to be established, the Working Group decided to focus its efforts on preparing a report, including recommendations, which could be presented to OHIC and used for consideration as OHIC develops its plan to give to the Ontario government. The Medical Technology Working Group sought to better understand the challenges and barriers to achieving its goals and asked its industry members to examine these issues and inform the membership of its findings in the form of a brief report. While the report’s recommendations are focused on the Ontario health care system, many of the recommendations are applicable to improve the adoption of innovation in jurisdictions across the country. The group presented the report last spring to OHIC; here is a summary of its recommendations: Continued on page M10

An extension of your hospital pharmacy

Over 28 years of commitment to patient safety

Dedicated specialists working closely with pharmacists

Robust and continuous quality improvement



MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Bill 21

GE Healthcare

Time to start thinking smarter about probe disinfection The trophonÂŽ EPR delivers fast, automated high level disinfection (HLD) of intracavity and surface ultrasound probes in just seven minutes. The compact design means it can be conveniently located at the point of care, helping to improve patient workow, while the fully enclosed system helps protect both patients and staff by limiting exposure to harmful disinfectant chemicals. As a point of care solution, the trophonÂŽ EPR helps reduce the need to transport probes between the ultrasound suite and separate cleaning rooms. This means probes can be more readily available, which may result in fewer probes required for the same patient volume. HLD efďŹ cacy is crucial for semi critical medical equipment where there may be risks of cross contamination. Clinically validated trophonÂŽ EPR meets recognized global standards for HLD and disinfects both the probe shaft and handle at the same time. Probe manufacturers have approved trophon EPR for use with more than 600 probes. Process quality consistency is provided by sensors which monitor temperature, mist volume and ow rates, and sophisticated software which controls all aspects of the process at all times. At the end of each disinfection cycle, the trophonÂŽ EPR’s intelligent control unit determines that the cycle is successful and this is validated by the Chemical Indicator color change. trophonÂŽ EPR is environmentally friendly. The disinfectant cartridge and more than 70% of the device’s components are recyclable, and the system breaks the disinfectant down into environmentally friendly water and oxygen by-products. An optional traceability solution is available to link your patient with the probe and the procedure. The automated documentation and reporting helps to minimize errors and facilitate compliance with audit and accreditation requirements. Learn more at Š2014 General Electric Company – All rights reserved. trophon is a registered trademark of Nanosonics, Limited.

Continued from page M4 Thiessen’s report addressed how medications are to be better and more safely prepared by vendors and pharmaceutical companies. He also recommended stricter oversight by the OCP, Health Canada and other regulatory bodies regarding prepared products to meet the highest quality standards – particularly those associated with sterile compounding. Bill 21 appears to support his recommendations. For example, if a hospital pharmacy is mixing its own products, the new standards could require the pharmacist to have specific training and/or experience. He says hospital pharmacies compounding products will also need electronic records to document the contents of each product and quickly locate up-to-date patient records, should any mishap occur. Thiessen expects some hospitals will not be able to economically meet the new standards while being able to ensure quality. Hospitals may have to decide whether their own pharmacies will consider admixing inhouse or purchase from an outside vendor. That choice will likely be defined by what is in the best interests of the patient. This means that whoever does the product preparation follows the quality procedures outlined in the Thiessen report. When it comes to outsourcing choices, including IV admixing services, hospitals should look to the company’s product preparation performance, and whether it can be trusted in providing a reliable service and high quality products for patients. The trust and confidence aspect would likely include the engagement by the outsourcing vendor with the hospital, and the track

record in providing exemplary service. As to whether IV admixing should be part of an RFP or procured through a group purchasing organization (GPO), Thiessen predicts outsourcing may be the most viable option. A GPO may provide a valuable service to hospitals but the key is to ensure all conditions for vendors identified by the Thiessen report be clearly defined and known through an RFP, before a selection is made. Out-sourced manufacturers face Bill 21’s same criteria. A helpful resource for hospitals as they decide may be the Canadian Society of Hospital Pharmacists’ report “Guidelines for Outsourcing Pharmaceutical Compounding Services.� While Bill 21 proposes new standards in Ontario, there are also national pending developments by Health Canada. These include requirements to safeguard product preparation, including IV admixing, outside the OCP’s domain. National standards could ensure consistency of care and treatment across the country and prevent future similar incidents. Pharmacy, like medicine, dentistry and any art or science, is always renewing itself. And that renewal is often joined by initial friction to build new strength. “The moment you create higher benchmarks, comes some tension. The tension is you’ve got to deliver if you can, or find alternatives, if you can’t,� Thiessen says. “Patients, their families and the public can be encouraged by the proposed benchmarks,� says Thiessen. “They all intend to meet the highest expectations for product H quality, consistency, safety and efficacy.� ■Tania Haas is a freelance writer.

Time to start thinking smarter about probe disinfection The trophonÂŽ EPR delivers fast, automated high level disinfection (HLD) of intracavity and surface ultrasound probes in just seven minutes. The compact design means it can be conveniently located at the SRLQWRIFDUHKHOSLQJWRLPSURYHSDWLHQWZRUNĂ€RZ while the fully enclosed system helps protect both SDWLHQWVDQGVWDČşE\OLPLWLQJH[SRVXUHWRKDUPIXO disinfectant chemicals.

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Š General Electric Company – All rights reserved. trophon is a registered trademark of Nanosonics Limited MM0082-US-AD V01



Focus on MEDEC members making a difference in Canadian Healthcare

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014

A surgical evolution



Advances to cataract surgery could reduce complications and dependence on glasses New technological advances are transforming the landscape of cataract surgery with exceptional surgical precision and consistency as well as greatly extended parameters for implanted intraocular lenses. rom its origins in antiquity, cataract surgery has evolved into a highly successful outpatient procedure. Currently, 90 percent of patients experience improved vision following surgery. This success is due in part to innovations such as the post-World War II introduction of intraocular lenses to replace the clouded natural lens, and the invention of phacoemulsification surgery (a technique that uses ultrasonic vibrations to break up the natural lens for easier removal) in the late 1960s. Today, two technological advances are further transforming the landscape of cataract surgery: the use of femtosecond lasers and the introduction of advanced technology intraocular lenses. Some ATIOLs are multifocal, allowing a person to see att d different distanciffe if fere fe rent re ntt d i ta is tanc nc-nc es. Others, known as as accommodating accom cccom mmoda moda mo dati tiin tin ngg lenses, correct vision n by by shifting ssh hiiffti t ng n position pos osit itio ion ion io with the movement off tthe mulhe eeye. he y . Bo ye Both Both t m uul tifocal and accommodating od odat datting in ng ATIOLs AT TIO OLs L can can los ss ooff el ss eelasticity las asti as tici city iin city ci n correct presbyopia (aa lo loss the lens of the eye that at makes maak kes e it it harder haard r er er to to focus on nearby objects). cts) ct s).. s)


In femtosecond assisted cataract surgery (FACS), a laser replaces the scalpel and automates several key manual steps of the surgery. Toric lenses, another type of ATIOL, corrects astigmatism (vision that is distorted or blurred at all distances, caused by an irregularly shaped cornea). Implanting a multifocal, accommodating or toric IOL can offer patients improved p p vvision, vi siion sion on, w hile hi le rreducing ed ducin uccin u ng depe d de epeend nden ence en ccee oon n while dependence co ont ntact acct le llenses ens nses es aand nd d gglasses. laassses es. contact A is As is true true tr ue for for or all alll surgeries surrge geri riies es deemed deeeeme med d medically catame edi d ca call llyy necessary, ll neeceess nece ssar a y, y, cconventional oon nveent ntio iona io naal ca n cata taaract ract ra c replacement rep e la l cceeme m nt nt surgery sur urge geerryy is is covered cove co vere red re d health by provincial by pro rovi vin nciaal he nc h alth al t insurance, th ins nsur uran ur aan nce ce,, as are are sstandard st tan anda ndard dard da d IOLs. IOL OLs. s Currently, s. Cur u re rent ntly nt ly, th ly thee advances adva ad v nces va ncces ooffered offe of ffe fere red re d by b FACS FAC ACS and ACS an nd ATIOLs ATIO AT IOLs IO Ls are are re not not ot

considered medically necessary, meaning patients who opt for these treatments must pay for the FACS procedure, enhanced lenses and any associated diagnostic tests. Government, professional organizations and clinical practice guidelines concur that patients are entitled to receive medically necessary products and services without charge. At the same time, patients who are able and willing to pay for products and services that are not medically necessary, but are nonetheless desirable, have the right to know their options and make an informed decision based on full knowledge of the available alternatives. By being transparent about which services are covered by provincial insurance and which are not, healthcare providers allow patients to make fully informed choices. Surgeons can be confident that they are providing a high standard of care while offering patients the opportunity to take advantage of leading-edge ophthalmic technologies that offer the promise H of better vision. â–

Femtosecond Assisted Cataract Surgery (FACS) In conventional cataract surgery, a surgeon uses a scalpel to make an incision in the cornea (the transparent layer covering the front of the eye), and removes the cloudy lens using phacoemulsification. In femtosecond assisted cataract surgery (FACS), a laser replaces the scalpel and automates several key manual steps of the surgery. With FACS, a surgeon is able to produce incisions that are extremely precise and consistent from one patient to the next. This improved precision may translate into better visual acuity(4) and allows for more accurate placement of the artificial intraocular lens (IOL) that replaces the natural lens, reducing the risk of lens decentration (a complication that can interfere with patients' vision). FACS is also associated with a lower likelihood of tearing the capsule (the structure in the eye that holds the lens). As standard IOLs are monofocal (allowing the eyes to focus at only one distance), patients often still need to wear contact lenses or glasses following surgery. Advanced technology IOLs (ATIOLs) can help reduce dependence on contact lenses and glasses by helping to correct vision issues that require people to wear corrective lenses. h it l m



Focus on MEDEC members making a difference in Canadian Healthcare


MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

The LenSx® Laser: Smarter. Better. Faster. As the proven global leader in laser refractive cataract surgery, the LenSx® Laser has been designed as an image-guided workstation since its inception. To enhance the precision and reproducibility of your procedures, choose the smarter, better, faster LenSx® Laser system.

SMARTER Unlike competing systems that may not perform consistently at every tissue plane, the LenSx® Laser provides: • Variable numerical aperture to optimize capsulotomies, fragmentations and incisions

Optimized Variable Numerical Aperture

Aperture optimized for: Cornea

Aperture optimized for: Capsule

Aperture optimized for: Lens

Ask your Alcon representative about the LenSx® Laser.

© 2013 Novartis 5/14 SU141119



Focus on MEDEC members making a difference in Canadian Healthcare

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014


The LenSx® Laser: Smarter. Better. Faster. As the proven global leader in laser refractive cataract surgery, the LenSx® Laser has been designed as an image-guided workstation since its inception. To enhance the precision and reproducibility of your procedures, choose the smarter, better, faster LenSx® Laser system.

SMARTER The LenSx® Laser OCT delivers excellent definition, depth and analysis: • Only high definition OCT to image entire anterior segment in one scan through 8.5 mm depth • Single, complete 360˚ scan that coincides with the capsulotomy pattern location to ascertain the true depth and tilt of lens • Eliminates potential error resulting from stitching together or processing images

Circle scan

Line scan

LenSx® Laser OCT

Ask your Alcon representative about the LenSx® Laser.

© 2013 Novartis 5/14 SU141121



Focus on MEDEC members making a difference in Canadian Healthcare

M10 MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Adoption Continued from page M5

Improving communication flow

Industry and the health care system could both benefit from improved dialogue and information exchange. This theme emerged in many of the groups’ discussions, across nearly all issues related to the medical technology industry. There was consensus that the medical technology industry should be better educated about Ontario’s health care system and its priorities and objectives, and at the same time the health care system should be better educated about available technology and global best practices in relation to medical innovations. To improve upon this, the group recommended that the government should identify an entity within The Ministry of Health and Long-Term Care to establish a health innovation office/officer and also consider mechanisms for technology solution seekers and solution creators that would enable the flow of information amongst health system partners. It was also recommended that mechanisms be considered for technology solution-seekers and solution creators that would enable: • Health technology users, health system managers and administrators to communicate their health priorities to industry, innovators and entrepreneurs; • Clinicians/users to collaborate with industry in creating health solutions; • Companies to showcase their new technologies and capabilities to generate

The Ontario Health Innovation Council (OHIC) with former Minister of Health Deb Matthews. This 15 person council of health care leaders was created to accelerate the adoption of new technologies in our health care system solutions for health care system challenges /needs

Adoption pathways and alignment of research and development (R&D) investments with health system priorities

Paths to the adoption of innovative technology into the health care system can be complex at times. One of the most prominent themes in the discussions was that there are many pathways and entry points for the adoption of new medical technologies in Ontario, which can be difficult for companies that commonly op-

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erate on a global scale to navigate locally, as well as small companies that do not have staff who can guide them through processes. For the innovator, there are no clear sources of information, or navigation tools available about appropriate parties they should engage and what they should know about the path to adoption at the health care system level, within a program area, across programs, or at an institution. Similarly for health technology endusers, there are no adequate clear sources of information or navigation tools to lead them to best-in-class technologies that are available right here in Ontario or to innovators who have the expertise and capacity to create new solutions that do not yet exist. Additionally, the cost and adoption of a medical technology goes beyond purchasing the product. Unlike consumables such as pharmaceuticals, medical technologies incur a utilization cost, the cost of clinicians and health care professionals carrying out a procedure where a new technology is involved, or the cost of training the practitioner if required. That said, in many instances there are often no fee codes to support the use of new technologies that are currently available in the market. The Ministry of Health and LongTerm Care is reforming its approach to funding of hospital budgets from a global budget funding model to a new model that includes a Patient-Based Funding component. There was strong support for current health care funding reform initiatives in Ontario, and it was noted that Quality Based Procedures are an area of high opportunity for the adoption of new medical technology. There is also a need to improve the alignment between the R&D investment into new medical technology and the governments’ health system policies and priorities. R&D programs and investment decisions in the medical technology industry are in many cases, not aligned with priority health care issues and concerns. Government invests in R&D in the medical technology industry in Ontario, but we miss an opportunity to benefit further from those investments by not using a portion of that existing investment to help companies bring successful technologies to market in Ontario.

Procurement of innovative medical technologies

Procurement objectives related to innovative technologies could be made clearer for the industry, and strategic objectives in procurement could be better aligned to consider the value of technology across the entire health care system. While there are strong government guidelines in relation to the process for purchasing technology, there is an opportunity to evolve the purchasing mechanisms to strategically align their objectives with the objectives and priorities of the health care system from a health quality perspective. Some key themes from the report’s recommendations on improving procurement include: • Making it a more collaborative and transparent process – engaging with industry to seek solutions through pre-RFP dialogues. This process could lead to better informed specifications being written into an RFP that supports adoption. • Establishing procurement mechanisms to acknowledge the value of medical technologies. • Reducing the complexity of procurement processes and allowing for shorter procurement cycles given the speed of new innovations becoming available for patients. Another idea presented is to have the specification of purchasing requirements consist of functional performance parameters (for example, a specific health outcome or health care solution) or standards which allow suppliers to produce any configuration of technology they feel can meet the needs of the health care providers. While the report is complete, we believe that the recommendations presented by the Ontario Medical Technology Working Group provide opportunities for dialogue and offer ideas to develop strategies that can both improve patient outcomes and contribute to health system sustainability through innovative medical technologies. We look forward to the recommendations that will soon be brought forward by the Ontario Health Innovation Council and MEDEC looks forward to our continued engagement with our health system partners across the country to improve the H healthcare system for patients. ■ For more information on the Ontario Health Innovation Council (OHIC) please visit

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014 M11

The LenSx® Laser: Smarter. Better. Faster. As the proven global leader in laser refractive cataract surgery, the LenSx® Laser has been designed as an image-guided workstation since its inception. To enhance the precision and reproducibility of your procedures, choose the smarter, better, faster LenSx® Laser system.

BETTER Competing patient interface technologies can be messy or inconvenient. The proprietary LenSx® Laser with SoftFit™ Patient Interface technology: • Is designed for both cataract and corneal work • Facilitates free-floating capsulotomies • Reduces IOP rise (16 mmHg increase over baseline)1 and laser time (33% faster)2 • Simplifies docking even with deep-set or small eyes • Fixates the eye, eliminating the need to tape down the patient’s head

Soft contact insert docking into patient eye

Free-floating capsulotomies

Ask your Alcon representative about the LenSx® Laser.

1. ER13 - 098 - SoftFit™ Patient Interface - IOP Assessment. Alcon data on file. 2. LenSx® Laser systems have undergone continuous improvement since launch to reduce both laser time and procedure time. Alcon data on file.

© 2013 Novartis 5/14 SU141123


M12 MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Ahmed Elnady (left) and Gil Herrnstadt wearing a device that could assist people in regaining neurological control of their arms and hands.

Dr. Ryan D’arcy, Surrey Memorial Hospital Foundation B.C. Leadership Chair in Multimodal Technology for Healthcare Innovation at the Surrey Neurotech Lab at Surrey Memorial Hospital.

Partnership-driven innovation urrey’s Innovation Boulevard operates on the shared belief that entrepreneurship, partnership, and access to the clinical environment can advance and commercialize health technology solutions faster to improve patients’ lives. Today, Innovation Boulevard has emerged as one of Canada’s fastest-growing health technology innovation clusters.


Co-location and partnerships

Innovation Boulevard is a network of health institutions, universities, compa-

nies and talented people located within one square mile in Surrey’s City Centre between Simon Fraser University (SFU) and the Surrey Memorial Hospital (SMH) campus. It concentrates the region’s health technology assets and efforts to drive health care advances through technology based business growth focused on medical, independent living, and digital health technologies. Innovation Boulevard is partnershipdriven and has established relationships with four universities, the Fraser Health Authority, Surrey Memorial Hospital, the City of Surrey, industry associations, devel-

opers and a large number of health technology based companies

A hospital campus and research university located downtown

Surrey Memorial Hospital is home to the busiest ER in British Columbia, a University of British Columbia teaching hospital, and its recent half-billion dollar expansion represents the largest health infrastructure investment in British Columbia’s history. SFU Surrey’s science, engineering and business faculties produce leading health technology innovations from a portable concus-

Exciting new cross-border Health Corridor Initiative recently launched in Windsor By Deborah Livneh

anadians often associate Windsor Ontario with the auto sector. However, on Monday, September 15th, MEDEC representatives travelled to Windsor for an exciting, ground-breaking initiative involving the medical sector. MEDEC CEO, Brian Lewis and VP of Government Relations, Nicole DeKort were in Windsor to meet with medical technology companies and to help launch an important Health Corridor initiative for the Windsor-Detroit region. Over the past year, the Windsor-Essex Development commission, WEtech Alliance (the local Regional Innovation Centre), and other community partners have worked to develop the Cross-Border Health Corridor Initiative. The unique geographical proximity of Windsor to Detroit offers access to worldclass medical institutions, universities, and educated personnel on both sides of the border, while at the same time allowing companies to take advantage of Canada’s regulatory framework, generous incentives for research and development (R&D), and the lower cost of doing business in the region. A corridor that has one foot in Canada and one in the US has the potential to facilitate faster adoption of new and innovative products for the health care system. This initiative aims



at supporting R&D and clinical trials to attract medical innovators and build a thriving, reputable medical corridor in the region. The high-profile launch was conducted at the Hotel-Dieu Grace Hospital. The participants included the CEOs of the local hospitals, the college CEO, university Deans and researchers, and community leaders involved in the medical industry and cross-border projects. About 20 industry representatives – mostly the presidents of medical technology companies from the region and beyond in Canada and the US, also attended and for the first time, had an opportunity to engage with MEDEC and MEDEC’s Michigan counter-part, MichBio. The conference was chaired by Sandra Pupatello, a former Ontario MPP and cabinet member and one of the most prominent leaders in the Windsor community. In her current role as the CEO of the Windsor-Essex Economic Development Corporation, she ensured that the presentations and discussions were focused on supporting life science companies, reducing border barriers, and landing out-oftown medical companies in the region. MEDEC CEO Brian Lewis outlined the baseline characteristics of thriving medical technologies communities in Canada. He concluded that the proximity of Windsor and Detroit, the presence of a high tech workforce and large hospitals with significant specialty base, as well as, a di-

verse population are key advantages for this region. “We know that access to markets, capital, and incentives are very important” said Lewis. “The success rate of innovative medical companies increases when the focus is on adoption, adoption and adoption.” Bill Marra, VP at the hosting hospital, discussed the opportunity to support the medical industry and led participants on a short tour of the facility. Rakesh Naidu, COO of Windsor Essex Development commission presented evidence of the advantages of carrying out clinical trials, R&D, and manufacturing in Windsor Essex. Deborah Livneh, Entrepreneur-in-Residence at WEtech Alliance described several of the acceleration programs offered to health technology innovators and offered help in commercializing new medical technologies. She also announced the DetroitWindsor Hacking Health event scheduled for the spring. At the end of day, it was clear that the visit of MEDEC leaders was a great catalyst for the launch of a long term vision. A life science industry Peer Group was initiated and the cross-border Health Corridor initiative was welcomed by stakeholders from both sides of the border. Community partners expressed eagerness to engage collaboratively and move forward in supporting a thriving H health sector in the region. ■

sion diagnostic system to an app that helps users detect the onset of skin cancer. Surrey Mayor Dianne Watts and SFU’s Dr. Ryan D’Arcy have been building partnerships to capitalize on the assets located in Surrey and the region. Dr. D’Arcy is the SMHF BC Leadership Chair in Multimodal Technology for Healthcare Innovation at SFU and the Head of Health Sciences and Innovation for SMH. These complementary roles have created significant new connections between the two institutions and beyond.

Clinically-embedded labs

In just over a year Innovation Boulevard has opened four clinically-embedded labs that provide companies and researchers access to the hospital, a privately-owned independent living facility and a university: • The Neurotech Lab at SMH focuses on point of care devices for brain vitality. • The Innovation Centre at the Retirement Concepts care facility focuses on independent living technologies. • The Digital Health Hub at SFU specializes in mobile health solutions. • Health Tech Connex is a health services advancement company with 12,000 square feet of innovation space located across the street from SMH.

Innovation Boulevard is a network of health institutions, universities, companies and talented people located within one square mile in Surrey’s City Centre between Simon Fraser University and the Surrey Memorial Hospital

A translational images centre and rapid prototyping facility are also currently under development. This access benefits both health technology companies and researchers. Health technology companies connect clinicians to technology innovation, perform research spanning from discovery to commercialization of health technology products, and are then able to better refine prototypes and business plans. Researchers are able to access clinical research opportunities and find partners to commercialize H technologies. ■

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014 M13

The LenSx® Laser: Smarter. Better. Faster. As the proven global leader in laser refractive cataract surgery, the LenSx® Laser has been designed as an image-guided workstation since its inception. To enhance the precision and reproducibility of your procedures, choose the smarter, better, faster LenSx® Laser system.

FASTER1 Designed to minimize procedure time for faster patient throughput from start to finish: • Laser time of 30-45 seconds,* minimizing laser time to the eye • Surgeon-selectable patient flow into and out of the OR • Compatible with a range of surgical beds • Simpler and easier patient docking2

Simpler docking – patient’s head does not need to be taped down

Ask your Alcon representative about the LenSx® Laser.

*Based on typical laser treatment parameter for cataract surgery. 1. LenSx® Laser systems have undergone continuous improvement since launch to reduce both laser time and procedure time. Alcon data on file. 2. Multicenter prospective clinical study (n=882 eyes). Alcon data on file.

© 2013 Novartis 5/14 SU141125


M14 MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

The value of medical technology: or more than 40 years, MEDEC members have been leaders in pioneering leadingedge medical technologies. These technologies will continue to play an increasing role in our health care system because as people work and live longer, demand for health services increase, and the need for governments to devise innovative, efficient approaches to delivering care heightens. One of the benefits of medical technology is that it enables clinicians and researchers to devise new and innovative techniques to deliver better healthcare. These techniques often result in shorter procedure times, reduced recovery times and better health outcomes for patients, while also improving the system as a whole. One example of this is minimally invasive procedures.


Credit: Doug Nicholson, Sunnybrook Media Source.

Enabling minimally invasive procedures

The TAVI or TAVR procedure involves implanting a new heart valve without opening the patient's chest.

What are minimally invasive procedures?

“Minimally invasive procedures” describe a number of minimally invasive surgeries as well as diagnostic procedures. It includes both laparoscopy (surgery through small incisions) and endoscopy (diagnostic and therapeutic procedures performed through the body’s organs and vessels). Traditional surgeries usually require a long incision made through muscle, which needs a significant time to heal. Surgeons performing minimally invasive procedures often do not have to cut through muscle, resulting in less tissue damage and quicker recovery. Many minimally invasive procedures are made possible by innovations in medical technologies. For example, some minimally invasive procedures use a fiber op-

tic camera and miniaturized instruments. Highly-trained surgeons insert small tubes into small incisions allowing the use of video-assisted equipment, providing surgeons with better magnification and visualization of internal organs and structure, which leads to benefits such as higher accuracy rates and reduces the chance of complications.

What are the many benefits of minimally invasive procedures?

Compared to traditional (open incision) procedures, minimally invasive procedures generally provide better outcomes for pa-

tients and reduce costs to the health care system. Benefits to the patient and to the health care system include: • Reduced chances of complications or infections • Shorter hospital stay • Higher accuracy rates • Shorter recovery time • Less blood loss resulting in cost-savings and decreased strain on blood supply resources • A quicker return to work and other regular activities • Less injury to tissue • Smaller, less noticeable scars

• Fewer hospital resources needed (e.g. nursing care) • Smaller doses of pain reliever needed One United States study of three common surgical procedures – hysterectomy, gallbladder removal and appendectomy – showed that minimally-invasive operations both reduced the overall cost of care, and shortened hospital stays when compared to conventional surgery. Another U.S research team calculated that during 2009, (just) six technologically advanced and minimally invasive surgical procedures contributed a cost savings and workplace value of more than $11 H billion. ■

Example of minimally invasive procedures A better alternative to open heart surgery A potentially deadly condition, and now the most common valvular heart disease in the Western World is a condition called aortic stenosis (AS). This condition occurs when a patient’s aortic valve cannot open and close properly. The heart becomes strained and can cause breathlessness, swollen ankles, chest pain, dizziness and blackouts. Some patients may be too ill to undergo open-heart surgery to correct the problem. A less invasive procedure – called transcatheter aortic valve replacement (TAVR) – allows a valve to be implanted using a catheter threaded through a large blood vessel in the groin or a small incision in the chest. A pivotal clinical trial showed that this less invasive procedure decreased mortality after one year by 45 per cent compared to open-heart surgery. Additionally, recent Canadian and United Kingdom health economic analyses conclude that this less invasive procedure is very cost-effective compared to the medical management of patients who are not good candidates for open-heart surgery. HOSPITAL NEWS NOVEMBER 2014

Laser therapy to treat enlarged prostate Enlargement of the prostate, or benign prostatic hyperplasia (BPH), is a condition that affects nearly half of all men over 50 and close to 90 percent of men over 80 worldwide. It’s a condition that causes urinary complications that can include a weak flow, the sudden feeling of urgency to urinate (often in the middle of the night), inability to fully empty the bladder and incontinence, among other symptoms. Prolonged BPH without treatment can lead to urinary tract infections, inability to pass urine and even bladder or kidney damage.

improving treatment and saving health care costs. This procedure – called photoselective vaporization of the prostate (PVP) involves the use of a laser to quickly vaporize and safely remove prostate tissue. PVP is a minimally invasive procedure that offers many benefits over TURP, including virtually no blood loss, faster recovery time and the fact that it can be performed in an outpatient setting.

Since the 1930s, an invasive surgical procedure known as transurethral resection of the prostate (TURP) had been the standard for treating BPH. This procedure involves the use of a surgical instrument to trim away excess prostate tissue that’s blocking urinary flow. While this is an effective procedure, it typically requires a hospital stay, can take several weeks for the area to heal completely and produces a number of side effects.

In addition to patient benefits, a 2013 study by Health Quality Ontario, an Ontario government agency that evaluates the effectiveness of new health care technologies, compared PVP with the more traditional TURP procedure. The study found PVP to be a more cost-effective alternative, providing similar or better clinical benefits to patients but at a lower cost to the health system. The results also indicated that patients recovered faster with fewer side effects and complications following surgery. Were it to be deployed across Ontario, the HQO study estimates an annual cost saving of $14M and 28,213 days saved in hospital bed occupancy.

However, recent technological advancements have led to the introduction of a therapy that is both

The PVP procedure “has a lower incidence of post-operative complications and requires less

Photoselective vaporization of the prostate (PVP) involves the use of a laser to quickly vaporize and safely remove prostate tissue and is a minimally invasive treatment for an enlarged prostate. hospitalization” says Dr. Paul Whelan, a urologist at St. Joseph's Hospital, Hamilton and contributor to the HQO study. “And with an aging demographic, it's also good for the future of Ontario's health care system”. Minimally invasive procedures like TAVR and PVP offer many exciting new opportunities with significant benefits to patients and the health care system. While these procedures unfortunately have not yet reached optimal levels of adoption in Canada, MEDEC continues to work with our government and health care partners on solutions to ensure that technologies that are enabling procedures such as TAVR and PVP are more quickly adopted into the health care system.

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2014 M15

Sending more patients home

FASTER AND SAFELY from Critical Care

An innovative, non-invasive Ventilator Early Weaning Program at St. Mary’s Hospital at Waterloo (Ontario) delivered an annual savings of $1.35 million by reducing up to 3,000 ALC days.1 Puritan Bennett ventilator with PAV™*+ helps decrease asynchrony2 and helps patients wean faster and improve quality of life by allowing patients to help direct the flow and timing of ventilator support based on their real-time demands.3 To find out more:

1. St. Mary’s General Hospital. (2013). Sending more patients home faster and safely from Critical Care [Press release]. Retrieved from 2. Xirouchaki N, Kondili E, Vapoidi K, et al. Proportional assist ventilation with load-adjustable gain factors in critically ill patients: comparison with pressure support. Int Care Med. 2008;34:2026-2034. 3. Younes, Magdy. Proportional Assist Ventilation, a New Approach to Ventilatory Support. Am Rev Respir Dis. 1992; 145:114-120. COVIDIEN, COVIDIEN with logo and Covidien logo are U.S. and internationally registered trademarks of Covidien AG. TM * Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license. Other brands are trademarks of a Covidien company. © 2014 Covidien.


M16 MEDEC 2014 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

SAVE THE DATE: MEDEC’s 2015 MedTech Conference April 29 and 30! The annual signature conference of MEDEC and the Canadian medtech industry will take place on April 29 and 30, 2015 at the Sheraton Toronto Airport Hotel & Conference Centre, 801 Dixon Road, Toronto. MEDEC’s MedTech Conference is Canada’s preeminent information exchange and educational forum for the medical technology industry – tackling issues such as innovation and change within the healthcare system. Attendees will hear from and engage with high-profile health system leaders and network with colleagues. Previous year’s conferences have hosted dignitaries such as Ministers of Health, Hospital CEOs and other influential thought leaders. This year is shaping up to be no different!

Registration information

coming soon

MARK YOUR CALENDAR and plan to join us for MEDEC’s not-to-be-missed annual conference!

Sign up for conference updates via email at with the subject line Medtech Conference. HOSPITAL NEWS NOVEMBER 2014


Focus 25


26 Focus


The power of people: Enhancing the patient experience By Andrea MacLean

s health care workers and leaders, it’s our job to provide expert, compassionate care to our patients. We go to school, get our credentials and apply these skills day in and day out. All with the purpose of helping the patient feel better, healthier and hopefully, ultimately, happier. At Bruyere Continuing Care, one of Canada’s largest health care organizations, the art of enhancing the patient experience comes from many roles other than the direct care team (i.e. patient’s immediate nurses and doctors). The staff supporting hospital operations plays a vital role and have a positive impact on patient care experience. Imagine for a second your husband of 20+ years. At the young age of just 53, he has begun counting his time on earth in weeks and days. He’s palliative, he’s tired and he wants to feel happy again. If only for an hour… Now imagine a cool September day, where you want to do something special for your husband and his wide circle of family and friends. Why not have a concert right in the hospital? Thanks to a quick collaboration between you, and support from corporate communications and Bruyere Foundation within hours a four piece band is filling the halls with joyful Celtic music. It is a powerful, emotional moment, one you will always remember. This happened at Bruyere, you can watch what transpired next: Google: youtube + music to our ears + Bruyere. You can see Bill – the man of the hour – tapping his toes to the music. Without a doubt, those tapping toes show an enhanced patient experience. Sadly, Bill


Bill Fedun is surrounded by his family and friends and another patient who enjoyed the concert in the hospital. lost his battle with cancer in October at Bruyere’s Elisabeth Bruyere Hospital.

Volunteers and the patient experience

Bruyere Continuing Care has over 700 volunteers who are at the heart of our large, multi-site organization. One such volunteer, Yih Lerh Huang has transferred his expertise and life’s work in high tech to the patients at Bruyere’s Saint-Vincent Hospital. Saint-Vincent Hospital is Ontario’s exclusive complex continuing care program. With 336 beds, this hospital fills an incredible need in the region’s health care system. Patients in this program are managing challenging health care issues, many have lost the ability to communicate through traditional means. However, thanks to Yih Lerh Huang and the passionate team in the Augmentative and Alternative Com-

At some point, everyone can use a hand.

munication department, the world has opened up in ways they had only dreamed. Patient Molly can SKYPE with her sister in British Columbia thanks to a headband from the corner store and a Gyroscope. Watch Howard a former engineer who, although he is struck with ALS, he still has a sharp mind. Howard is able to read the news and listen to classical music simultaneously thanks to the Tobii Eye Tracker. Google: YouTube + engineering at Bruyere Yih Lerh doesn’t get paid and rarely leaves before 5 p.m. most days – but he knows he is enhancing the patient experience.

Helping patients navigate the system

Navigating the health care system is stressful for the patient, the family and the caregiver.

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At Bruyere, there was a gentleman whose mom had done a health care tour of Ottawa due to her debilitating turned terminal illness. He was tired and run down from the hand-over-fist money exchange and constant search for information. The entire family was in a state of shock over the money being paid to various social services in order to keep both his life and that of his mom’s afloat for the last six months. It was one comment, likely mentioned a dozen times a week at Bruyere’s Accounts Payable department, as part of the admission script that changed everything. As the son went through the admission paper work process he had done so many times before, the employee gently smiled and said, “Sir, please don’t worry, you’ll never receive a bill from us.’

A portrait of caring

Finally, there’s Ruth – an accomplished portrait photographer – who has been walking her dog Diesel past patients sitting outside one of Bruyere’s five sites for 20+ years and has been so intrigued about this community of people young and old. Ruth contacted Bruyere offering to capture as many of the 336 patients interested in telling their story through photography. The patients who are participating say they are “flattered,” and “honoured,” that someone in the community has taking a special interest in them.

Process, policy and people

As health care leaders, we keep an eye on process and policy. For example, some health care organizations are considering removing visiting hours entirely – because it’s the comfort of the loved ones visiting which enhances the patient’s experience. At Bruyere Continuing Care we are astutely aware of the most important ‘p’ to consider – people. Regardless of what role you play either inside the hospital or as member of the community, we can all enhance H the patient experience, n Andrea MacLean is Director of Communication, Donor & Digital Engagement at Bruyere Foundation.

Judith Hull & Associates Professional Corporation



Focus 27

Yukon hospitals launch patient experience survey at the bedside By James Low

ith a few taps of a finger, patients at Yukon hospitals will be among the first in Canada to use tablet computers to provide feedback about their care. But what makes this patient experience survey even more unique is that it’s delivered by nursing staff and liaisons from Yukon’s First Nations Health Program at the bedside, just before discharge from hospital.


The tablet with the survey is secured to a customized IV pole, which can be easily wheeled from one bed (or treatment space) to the next. “Each day our team is focused on safe and excellent care and how our patients feel about their care is very important to us,” says Maureen Turner, Executive Director of Patient Experience at Yukon Hospital Corporation, which oversees the three acute care hospitals in the territory. “Asking about their experience – from the cleanliness of our facilities to the responsiveness of our care – is a key part of our

care and continuous improvement efforts.” The tablet with the survey is secured to a customized IV pole, which can be easily wheeled from one bed (or treatment space) to the next. Using the touchscreen device, patients answer 10 short questions related to their overall hospital experience with an option to participate in an additional, more detailed survey at a later date. Previously, a traditional, paper-based survey was mailed to patients after a hospital stay. In many cases, feedback would be reported back months after discharge. However, the tablet has cut this time significantly with results now available on a rolling monthly basis. Turner adds that a number of survey options were considered, but a tablet made the most sense given the benefits to patients and staff. “When the hospital experience is so close-at-hand, a point-of-care survey collects the most relevant feedback and offers timely information, so we can act quickly on what our patients tell us,” she says. “This approach also gives our direct care providers more opportunity to connect with patients and start a conversation about their experience.” The survey started as a pilot project in the inpatient units at Whitehorse General

Sean Secord, Clinical Care Manager at Whitehorse General Hospital, presents a new patient survey on a tablet computer. The mobile technology is being used at the point-of-care to help Yukon hospitals measure the patient experience. Hospital, which is a 55-bed facility and Yukon’s primary acute care centre. This was enabled by the recent launch of a facilitywide wireless internet service, which was made possible through support from the Yukon Hospital Foundation. The tablet survey has now been introduced to WGH’s emergency department with plans to roll out to outpatient service areas as well as the community hospitals in Dawson City and Watson Lake. The hospitals are working with an independent, third-party provider to manage the survey and ensure patient feedback is kept anonymous and confidential. Preliminary results have been very positive in terms of patient participation and

overall high satisfaction with hospital care. Jason Bilsky, the hospital corporation’s CEO, notes that both nursing staff and patients have been excited to take part. “Patients are eager to tell us about their experience. This is great news because we want them to be engaged and involved in their care,” he says. “Like many health care facilities across the country, we continuously look at a number of measures to ensure we provide a high standard of care, and we recognize as care providers, that it’s essential to know if we’re also meeting needs and H expectations.” n James Low is Communications Manager at the Yukon Hospital Corporation.

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28 Evidence Matters

Proton Pump Inhibitors: Are we doing no harm? By Sarah Jennings and Dr. Janice Mann ngoing stomach and digestive problems can be miserable for patients – and are a common cause for visits to a health care professional. Patients are often looking for a prescription to help ease their symptoms and health care professionals want to be able to help their patients. But what if the medication prescribed puts patients at risk? Proton pump inhibitors (PPIs) are some of the most commonly prescribed medications in Canada. They suppress acid production in the stomach and are highly effective in the treatment of common conditions such as peptic ulcers and gastroesophageal reflux disease (GERD). They may be used for ulcer prevention as well, in people taking ASA or NSAIDs, or in hospitalized patients at risk of stress ulcers. PPIs can bring relief to patients with long-standing or severe heartburn, and complaints about any side effects are rare. And, with generic versions of the drugs available, PPIs are also less costly. So, what’s the harm? Dexlansoprazole, esomeprazole, omeprazole, pantoprazole, pantoprazole magnesium, and rabeprazole are indeed very tolerable, with few day-to-day side effects. But as we’ve gained more experience with these drugs, a list of complications has


emerged: pneumonia, hypomagnesemia, fractures, and Clostridium difficile infection have all been associated with PPI use. Clostridium difficile infection (CDI, or as it’s commonly called “C. diff”) is a bacteria that can cause watery diarrhea, fever, loss of appetite, nausea, and abdominal pain. It is transmitted through stool or through spores in the environment. C diff. is a constant concern in the hospital.

Given that there is a link between PPI use and C. diff infection, careful and thoughtful use of these drugs is warranted.

It’s reported to occur in 4.6 cases per 1,000 patient admissions, with a mortality rate of 5.7 deaths per 100 cases. Hospitalization and the use of broad spectrum antibiotics are well-known risk factors for C. diff. Other risk factors include residence in a long-term care facility, advanced age, immunosuppression, surgical procedures,

comorbidities – and the use of acid-suppressing drugs. In fact, Health Canada in 2012, issued an advisory about the possible association of C. diff and PPI use. Today, PPI product monographs all carry warnings that a decrease in stomach acid may increase the risk of gastrointestinal infections such as Salmonella, Campylobacter, and C. diff. CADTH – an independent, evidencebased agency that assesses health technologies – finds and summarizes the research on drugs, medical devices, and procedures. CADTH’s Rapid Response service recently completed three reviews of the evidence on PPIs and C. diff. The first CADTH review looked at the evidence for the risk of developing a C. diff infection in adults taking PPIs. The review of the evidence showed that there is indeed a link between C. diff infection and the use of PPIs – but that the nature of the link is unclear. There just isn’t enough evidence to prove that PPI use causes the development of a C. diff infection. The second review looked at whether natural health products such as probiotics could help to prevent C. diff infections in hospitalized patients taking PPIs. A previous CADTH review had found that the probiotic Saccharomyces boulardii may

reduce the risk of recurrent C. diff infections in patients taking antibiotics, but wasn’t specific to patients also taking PPIs. However, the question of probiotics for C. diff prevention remains unanswered – the CADTH review was unable to find any evidence on this. The final CADTH PPI review addressed another question important to this issue. It’s estimated that a significant proportion of patients taking PPIs are actually being prescribed these drugs inappropriately – in other words, they don’t have conditions requiring ongoing PPI treatment or they may be taking the medication at the wrong dose or for too long. With this in mind the CADTH review looked at cessation programs that have been developed to help reduce the use of PPIs. The review of the evidence showed that cessation programs focused on clinicians or patients may be effective in reducing PPI use but it’s unknown whether that reduction leads to fewer C. diff infections or better health outcomes for patients. So what does all this mean for clinicians prescribing PPIs and for patients taking them? Given that there is a link between PPI use and C. diff infection, careful and thoughtful use of these drugs is warranted. Continued on page 29

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Focus 29


Point of Care Leadership Rounding By Zita Raponi alton Healthcare Services (HHS) is currently exploring a new, innovative approach using mobile technology to gauge patient experience at Milton District Hospital (MDH). HHS is the first Canadian health care facility to pilot a unique application (app) called Point of Care Leadership Rounding.


Patient experience is a complex entity that extends well beyond the actual medical care a patient receives during their hospital stay. It starts with how a patient is welcomed upon their arrival at the hospital and includes everything from the quality of their meals to the comfort and privacy of their room. This app measures key aspects of a patient’s experience through confidential patient interviews conducted by hospital leaders at the bedside using their cell phones or tablets. The app was developed by National Research Corporation Canada (NRCC), formerly known as NRC Picker. Joan Jickling, HHS Director, Quality and Patient Relations explains that patient experience is a complex entity that extends well beyond the actual medical care a patient receives during their hospital stay. It

starts with how a patient is welcomed upon their arrival at the hospital and includes everything from the quality of their meals to the comfort and privacy of their room. It also encompasses the patient’s interactions with everyone they encounter during their stay, from the volunteer or the housekeeper to their entire health care team. It may even be influenced after discharge by the attitude of the clerk when the patient pays a hospital bill. “Understanding all aspects of a patient’s experience is essential to providing quality care and it is absolutely essential to any improvement initiative,” explains Jickling. “The challenge is determining how best to measure something this intricate and multi-layered.” After downloading the Point of Care Leadership Rounding app to their tablets or cell phones, leaders (Managers, Directors, Chief Operating Officer) can survey patients throughout the hospital, on inpatient units as well as the Emergency Department. The app guides them through a series of structured questions and helps them capture the data with ease. It also helps them respond to service recovery opportunities such as an overflowing garbage can or a missing meal by simply sending alerts to food services, environmental services or housekeeping to resolve these issues quickly. Since the rounding is done by bed number, no identifying information is captured so patient information is kept confidential. “Our leaders at MDH have embraced this new approach enthusiastically, and are capitalizing on the opportunity to learn about patient experiences first-

Janet Skupsky, Milton District Hospital’s Chief Operating Officer, interviews a patient. hand,” notes Denise Hardenne, HHS President and CEO. “Point of Care Leadership Rounding streams data in real time so leaders can share the patient feedback with their staff immediately. It provides care teams with a quick snapshot of their results so they can adjust their workflows and processes on the spot, as needed, in order to enrich the patient experience.” “With constant changes in our clinical processes, we want to make sure that what we are doing really makes sense from a patient perspective. Point of Care Leadership Rounding is a chance to purposefully chat with patients, discuss their care, explore their suggestions and help elevate their experience, all while collecting valuable data,” explains Janet Skupsky, MDH Chief Operating Officer. “It is a great way to engage patients and it provides us with more immediate feedback on what is working and what is not.” Like most Ontario hospitals, HHS also uses the services of the NRCC to conduct regular confidential patient satisfaction surveys on an ongoing basis. NRCC sends patient satisfaction questionnaires to a random selection of recently discharged HHS patients, analyzes the returned surveys and generates a detailed report for HHS. “HHS will continue to use a variety of

tools to measure patient experience. This new approach provides us with yet another way to tap into patient experience,” explains Sylvia Rodgers, Chief Nursing Officer & Professional Practice Leader. “It complements the information we receive through the mailed out NRCC Patient Satisfaction Surveys and will be valuable in helping us develop initiatives and corporate strategies aimed at improving patient experience.” The Point of Care Leadership Rounding initiative will be introduced at OakvilleTrafalgar Memorial Hospital and Georgetown Hospital later this fall. As an Internist and Critical Care Specialist at Halton Healthcare Services’ Oakville-Trafalgar Memorial Hospital, you can only imagine how busy Dr. Sonny Kohli is on a day-to-day basis. When not in the Intensive Care Unit, you may find him chairing the Hospital’s Cardiac Arrest Committee or teaching medical students and residents from McMaster University. In spite of his hectic schedule, Dr. Kohli works behind-the-scenes to help improve access to medical care in remote areas of H the world. n Zita Raponi is a public relations officer at Halton Healthcare Services.

Continued from page 28

A single source for your clients’ home care and rehab needs

Strategies could include using PPIs at the lowest dose and for the shortest duration possible, depending on a patient’s condition. On demand treatment, rather than continuous treatment, could be tried for some conditions. A careful review of a patient’s medications can help prevent patients that start taking a PPI in hospital inadvertently taking the medication long-term. If you’d like more information about the CADTH Rapid Response reports on PPIs – or on a variety of other drugs, devices, or procedures – they are all freely available on the CADTH website: www. Here you’ll find the reports listed chronologically as they are completed or you can use the search function at the top right of your screen. To learn more about CADTH, visit, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: http://www. H n

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Therapy & Rehab NOVEMBER 2014 HOSPITAL NEWS 2013-05-28 10:33 AM

30 Focus

Cover Story


Top 10 new and emerging health technologies:

Are they

By Andrea Tiwari

Earlier this year, in a Canadian first, a group of experts came together to identify a list of potentially ‘game-changing’ health technologies that could impact the lives of patients and the delivery of healthcare. The Top 10 New and Emerging Health Technology Watch List* for 2014 includes three new cancer treatments, five medical devices, and two medical procedures. Produced by the Canadian Network for Environmental Scanning in Health (CNESH), the list is meant to help health care leaders plan today for what the future may bring. ew health technologies, including devices, procedures, or drugs, may have the potential to reshape many parts of the health system. But as they become available, pressure grows for governments to add new drugs to public formularies and for hospitals to buy new devices or fund new procedures, despite limited evidence of their effectiveness. “Every day there is more health innovation coming to market, and making decisions about whether to invest in these new technologies is fraught with challenges and uncertainty,” says Rosmin Esmail, Chair of CNESH and Director, SCN Health Technology Assessment and Adoption at Alberta Health Services. “By looking closely at the evidence and creating the Watch List, we hope to help decision makers prioritize their efforts.” Health technologies were identified through a public call for nominations and the committee followed a rigorous prioritization process to arrive at the final list of 10 technologies. Developing the list is a key initiative for CNESH and is one way that the committee fulfills its mission to identify and broadly share information on emerging health technologies. The nomination period for the 2015 Watch List just ended and the committee is now in the midst of reviewing and prioritizing the entries. *The technologies are in no particular order. So, what innovations made the 2014 Watch List?


A bed railing receives a copper coating.

Antimicrobial copper surfaces to reduce hospital-acquired infections in the ICU

The penny may be phased out from our pockets, but we could soon be seeing more copper in our hospitals since new research HOSPITAL NEWS NOVEMBER 2014

suggests that the metal may be an effective tool in the fight against hospital-acquired infection. Patients in the intensive care unit are among the most vulnerable to contracting infection. Surfaces touched often like taps and bedrails are typically made of stainless steel or plastic. They are cleaned regularly according to stringent guidelines, but it’s not always enough to stop the spread of germs. Touch surfaces made or coated with antimicrobial copper seem to be a promising alternative because, in between regular cleanings, they have the natural ability to continuously kill viruses and bacteria that live on surfaces.

Ex vivo lung perfusion device

Preserving the lung is key to successful lung transplantation. Typically, after the donor lungs are removed they are flushed with a preservative solution and packed on ice, but the longer the lungs are kept on ice the greater the risk that they will be rejected due to damage. The original research and successful world first application of ex vivo lung perfusion technology was led by Dr. Shaf Keshavjee and Marcelo Cypel at Toronto General Hospital. The ex-vivo system they developed first allowed surgeons an opportunity to assess and treat injured donor lungs, while outside the body to make them suitable for transplantation. The newest ex vivo (meaning out of body) lung perfusion device is a portable system that preserves the lungs. Donor lungs are placed in the sterile chamber which maintains a warm temperature and humidity. The system then provides a constant supply of oxygen and a solution that contains packed red blood cells. A wireless monitor lets clinicians continuously assess

A new anti-cancer drug called obinutuzumab, used in combination with chlorambucil (an older pill that’s been used to treat CLL for many years), shows promise as a better option for newly diagnosed patients who have coexisting medical conditions. the function of the lungs to make sure they are still viable. This new innovative portable perfusion system improves the condition of donor lungs and minimizes the damage that is commonly seen with cold storage methods. By improving the quality of donor lungs, this technology could help increase the number of lungs available to the more than 300 patients on Canada’s waiting list for lung transplant. In 2013, the University of Alberta’s Mazankowski Alberta Heart Institute established an ex vivo program and became home to the only portable device in Canada. In August 2014 the Federal Drug Administration in the U.S. approved the device, citing its potential to expand the donor organ pool.

Used together, the combination treatment more than doubles the chance that patients with CLL with live without disease progression and the common adverse events associated with the treatment are reported to be manageable.

Obinutuzumab (plus chlorambucil) for patients newly diagnosed with chronic lymphocytic leukemia

Most patients with chronic lymphocytic leukemia (CLL) are seniors over 70 years old and, for many, CLL is not the only medical condition they live with. While healthy patients who are newly diagnosed with CLL are often treated with a cocktail of aggressive chemotherapy and other drugs, the same options aren’t available to patients with coexisting medical conditions. But a new anti-cancer drug called obinutuzumab, used in combination with chlorambucil (an older pill that’s been used to treat CLL for many years), shows promise as a better option for newly diagnosed patients who have coexisting medical conditions.

Mitral valve clip for degenerative mitral regurgitation

For patients with the common heart valve disorder known as mitral regurgitation, symptoms like shortness of breath, fatigue, and chest pains can negatively impact their daily life. The condition causes blood to flow backwards into the upper heart chamber, because a valve on the left side of the heart that separates the upper and lower chamber is ‘leaky’ and does not close properly. In mild cases medication can help, and in severe cases open heart surgery may be

Focus 31


‘game-changers’? performed to repair or replace the valve. But for older patients who are too sick or frail to survive heart surgery, there are few options. But a new device called the MitraClip device provides the first non-surgical alternative for some high risk patients with degenerative mitral regurgitation. The MitraClip is inserted using a long, flexible, soft plastic tube through a small incision in the groin and delivered to the heart using the femerol vein (found in the leg). Once implanted, it allows the heart to pump blood more efficiently by improving valve closure. The device is now being used in a just few specialized Canadian centres, including Sunnybrook Health Sciences Centre in Toronto and the University of Ottawa Heart Institute in Ottawa. In April of this year Health Canada formally approved the device.

This self-expanding drug-coated stent is used in the treatment of peripheral arterial disease.

Since 2012 ipilimumab has been available to Canadian patients who tried but did not respond to other therapies, or who simply cannot tolerate other therapies for advanced melanoma, but in September 2014 Health Canada approved the drug for use as first-line treatment in newly diagnosed patients. The CADTH pan-Canadian Oncology Drug Review is currently reviewing the drug for this new indication.

Today no therapies have emerged as the optimal solution to this problem. But a new non-invasive automated cuff can now be worn on the arm or leg to provide remote ischemic conditioning, which temporarily stops and restarts blood flow through a series of inflations and deflations. The device, created by two doctors at SickKids, can be used before, during, or after cardiac surgery, or after a heart attack and has shown strong potential to protect the heart from damage.

Self-expanding, drug-coated stent to treat peripheral arterial disease

Ipilimumab for unresectable or metastatic melanoma

Melanoma is the deadliest form of skin cancer and it’s on the rise among Canadians. When the cancer is diagnosed early, it can be cured by surgery to remove the tumour. But if the cancer has spread locally and cannot be removed completely through surgery (known as unresectable melanoma) or it has spread to other parts of the body (called metastatic melanoma) the disease progresses quickly and has had low survival rates.Advanced melanoma is an aggressive disease and existing treatments have been largely ineffective in extending life expectancy. But ipilimumab is a new drug that works by stimulating the body’s immune system to fight the cancer. It is the first drug to show a dramatic impact on survival in advanced melanoma. In some cases, it nearly doubled survival rates at both one year and 18 months, compared with a glycoprotein vaccine.

in patients who have some light perception and nerve function left in the eye. The implant electrically stimulates the retina to produce light perception. It is attached externally to a camera and video-processing unit through a cable connected to a pair of glasses worn by the patient. Studies have shown that patients receiving the implant had improvement in distinguishing motion, recognizing letters, and perceiving colours. However, at $115,000 US, the estimated cost of the device is not insignificant.

Retinal implant for patients with retinitis pigmentosa

Remote ischemic conditioning (RIC) device

Cardiac surgery or a heart attack can sometimes bring about damage to the heart by restricting the blood supply to the heart. When blood flow to cardiac cells is disrupted and then restored, it creates a risk for tissue damage known as ‘reperfusion injury’.

With so many rapid technological advances in the field of prosthetics, is the ‘bionic patient’ really so far off? A new prosthetic, likened to a ‘bionic eye’, has been developed to possibly restore some vision in adult patients with severe sight impairment due to retinitis pigmentosa (RP). RP is a group of eye diseases involving the retina that causes slow but progressive loss of vision. It affects almost 11,000 Canadians and half of all cases are linked to family history. This prosthetic retina works by being surgically attached to the back of the eye

Peripheral arterial disease (PAD) in the superficial femoral artery (SFA – the main artery in the thigh that brings blood and oxygen to the leg) is a common circulatory problem where the arteries narrow and reduce the blood flow to the legs. The condition can be debilitating, causing pain in the legs when walking and preventing people from performing daily tasks. It’s more common in the elderly, smokers, and patients with diabetes. But a new stent, which is coated with a drug called paclitaxel, stays in the artery to help prevent it from narrowing again. The device has proven to be an important advancement for treating patients. It’s the first stent indicated for use in the SFA and its self-expanding material allows it to return to its original shape after external pressures are removed. It’s also the first stent approved in Canada to treat PAD in the SFA. Continued on page 32 NOVEMBER 2014 HOSPITAL NEWS

32 Focus


Game-changers Continued from page 31

Tympanostomy tube insertion delivery system for kids with chronic ear infections

Trastuzumab emtansine for HER2-positive metastatic breast cancer

A new treatment for advanced breast cancer offers a new option for patients. Women who are in advanced stages of breast cancer, and who test positive for the human epidermal growth factor receptor 2 gene (HER2) experience a very aggressive form of the disease and have a shorter survival. Trastuzumab emtansine (T-DM1) is a new drug that incorporates three components: an anti-HER2 agent that attaches to HER2 receptors, a stable linker, and an anti-cancer substance. It allows drug delivery specifically to HER2-cancer cells and minimizes exposing normal cells to the therapy. When compared to standard treatment, the clinical evidence suggests that T-DM1 alone can improve a patient’s overall survival by 5.8 months and lower adverse events. This targeted approach shows greater efficacy and lowered toxicity, compared with standard treatment.

Parents hate to see their children suffer the pain of chronic ear infections. Unfortunately, many children between six months and five years of age suffer frequent infections that cause discomfort, loss of sleep, and many trips to the doctor’s office. The infections can also lead to the most common same-day surgery performed on Canadian kids: ear tube insertion (officially known as tympanostomy tube insertion). But a new, integrated in-office tubedelivery system may offer an alternative to conventional surgery. In a clinic or office setting, the doctor applies local anesthetic and the tube-delivery system makes a quick incision in the eardrum and inserts the tube in the ear in a single, automated motion. For more details about each of the health technologies included on the 2014 Top 10 New and Emerging Health Technology Watch List and a description of the methodology used to create the list, visit CADTH (Canadian Agency for Drugs and Technologies in Health) serves as the secretariat for H CNESH. n Andrea Tiwari is a Communications Office at the Canadian Agency for Drugs and Technologies in Health (CADTH).

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Engaging clients and families in meaningful ways – like children’s advisory council’s review of the inpatient menu – is important to Holland Bloorview Kids Rehabilitation Hospital. The hospital developed an innovative tool to measure the quality of our partnerships with clients and families.

Measuring the quality of client and family engagement By Lydia Hansen oven into the fabric of Holland Bloorview Kids Rehabilitation Hospital is the client and family voice. To ensure client and family voices are integrated in meaningful ways, the hospital has developed an innovative process to measure the quality of our partnerships. In collaboration with families, the hospital developed a survey tool to measure the effectiveness of the family leadership program, through which the client and family voice is embedded in hospital planning and decision making. Holland Bloorview asks family leaders to rate the authenticity of their partnerships with the hospital. The hospital collects both quantitative and qualitative data though the survey, which includes questions that aim to understand if family leaders feel their input at the hospital is meaningful and respected. “Holland Bloorview has a culture of shared decision making with our clients and families,” said Laura Williams, director of client and family integrated care. “Together we are creating effective ways to achieve that.” The hospital set targets for the ratings and first included the survey process in its 2012/2013 Quality Improvement Plan (QIP). The QIP outlines the hospital’s quality and safety priorities and is reported publicly. Setting targets for the survey process in the QIP represented a shift from reporting the number of families who are engaged at the hospital, to the quality of the engagement. The hospital’s 2014/2015 QIP raised the bar by setting even higher targets for the ratings. “By embedding this process into our QIP, Holland Bloorview is stating very clearly that this is a priority and we are accountable to it and, more importantly, to our clients and families,” says Williams. The implementation of the survey process was the logical next step following the creation of the hospital’s family leadership program a few years earlier. Heather Evans was one of the family leaders who was instrumental in the development of the program.


Evans explained that after participating on the hospital’s family advisory committee for a number of years and becoming its co-chair, she wanted to explore more ways to integrate families at the hospital. At the time, Holland Bloorview was keen to do the same. “The timing was right,” she says. Family leaders and the hospital’s client and family integrated care team worked together to create the family leadership program, that among other things provides a formal framework to integrate family members in hospital committees and research, facilitates peer mentorship and offers the support and training necessary for success. Holland Bloorview also has a youth advisory council and children’s advisory council, which provides opportunities for clients and their sibling who are as young as three years old to share their ideas about how to make improvements at the hospital. “The family leadership program has really become the heart of client and family centred care at Holland Bloorview,” says Amir Karmali, family-centred care specialist who oversees the program. “It ensures that no major initiative or strategic process at the hospital moves forward without meaningful family input.” “Seeing it today, it is better than I had hoped,” says Evans, whose daughter has been a client at Holland Bloorview for over 10 years. Positive changes are happening as a result of the measurement tool, which will continue to be enhanced. Survey feedback from family leaders has led to concrete improvements that include training for chairs of committees at Holland Bloorview to ensure family leaders have the assistance they need to participate fully. Accreditation Canada, which leads a voluntary peer review process of health care organizations, has recognized Holland Bloorview’s family leadership program as a H leading practice in the field. n By Lydia Hanson is a Senior Communications Associate, Holland Bloorview Kids Rehabilitation Hospital.



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Focus 33

How one hospital made hand hygiene rates soar By Janice M. Skot


oyal Victoria Regional Health Centre (RVH) takes its commitment to safety seriously. In fact, that unwavering focus on quality care is our highest priority – guiding every decision; every action. One of RVH’s most important initiatives is also one of the simplest – ensuring staff, physicians, volunteers and students clean their hands thoroughly and frequently. We all know that hand hygiene is one of the most effective ways we can keep our patients – and each other – safe. RVH’s hand hygiene compliance rates are high; over 96 per cent as measured during the last hospital-wide audit. But our strategic plan states we will “exceed all safety measures”, so RVH is aiming for 100 per cent compliance. Hospitals in Ontario are required to publicly post hand hygiene rates on their website, but Royal Victoria Regional Health Centre has taken that transparency and commitment to safety even further. Departmental hand hygiene rates are prominently posted at the entrance to every clinical unit. As well, RVH has taken the unique and bold step of posting large signs comparing current departmental hand hygiene compliance rates in busy locations throughout

RVH has taken its commitment to safety and transparency even further with its Bug Busters campaign and taken a bold step by posting large signs comparing current departmental hand hygiene compliance rates in busy locations throughout the health centre.

the health centre, such as entrances, the Food Court and near staff badge-in kiosks. Posting our results enables RVH to celebrate high compliance rates, recognize departments that demonstrate outstanding commitment to patient safety and reinforce our dedication to hand hygiene.

RVH has taken the unique and bold step of posting large signs comparing current departmental hand hygiene compliance rates in busy locations throughout the health centre, such as entrances, the Food Court and near staff badge-in kiosks. This type of very public reporting inspires improved performance, enhances patient safety, and strengthens the public’s confidence in our health centre. During the past year, RVH has made significant efforts to improve hand hygiene through several creative initiatives, one of which – the Bug Busters campaign – was recognized by the Health Care Public Relations Association for communication excellence. This multi-media campaign, based on a parody of the Ghostbusters movie, included a music video, posters, an ongoing comic strip and monthly Bug Buster recognition for RVH’s infection control champions. The campaign built a recognized brand and a spirit of fun around RVH’s hand hygiene efforts, resulting in significantly increased compliance rates. The health centre’s overall compliance rate in 201213 was 86 per cent, jumping to its current rate of over 96 per cent. Transparent, very public reporting has elevated hand hygiene awareness throughout the organization and for the first time some RVH inpatient units have begun reporting 100 per cent compliance. RVH has implemented mandatory annual hand hygiene education for all staff, as well as a required yearly quiz. RVH also makes it easy for healthcare professionals and visitors to wash their hands by locating over 1,000 alcohol-based hand rub stations throughout the facility. We also added automated audio messages and prominent signage at our entrances reminding everyone entering and exiting the health centre that washing their hands is the single most effective way to reduce the spread of infection. H Simply put, hand washing saves lives. n

RVH has made significant efforts to improve hand hygiene through several creative initiatives including the Bug Busters campaign, which was recognized by the Health Care Public Relations Association for communication excellence.

Janice M. Skot is President and CEO, Royal Victoria Regional Health Centre in Barrie Ontario. NOVEMBER 2014 HOSPITAL NEWS

NEXT ISSUE – On Stands December 1st

December Focus on Women’s Health, Men’s Health, Accreditation and Pharmacology

34 Focus


Communicating to win

the patient pathway relay By Mary Ann Freedman anada is becoming a nation of the aging. The 2011 census revealed the oldest median age our country has ever seen: 40.6. We will soon face what demographers have dubbed the cross-over: the day when there are more seniors than children. By 2036, seniors are projected to account for 23.2 per cent of Ontario's population. This surge is intensifying the demand for care. According to the provincial auditor, the number of people waiting for long term care beds jumped by almost 85 per cent between 2005 and 2012, but the number of beds grew only by three per cent. The reality of 80 year olds caring for 80 year olds is forcing Canada’s health care system to undergo a myriad of changes. As a communications professional who’s worked in this older adult sector for many years, but also as a daughter of an 89 year old father who recently spent a lengthy time in hospital, I consider the new-found focus on the patient experience one of the most promising shifts. All eyes are on the patient pathway, how we transition the ill and recovering from care facilities to their homes, a journey I believe we should view as a relay with the patient likened to the precious cargo, the baton. The legs of a relay are of equal importance: each athlete gives their all to make sure the baton is passed to the next in a


manner that allows them to start their run in the best position, ensuring the last athlete will win the race – for the whole team. Everyone trains with the same goal of winning, but the reality is no matter how hard one works, a win is seldom achieved if you drop the baton. Today, one in 12 patients is re-admitted after only 30 days of being discharged, a clear sign that the baton is being dropped in many patient pathways. This isn’t the result of professionals lacking the capacity to care or the appropriate medical knowledge. It’s the result of an absence of communication as the baton is being passed. There are 247 steps in the hospital-tohome care process, with nine databases, 35 different forms and 11 handoffs/waits for patients (among staff and between steps). Of the 200 minutes of total staff time involved in transitioning someone into home care, only 20 minutes are spent with the patient (The Change Foundation). According to Andrea Duncan, Professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto, “In today's system, the professionals who take care of the patient in a hospital, or other care facility, don’t follow that patient home, creating opportunities for miscommunication. In discharge home, patients are transferred to the CCAC system where decisions about levels of care are made. This process can

take time, leaving patients unattended in the community during a vulnerable time.” Duncan adds, “This multiple touch point process means that important information about the patient's needs can be lost. Many hospitals and homecare organizations recognize the opportunity to improve the system and changes are being made. The recent announcement of the merger between Mount Sinai hospital and Circle of Care is a great example of how system improvements are being made to address today's gaps in patient care and flow of information.” Renee Henriquez, RN and home care professional credits the absence of a unified information depository to the communication gap. She strongly believes that a portal where health professionals from both the public and private sector can enter post discharge information could positively impact our hospital readmission rate. According to the Ontario Home Care Association, 34 million hours of care were provided by the publicly funded system in 2012/13 and an additional 20 million hours of care are privately funded by families. Henriquez adds that families are increasingly using a mix of publicly funded care together with care from private home care companies. I also have a few recommendations I believe will contribute to a more person-centered approach in the patient pathway relay.

1. Publicly funded and private home care must work hand in hand to collaborate and advocate for information management systems that cross care provider boundaries. 2. Care professionals involved in the patient pathway must position themselves as trusted advisors to patients and families. No matter how rushed they are, they need to ask what information is missing and fill the gaps using consistent, patient-friendly language, helping families understand what is available and where to access it. 3. This may seem obvious, but, if everyone makes it a priority to initiate dialogue with one another, members of the care team suddenly move to a fully informed team with open channels of communication. The patient pathway relay is not a solo journey. Everyone involved in the care relay – both family and health and home care professionals – must collectively channel their desire to care and simply talk to one another to guarantee success at each leg of the race so every patient, H and the health sector, wins. n Mary Ann Freedman has provided marketing and PR counsel to organizations and companies in the 50+ sector for over 15 years. Visit to learn more.

“It’s my pleasure to say ‘thank you.’ Your knowledge and confidence guided us through all the time. You were like the light and the hope in the dark, especially in the first couple of years. I am glad it is over, successfully. Thank you.” – A.W.


Focus 35


Patient-centred care focus of new

Longitudinal Integrated Clerkship Pilot By Kaylea Forde t. Michael’s is piloting a new curriculum for third-year medical students allowing them to follow patients from admission to discharge.The program, known as the Longitudinal Integrated Clerkship (LInC) Pilot, is the first of its kind at a Toronto teaching hospital. Seven students from the University of Toronto’s FitzGerald Academy were accepted to study under this pilot, which focuses on patient-centred care on a longitudinal basis. These students will follow patients through all phases of their diagnosis and treatment, across clinical services including family medicine, internal medicine, surgery, obstetrics and gynecology, pediatrics, psychiatry, anesthesia, dermatology, emergency medicine, ophthalmology and otolaryngology. They will accompany their patients to follow-up appointments during their year of training Unlike the traditional block clerkship program, which has students changing services and preceptors every two to eight weeks, LInC students will be paired with the same preceptor for the year and will weave in and out of services “This model provides a new approach to hands on learning,” says Dr. Molly Zirkle, the director of the FitzGerald Academy at St. Michael’s Hospital. “Our students are able to follow a patient over the course of their medical journey directly seeing how the integration of care affects a patient’s experience.” If a patient arrived in the Emergency Department (ED) with abdominal pain and needed surgery, the LInC student could follow the patient from the ED to the operating room and then continue to be involved during the post-op care “I was drawn to the LInC curriculum because of the variety of care environments I could be in over the course of a day,” says Matt Speckert, a LInC student. “It excites


Photo Credit: Yuri Markarov, Medical Media

me to think that my day could start in the family medicine clinic and end in the operating room instead of having to wait until my surgical rotation to experience what it’s like to be in that setting.” Another aspect that sets the LInC curriculum apart from the block clerkship model is the allocation of white space time, which students can use toward flexible self-directed clinical time, to attend appointments with patients or academic development.

These students will follow patients through all phases of their diagnosis and treatment, across clinical services including family medicine, internal medicine, surgery, obstetrics and gynecology, pediatrics, psychiatry, anesthesia, dermatology, emergency medicine, ophthalmology and otolaryngology. Both programs have their advantages and provide the same quality of education,” says Dr. Zirkle. “They have the same objectives, exams, curriculum content, preceptors, clinic time, patient encounters and procedures. Our students will be just as prepared for their fourth year no matter which route they chose. We do, however, feel the LInC will give a window to the patient experience that will be very meaningH ful for students.” n

Dr. Karen Weyman, a staff physician and the Longitudinal Integrated Clerkship faculty lead at St. Michael’s, and Matt Speckert, a third-year medical student, review a patient's medical history.

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Kaylea Forde is a communications intern at St. Michael's Hospital. Hospital News - Nursing - Nov2014-Oct24-SM.indd 1

NOVEMBER 2014 HOSPITAL NEWS 28/10/2014 12:03:06 PM

36 Focus


Healthcare that (almost) makes house calls By Tracie Smith

cancer diagnosis can be traumatic for not only the patient but also family members and caregivers. Feelings of stress, anxiety, sadness, anger or a sense of a loss of control are common and it is important to have someone to talk to. The psychosocial counsellors in the Cancer Centre’s Supportive Care Program at Thunder Bay Regional Health Sciences Centre provide confidential counselling to cancer patients and their families. “Cancer impacts the whole family,” says Susie Hamilton, MSW, RSW, one of the


Tele-counselling offers greater flexibility,” says Susie Hamilton, counsellor in the Cancer Centre’s Supportive Care Program at TBRHSC. At the request of one of her out of town patients, Hamilton investigated the possibility of having their appointments via the Ontario Telemedicine Network, between Hamilton’s Cancer Centre office and the patient’s home.

Turning the hand hygiene ship around By Ken Donohue

was on a BC Ferry once waiting for my young son in the washroom. Biding my time, I watched to see how many people washed their hands after using the toilet. Of the 15 or so I counted, most “washed” their hands with water only. I’m no microbiologist, but my mother taught me that soap was needed to clean my hands. Only a handful actually used soap and water during my visual research, while some left without cleaning their hands at all. This, despite the signs above the toilets reminding people to wash their hands to prevent the spread of infections. One person actually went through the motions at the sink, but no water or soap touched


his hands. Now that was interesting, I wanted to say to him as he walked past me, but like most of us, I presume, I chose to say nothing. If my brief study is any indication, hand hygiene amongst the public is a little, should we say, hit and miss, but in health care, the public expects 100 percent. And so they should. That’s why our organization has worked hard in recent years to improve hand hygiene compliance across all our sites. The effort has showed results. In 2011/12, the rate of hand hygiene compliance across Fraser Health was 60 per cent. Last year, that number climbed to 79 per cent, and the year to date rate is now close to 85 per cent.

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This has been accomplished in part through more awareness, greater access to hand hygiene products and cleaning stations, and implementation of a peer auditing system. Though most of the credit belongs to our staff, who are committed to providing a safe environment for our patients. Peace Arch Hospital is one example of a site that has made great strides. Less than three years ago, hand hygiene at the site was just 70 per cent. Today it’s 90 per cent. Mary Rhode, Peace Arch’s director of site operations, is proud of the way the hospital’s staff have embraced hand hygiene. Continued on page 38


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counsellors in Supportive Care. “In counselling we see as many family members as we see cancer patients.” A Social Worker and Counsellor, Hamilton counsels individuals and families, focusing on issues like anxiety, depression, loss, grief and bereavement. Supportive Care staff strive to provide the best possible patient care, so when one of Hamilton’s regional patients asked if she could look into a way to have a counseling session without her leaving home, Hamilton did not hesitate. “I had been meeting with the patient in Thunder Bay, when she travelled up for medical appointments, as well as meeting through scheduled telemedicine visits,” she says. “The patient would go to an Ontario Telemedicine Network (OTN) site in her home community.” At the patient’s request, Hamilton began to investigate the possibility of having their appointments via OTN, between Hamilton’s Cancer Centre office and the patient’s home. Through a piloted trial, the patient was able to use her laptop with Internet connection and a webcam. “The counselling session for her would take place in the comfort of her own home,” says Hamilton. “She was able to connect through various devices, such as an iPad, iPod and even her Smartphone. I also provided counselling to her two children in the mornings or after school. It was convenient for them. The patient loves the convenience, as she doesn’t need to leave home or drive anywhere, as there were some difficulties with mobility.” Not only does tele-counselling offer greater flexibility for the patient and her family, it’s also easier to set up appointments. Hamilton does not need to book a telemedicine suite to conduct her counselling session, as she has the ability to use the OTN services through her desktop computer. Another benefit is privacy. People in the community don’t see the patient and family attending an appointment, something that can be an issue, especially in small communities. “Our patients are dealing with a number of issues: emotional distress, high anxiety, feeling down or depressed, life stressors brought on by a diagnosis or treatment, and survivorship,” says Hamilton. “Emotional well-being is important in recovery. Being emotionally well helps with the journey of cancer.” Providing face-to-face counselling support can be challenging, given the fact that many patients live in isolated communities spread throughout Northwestern Ontario. “We definitely needed to think outside the box in order to provide the best possible patient care to all of our patients,” says Hamilton. “This is definitely a step in H the right direction.” n Tracie Smith is Senior Director Communications & Engagement at Thunder Bay Regional Health Sciences Centre.

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Focus 37


Patient hand hygiene initiative prevents illness By Catherine Walker


he recently launched mealtime patient hand hygiene initiative at Quinte Health Care (QHC) is having amazing results. The number of patients contracting antibiotic resistant organisms during their hospital stay has decreased. Last year, nutrition and food services staff at QHC pointed out to managers that the hand wipes distributed to patients at meal time were not being used. An audit revealed that seventy per cent of the packets were being returned unopened and when used by a patient it was after their meal. Patients were clearly missing the most important moment of patient hand hygiene, before they ate their meal. “Not washing your hands before eating a meal increases the patient’s risk of contracting antibiotic resistant illnesses that are transmitted through hand to mouth contact,” says Wanda Stewart, Infection Control Practitioner at QHC. “The process and the product being used here was clearly not working and that’s when we started the search for a better solution.” The Infection Control Team began to look at alternatives that would make it easier for patients to perform hand hygiene before they eat. The old wipes were similar to regular fast food wipes which were often dried out and difficult to open. “It is very hard for someone who is unwell to get out of bed to wash their hands.

Sheila Chartrand from infection control and Francine Maurice from food services team up to make sure a QHC patient has clean hands before he enjoys his meal. The wipes we provided were difficult to open and being used at the wrong time,” says Sheila Chartrand, another member of the Infection Control Team. A new product was found that was sturdier and in a dispenser that was easier to access. But how could QHC encourage patients to use them? The first group that came to mind was the team that identified the issue in the first place – Nutrition & Food Services. Nutrition and food services staff mem-



bers deliver patient meals three times a day, so Infection Control inquired if they would be willing to play a part in improving patient hand hygiene by proactively distributing the new hand wipes. The only initial concern was adding to their already extremely busy workload at meal time. The staff enthusiastically became the drivers of the initiative. “Nutrition and food services staff members are with the patient in that crucial moment when hand hygiene is so im-

portant in breaking the chain of transmission,” Stewart explains. “We worked out a plan that with each meal they would hand the patient a wipe directly and remind them to clean their hands before they eat.” According to Bonnie Kerr, manager of nutrition and food services her team didn’t look for problems or excuses, just solutions. “Everyone worked together and made it work for the patient. It’s takes that extra bit of their time, but I’ve not had one staff member complain about the extra step in their routine. They are proud to be helping patients and it’s clearly making a difference,” she says. The results were impressive. The initiative was piloted on four inpatient areas at QHC’s Belleville General Hospital and then rolled out across all four hospitals in July. We did see a decrease in numbers on the trialing units for June, and corporately for July and August, said Chartrand. Infection Control is committed to keeping the nutrition and food services team updated with reports of the transmission numbers so they can see the significant impact they are making to patient safety. Chartrand praised her co-workers. “I am really excited about the response from staff and how they value patient safety and have embraced their role in it. It has H made such a huge difference.” n Catherine Walker is a Volunteer & Spiritual Care Worker at Quinte Health Care.

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38 Focus


I am the patient experience By Krista Luxton and Rachael Vandergaast ichael Stern is a fighter. For two years he had been fighting prostate cancer until he underwent a radical prostatectomy – a surgery to remove the prostate gland – in August at The Scarborough Hospital (TSH). But during his recovery, Michael could simply surrender, relax and focus on getting well. The exceptional care he received created an experience between him – the patient – and his health care team that was built on trust, communication and collaboration to achieve optimal results. “Uziel (Hernandez, RN) was the first person to take care of me when I was in recovery,” says Michael. “She was kind, personable and talkative. Her sunny personality made me feel a lot better and I truly believe it helped speed up my recovery. She went above and beyond what was needed and provided exceptional care.” Michael adds that he asked for her name because he figured she would be the exception, but admits he was wrong. “It turns out that every nurse, doctor and staff member who attended to me during my time in the hospital went well beyond what was needed,” says Michael. “One nurse went as far as getting me earplugs because I was having difficulty sleeping.” Michael’s positive experience throughout the entire care process is becoming more common at TSH as the hospital has launched a grassroots effort to provide a patient-focused approach to care. ‘“I Am the Patient Experience” is more than a tagline at TSH, but the beginning of an entire culture shift that recognizes the inherent value of working with our patients and their families,” says Rhonda Seidman-Carlson, Vice-President, Interprofessional Practice and Chief Nursing Executive. “We ARE the patient experience, and when we provide care from that aspect of connection, we create a positive and meaningful experience for everyone.” But what does patient-focused really mean, and how do we truly know we are providing our patients and their families with a positive and meaningful experience? Several staff members who have become passionate champions for the effort have begun looking for ways to find out – and


I Am the Patient Experience is a grassroots effort at The Scarborough Hospital that aims to shift the culture of care to become truly patient-focused.

‘“I Am the Patient Experience” is more than a tagline at TSH, but the beginning of an entire culture shift that recognizes the inherent value of working with our patients and their families.” what better place to start than with the patients and families themselves. “I Am the Patient Experience” champions recognize the inherent value that patients and family members bring to the health care team, and are proactively inviting them to visit the units on which they received care to share their stories in person. Staff will be able to learn directly from their patients what was meaningful

and where there were opportunities for improvement and conversely, patients have the opportunity to participate and collaborate in their care. “It may make us all a little uncomfortable at first,” says Rhonda. “But opening our ears, our minds and our hearts to really understand our patients’ feedback is a huge step in providing true patient-focused care. Only they can define their experience, and it’s our job to learn, grow and make it happen.” TSH is also planning to introduce shared care plans on many of its units and is actively recruiting for Patient and Family Advisors to further advance its commitment to patient-focused care. The Patient and Family Advisors will partner with health care providers and administrators to enhance programs, participate in corporate and department-level improvement initiatives and provide fresh eyes for identifying efficiencies in many areas including: service delivery, policies and procedures,

interprofessional care planning, patient education, hospital navigation and the general environment, and follow-up processes. “By working together and learning from each other, we can ensure better outcomes for our patients and their families,” says Rhonda. “And at the end of the day, that’s why we are all here.” Within three days of his surgery and recovery, Michael was well enough to get up and walk around. He left the hospital that same day, and insists his speedy recovery was a result of the excellent care he received during and after his surgery and his participation in his care. “I can’t stress how much of a difference a pleasant personality makes in helping the recovery process. I can’t imagine any other hospital providing a better experience,” H says Michael. n Krista Luxton and Rachael Vandergaast work in communications at The Scarborough Hospital.

Hand hygiene Continued from page 36

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“The work we’ve done in this area has reignited the passion our staff have for delivering good care,” she says. “We’ve been able to create the kind of culture where it’s okay to ask or remind colleagues if they’ve washed their hands.” Rhode credits physicians at the site for taking ownership of this issue. It’s no surprise then that audited hand hygiene compliance for Peace Arch physicians is among the highest compared to physicians at other sites. One doctor walked around wearing a big button that read, it’s okay to ask if I’ve washed my hands. “It’s made a huge difference that our physicians have been active in helping shift the culture,” says Rhode. So, what are they doing at Peace Arch that’s been successful? Turns out a lot of simple things. They identified two areas in the hospital that weren’t performing

as well as others, and used the success of other areas to show the positive outcomes. They increased the number of hand rub dispensers throughout the hospital and coloured them bright orange, so they are visible. Volunteers check them on a regular basis to ensure they don’t run empty, and contact housekeeping to refill. Rhode is quick to point out that hand hygiene is everyone’s responsibility. That’s why Peace Arch has involved the community in creating more awareness. “During World Hand Hygiene Day, we had the mayor here handing out hand hygiene products and greeting patients and visitors,” says Rhode. “And we developed a campaign with the face of a fouryear old girl, who was born at the hospital and known to our staff. More people became champions, when her image went

up around the site on posters with the line, If I can do it, so can you.” In addition, some eye catching, can’tmiss elevator wraps were installed at the site, and a fun video showing staff washing their hands was created. If you’re on the hospital’s Infection Prevention and Control Committee, then you better be prepared to sign on as a hand hygiene auditor. Even housekeepers have been trained as auditors. “We now have our staff coaching patients on hand hygiene,” says Rhode. “When you take that leap to coach patients it’s a huge shift in culture.” When asked if hand hygiene rates at Peace Arch can go higher, Rhode says, “Absolutely, we’re aiming for a hundred H per cent.” n Ken Donohue is the director of Public Affairs for Fraser Health.

Focus 39


Putting patients at the helm of symptom management The Systemic Therapy Ambulatory Toxicity Management By Jayani Perera ancer Care Ontario (CCO) is completing the Systemic Therapy Ambulatory Toxicity Management (AToM) Pilot which takes a patient-centred approach to improve how treatment-related toxicities are managed. Population-based studies within Ontario and in other jurisdictions have shown that a high percentage of patients who receive cytotoxic chemotherapy will visit the emergency department (ED) following their treatment, and are sometimes even hospitalized, due to toxicity. Earlier this year the Cancer System Quality Index reported that almost half of the patients who received adjuvant chemotherapy for early stage breast cancer in 2012 visited the ED during a course of treatment. Clearly, there is both room and need for ongoing improvements and AToM has been developed to improve the quality of care for patients receiving systemic treatment.


manually report their own symptoms and document treatment toxicities.

Coupling self-management with follow-up support

As part of the Pilot, at each chemotherapy appointment, patients are asked to complete the NCI PRO-CTCAE tool and are also asked to fill out a questionnaire detailing any additional problems they may be experiencing, including how they have handled these problems such as visits to

ED or hospitalizations during the previous cycle of treatment. Once patients leave their cancer centre after receiving chemotherapy, they are contacted by phone twice by a nurse – first between 24 to 48 hours following chemotherapy and then again between eight to 10 days following chemotherapy – and the nurse works with the patient to complete the NCI PROCTCAE tool to identify symptom burden and make recommendations regarding their management.

Improving patient outcomes

The AToM Pilot launched September 2013 at Sunnybrook, Thunder Bay & satellite sites in Northwest and currently, there are more than 70 patients enrolled. The feedback has been positive. Providers value this initiative as it provides additional support and a systematic approach to ensure the utmost quality of life for patients as they are going through treatment. Continued on page 40

A proactive, systematic and patient-centred approach

The AToM Pilot was initiated as a collaboration between CCO’s Systemic Treatment Program and Regional Cancer Programs. Developed by a multidisciplinary team that included physicians, nurses, pharmacists and a patient representative, and led by Dr. Monika Krzyzanowska, a medical oncologist and Clinical Lead for Quality Care & Access at CCO, the Pilot was designed to evaluate the effectiveness of a proactive, systematic approach to symptom assessment and management during chemotherapy using a patient-reported outcome measurement tool to capture toxicity from the patient perspective. “AToM empowers patients to actively be part of their own cancer treatment,” says Robin McLeod, VP, Clinical Programs and Quality Initiatives, “Through enabling patients to self-identify and document symptoms, this Pilot enables health care providers to better manage a patient’s symptoms and provide them with collaborative care.”


Enabling patients to report their own symptoms

AToM’s approach is unique because traditionally, in clinical trials and routine care, treatment-related toxicity has been reported by the patient to the provider who then records the toxicity type and severity. However, as reported in studies published over the last decade, there are systematic differences in toxicity-reporting depending on who is doing the reporting. According to Dr. Krzyzanowska, “engaging the patient directly in reporting their symptoms, using a validated tool, ensures that symptoms that are relevant to the patient are addressed and it encourages self-management.” Significant interest in developing tools that enable patients to directly report on their toxicity themselves motivated the design of the NCI PRO-CTCAE – the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. The tool, being used by CCO in this Pilot, enables women with breast cancer undergoing adjuvant chemotherapy to

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40 Focus


Ultraviolet and HVAC: Keys to reducing hospital acquired infections By Richard Dixon

he use of ultraviolet light systems is becoming more widely used in health care facilities for disinfecting patient and operating rooms. Yet, ultraviolet lights systems are misunderstood in spite of significant research and use in other industries. So let’s unravel this mystery. Ultraviolet (UV) light in nature is electromagnetic radiation produced by the sun. The most common forms are UV-A which is a long wave light and not absorbed by the ozone layer (also called black light), UV-B which is a medium wave and mostly absorbed by the ozone layer and finally UV-C which is a short wave light and completely absorbed by the ozone layer. Modern science has been able to create UV-C lighting able to penetrate the cell wall of microorganisms, and alter the DNA structure such that the microorganism becomes non-viable; unable to reproduce or infect a patient. Did you know UV-B induces production of vitamin D in the skin, sunburn happens at wavelengths near the boundary of the

UV-A and UV-B bands, overexposure to UV-B radiation not only can cause sunburn but also some forms of skin cancer. Disinfection using UV-C radiation is commonly used in wastewater treatment applications and is finding an increased usage in municipal drinking water treatment. UV-C is also used in night time cleaning of laboratories and meat packing facilities. Another term used for UV-C disinfection is Ultraviolet Germicidal Irradiation (UVGI). Healthcare Acquired Infections (HAI’s) are the 4th leading cause of death in health care facilities in Canada. Besides the traditional prevention and control strategies of hand hygiene, environmental cleaning and infection control surveillance, the built environment can significantly contribute to the reduction of HAI’s. One of the most popular forms of disinfection is the use of portable UV-C systems. A Canadian company Sanuvox manufactures a twin unit which can be placed in the patient room with one unit on either side of the bed to cover off the shadow


Chart A


Distance nW/cm2 K pneumonia Seconds VRE Seconds MRSA Minutes C diff Minutes

Chart B

5 ft. 1314 18 30 1.2 4.6

Application Lamp Quantity Good 4 Good 4 Better 8 Better 8 Best 20 Best 20

6 ft. 999 24 36 1.6 6.0

7 ft. 778 30 42 2.1 7.7

8 ft. 620 42 54 2.6 9.7

Air Changes Per Hour Single pass 6 Single pass 3 Single pass 3

9 ft. 504 48 66 3.2 11.9

10 ft. 417 60 78 3.8 14.4

Kill Rate Efficiency 50% 99.98% 75% 99.98% 90% (+) 99.999%


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Sanuvox Aseptix twin units disinfecting patient room. effect and of course with no patient in the room and the corridor door closed. The lights can be activated remotely via WiFi applications to smart phones plus infrared mechanisms on the units turn off the UV-C lights if there is the slightest movement in the room. Disinfection results are measured in terms of distance from the light to bed, wall, etc. and the intensity of the bulbs themselves are described in Chart A. Therefore, even the stubborn C. diff bacteria are eliminated in less than 15 minutes in the patient room. Because the bathroom is even smaller, placing one of these units in the bathroom would require a clean time of less than five minutes. And yes, environmental services staff still have to clean the patient room in their usual manner and we still have to always wash our hands. Let’s go one step further and place another Sanuvox UV-C product in the Heating Ventilation and Air Conditioning (HVAC) system to disinfect the air of both bacteria and viruses. Units can either be placed in the ducts or inside the main HVAC unit. Other stand-alone units can be placed inside the bathrooms of patients above the door to clean on a cycle basis. Think of the patient with C diff. and their diarrhea episodes resulting in the fecal cloud depositing the bacteria back onto the bathroom surfaces. The bathroom UV-C light cycles on when the door is closed and the patient not in the room… and the room is free of bacteria and viruses in 5 minutes. Another great application of UV-C cleaning would be between cases in the operating room. Another company York Air Conditioning is manufacturing a HVAC unit with UV-C lights built inside the unit. A typical configuration for high risk healthcare application places the UV-C lights downstream from the cooling coil to

deal with the spore size micro-organisms and upstream of a high efficiency HEPA (High Efficient Particle Arrestance) filter to eliminate airborne bacterial and viral contaminates. The York Solution UV-C system has been developed with their partners Johnson Controls and UltraViolet Devices, Inc. The following table (see Chart B) shows the effectiveness of the York Solution UV-C system. And finally, here are a couple of real life examples. An Invitro Fertilization Laboratory in the United States installed UV-C cleaning in their HVAC system and increased the clinical pregnancy rates from 38.9 per cent to 62.3 per cent. The Women’s & Children’s Hospital of Buffalo, NY reported the following. “eUVGI eradicated microbes in HVACs and was associated with a decrease in NICU environmental pathogens and tracheal colonization. Significant reductions in VAP and antibiotic use in NICU high-risk patients were associated with eUVGI in this limited study.” In mid-October, TRU-D Smart UVC deployed two superbug-slaying machines at JFK Hospital and ELWA Hospital in Monrovia, Republic of Liberia. They are helping to disinfect health care environments where Ebola patients are being treated. In an effort to eliminate Ebola at the source, the use of innovative disinfection technology, such as TRU-D, is critical to creating and maintaining a pathogenfree environment for patients and healthcare staff. UV-C disinfect cleaning is real and works! Use these systems and reduce H HAI’s. n Richard Dixon is Deputy Chair, Coalition Healthcare Acquired Infection Reduction (CHAIR) Canada

Toxicity managmement Continued from page 39 “As a health care provider, a proactive symptom management approach such as this is highly valued,” says Dr. Gandhi, Medical Oncologist at Sunnybrook Odette Cancer Centre, “It allows more timely management of chemotherapy-related issues so the goal of safely and fully completing therapy can be achieved. Clinic visits can be more productive and efficient, and the avoidance of emergency assessments

can benefit not only patients, but the system at large. Ultimately, the patient experience through a vital time of the cancer journey can be optimized.” The Pilot is anticipated to finish by Spring 2015 at which point the results will be H analyzed. n Jayani Perera is a Senior Public Relations Advisor at Cancer Care Ontario.


Focus 41

Enabling population management and improving operability:

The Integration Engine By Gary Folker

anadian hospitals face an ongoing challenge – integration. As health care facilities continue to push toward a more patient centric care environment, the demands of balancing and connecting core hospital systems with a multitude of external and internal clinical and business applications is an ever present challenge that weighs on the minds of facility operations. Quinte Healthcare Corporation (QHC) was not exempt from these integration challenges. QHC provides a wide range of health care services to 160,000 people living in Prince Edward and Hastings counties. There are four hospitals: QHC Belleville General Hospital, QHC North Hastings Hospital, QHC Prince Edward County Memorial Hospital and QHC Trenton Memorial Hospital. Within this network, the integration system is the backbone of the hospitals and is expected to work seamlessly with numerous clinical and business applications. True integration allows for interoperability between legacy and next-generation health systems upon installation and for future applications. An integration engine is a key component of health reform that enables improved secure and authorized access and sharing of information between health care providers, patients and healthcare institutions. With an integration en-


gine, hospitals can better manage their clinical and business applications and allow them to build interfaces in a more efficient and timely manner. New interfaces often require specialized developers with proper training. QHC was relying on external vendors to build each interface or perform maintenance services, and found that with each new interface or update, a lack of control and a steep price tag were attached.

With an integration engine, hospitals can better manage their clinical and business applications and allow them to build interfaces in a more efficient and timely manner. It was time to change the system. An integration platform that would fit with their current and future needs and was not the traditional “rip and replace” solution drew QHC to selecting the Rhapsody© Integration Engine as its solution. “Like all hospitals, we have a core hospital information system and we also have a variety of clinical and business applications

both within the hospital and externally, so that drives the need for multiple interfaces within the system,” says Todd Dafoe, Applications Services Manager, IS Project Leader. “We don’t need to have someone who is an expert in HL7 to develop interfaces anymore. A general technical person who knows the interface they need to develop can rely on Rhapsody to bring them down the path to build it.” With a robust integration engine, Quinte is able to create and maintain interfaces in-house. No longer requiring vendors or specialized developers – the control is back inside the hospital. With the ability to maintain and manage all activity internally, they are saving the cost for additional external resources. Employees can now effectively develop interfaces, reducing turnaround time from conception to completion. Many hospitals only consider the acquisition costs when selecting an integration engine rather than investing in a solution that provides security. Quinte now relies on strong security, effective IT support, monitoring and mobility monitoring capabilities that come with its new system – all which are essential in today’s connected world. Quinte can develop interfaces that safeguard sensitive patient and organization data from unauthorized users. Having a system that is reliable and scalable

allows health care facilities to organize and integrate legacy systems and transition to new technology continuously over the coming years. The trend toward IT-enabled healthcare continues to rise as doctors continue to go digital. As the adoption and usage of EMR and HIE continues to rise, the penetration of electronic health records will increase. According to the Accenture 2012 Digital Doctor is In Survey, the top four areas where doctors surveyed see the most positive impact of digital health solutions are in reduction of medical errors (76 per cent globally, up 4 per cent from 2011), better access to quality data for clinical research (74 per cent), improved cross-organizational working processes (74 per cent) and improved quality of treatment decisions (74 per cent). The development of an integration system cannot stand still – it needs to stay current with new tools and to keep up with the changing demands for health population data along with other health IT needs. Health care facilities will require well-integrated systems that will allow for fluid population management. Effective population management requires a tremendous amount of data from a variety of sources; whether it is from a particular patient or patient population. Continued on page 45


42 Nursing Pulse

A life enjoyed with the right help Nurses and other health professionals offer enhanced care to dementia patients thanks to Alzheimer Society educational program. By Melissa Di Costanzo efore every shower, Jerry* would resist, kick, hit and yell. Staff at The Scarborough Hospital (TSH) couldn’t understand why bathing caused him such anxiety. A dementia patient on the hospital’s mental-health unit, his methods of communicating discomfort were limited to acting out due to the crippling mental effects of the disease. Staff considered using medication to calm him. Nurses tried coaxing him into the stall, to no avail. Members of the security team were often called because providers feared for Jerry’s safety and their own. TSH psychogeriatric assessment RN Sarah Aiken says heavy workloads and busy shifts often mean nurses struggle to get to the bottom of their patients’ anxiety. In many instances, nurses have little time to explain the steps leading up to – and the pain that will accompany – an injection, for example. Surprised by the jab, many with dementia will lash out if they’re not properly warned. “We forget that patients with dementia (lose) their verbal and reasoning insight. They know there’s something wrong, but they can’t tell you what’s wrong,” says Aiken. Plus, many nurses don’t recognize the signs and symptoms of dementia, and may become frustrated or impatient with pa-


tients’ loss of judgment and reasoning, and changes in mood and behavior that are common effects of the disease. “If (patients) are able-bodied…you tend to (expect) them to respond normally,” Aiken explains. Jerry’s team of health providers eventually learned he doesn’t like being cold. They assured him that, before every shower, they would run the water to ensure it was warm. And they brought extra towels to scrub him dry. “Understanding what patients are trying to communicate is the most important thing,” says Aiken. After this reminder, she decided to learn more about the disease by turning to the Alzheimer Society of Toronto (AST). Aiken discovered the Dementia Care Training Program, which provides practical, theoretical and research-based education. She pushed for the four-class program at TSH, and signed up 10 providers from the psychogeriatric floor, including nurses (Aiken was one), occupational therapists and social workers. “It’s about slowing down, and teaching people to see (things) through the eyes of the elderly,” says Aiken. Esther Atemo, public education co-ordinator with AST, says the focus is on non-pharmacological approaches. Participants, for example, wear glasses that blur their vision and have

their fingers taped to mimic the effects of arthritis. Communication is also emphasized, because dementia patients have difficulty interpreting meaning, and words don’t come easily to them. Relaying care plans to providers during shift changes also ensures everyone is aware of mood patterns and preferences. For psychogeriatric RN Vivian Rabinovitch, the course helped her to put herself in her patients’ shoes. “If you haven’t had this kind of training, you tend to act more from the gut,” she explains. The program “gives you a framework and language... and it removes some of the anxiety around caring for (patients with dementia).” Rabinovitch has worked with older adults for about a decade, and says the course was a good reminder that “all behaviour has meaning.” “We need to step back and remember: whatever kind of angst we’re having, their angst is tenfold, their suffering is tenfold,” she says. Rhonda Seidman-Carlson is VP of interprofessional practice and chief nursing executive at TSH. She is also immediate past president of the Registered Nurses’ Association of Ontario (RNAO). In an acutecare setting, nurses make up the bulk of the staffing pool, she says. They play a central role when it comes to providing safe,

quality care to the elderly. This is especially important when you consider Alzheimer Society of Ontario statistics that suggest 181,000 seniors in the province are living with dementia. The organization’s national counterpart says 747,000 Canadians have the disease, a number that is expected to double to 1.4 million by 2031. Nurses must understand the effects of this disease on patients, Seidman-Carlson says. That means using less psychotropic medications, which can be linked to falls and agitation, and decreasing reliance on restraints, which can increase anxiety, skin breakdown and incontinence. This will, in turn, help to reduce length of stay and help the client feel like “an individual, as someone with remaining abilities, and not just losses.” “For those living with dementia, we want them to do exactly that: live with dementia,” Seidman-Carlson says. “We do not want it to be merely an existence, but H rather a life enjoyed in all ways possible.” n Melissa Di Costanzo is communications officer/writer for the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses, nurse practitioners and nursing students in Ontario.

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Developments in measurements patient safety practices. Advance of New treatmen patient outcomes and program s in the t approaches to metrics. mental health addiction. Programs and within an effective, and initiatives to provide optimal accountable and sustainable

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44 Focus


Building strength, together Mackenzie Health and Saint Elizabeth use innovative service model to improve rehab care By Stefanie Kreibe and Madonna Gallo hen Joan Moon first entered the Cardiovascular Rehab and Wellness Centre at Mackenzie Health, she was fresh out of intensive care and using a walker. Like many Canadians, she was confronted by the overwhelming effects of her chronic disease. A recent heart attack, brought on by congestive heart failure, meant Joan needed ongoing medical attention and support. Though she didn’t realize it at the time, something special started to unfold that morning – a lifelong journey towards wellness that she continues to embrace every day. With regular exercise, education, counselling and professional support, Joan completed the various stages of Mackenzie Health’s Cardiovascular Rehabilitation Program, followed by the Lifestyles Program, which focuses on maintenance and sustainability. Now an alumnus of the programs, she continues to volunteer at the clinic, participate in step classes and lead warm-up exercises, and offer support and encouragement to other patients. Increasingly, rehabilitation programs are being recognized as a vital component of wellness, recovery and a return to independence that can also dramatically reduce the burden of disease and its associated pressures on the health care system. “When I walked into the clinic for the first time, I was in a weakened state and frame of mind. I looked around and saw people exercising on machines and wondered if I was in the right place,” says Joan. “But the staff assured me that each person works on their own program, at their


With the ongoing support of Mackenzie Health’s Cardiovascular Rehab and Wellness Centre, Joan Moon is better able to manage her significant health challenges. Joan is seen here with Melissa Nicholson (left), a Registered Kinesiologist and Clinical Exercise Specialist at the Centre. own pace – and with their support, that’s what I did.” For hospitals, the growing importance of a seamless transition from inpatient rehabilitation to outpatient rehab services means they must be integrated and function at the highest level to support better health outcomes, overall performance targets and patient satisfaction. As two leading organizations have discovered, working together can be a great way to get there. In 2013, Mackenzie Health enhanced rehab care for patients requiring inpatient and/or outpatient rehabilitation services

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with a new arrangement to improve access to these services and provide better continuity of care for patients moving from in-hospital to outpatient care. As a large regional health care provider serving the growing communities of York Region in Ontario, the organization determined that the best way to provide quality rehab care was to partner with an expert that shared its passion for innovation and excellence.

Increasingly, rehabilitation programs are being recognized as a vital component of wellness, recovery and a return to independence that can also dramatically reduce the burden of disease “At Mackenzie Health, our vision is to create a world-class health experience,” says Richard Tam, Executive Vice President and Chief Operating Officer at Mackenzie Health. “Our criteria for selecting an external partner included the need for proven clinical leadership, the desire for new and innovative service delivery models, and a consistent focus on best practices, performance and outcomes.” Through a competitive process, Mackenzie Health found all of those attributes in Saint Elizabeth, a leading non-profit and charitable provider of rehab services in hospitals, clinics, long-term care and home care. Saint Elizabeth now provides all inpatient and outpatient physiotherapy and occupational therapy services within the Mackenzie Richmond Hill Hospital, at Mackenzie Health’s community-based locations, and at Saint Elizabeth’s Rehab Health Clinic.

From the outset, both partners worked closely to achieve a thoughtful and structured approach to rehab care. Following a full evaluation of the existing program, a new service model was designed based on patient and hospital needs and clinical best practices. One of the important change elements included enabling all therapy staff to work to their full scope of practice in order to deliver services in the most effective and efficient way. Within weeks of finalizing the partnership, Saint Elizabeth hired over 60 staff, including an onsite director, practice leaders and therapy providers. The team is integrated into the culture and operations of Mackenzie Health and works collaboratively with the organization’s leadership, staff and physicians to ensure smooth transitions for individuals requiring inpatient and/or outpatient rehab services. Under the new model, rehab services better meet the needs of the hospital and patient community: from the Emergency Department, to inpatient programs and ambulatory clinics, to the Cardiovascular Rehab and Wellness Centre which focuses on disease prevention and health promotion for a variety of chronic diseases. Inhospital rehab services are now provided Seven days-a-week to meet rehab needs continuously and enhance the patient experience. In April, Saint Elizabeth opened the doors of its new Rehab Health Clinic, which provides outpatient physiotherapy and other complementary health services to Mackenzie Health patients and other clients from the community. “It’s been amazing to work with the team at Mackenzie Health to build a culture of rehabilitation that is based on exceptional services and performance excellence,” says Rheta Fanizza, Senior Vice President of National Operations at Saint Elizabeth. “Our two organizations share many similar values, yet we have also learned a great deal from each other. There is wonderful richness and creativity that comes from working together.” The partnership is already producing positive results for patients and the hospital community. Using a Balanced Scorecard approach, Saint Elizabeth has been able to demonstrate that the rehab program is contributing to positive outcomes associated with reduced length of stay, increased therapy time and improved patient satisfaction scores. Inpatient rehab referrals and patient attendance have also increased. Expanding services, improving satisfaction and access to care are important strategic directions for both Mackenzie Health and Saint Elizabeth. As the health care system continues to evolve and community needs grow, working together makes a whole lot of sense. For more information, visit booth #1621 at the Ontario Hospital Associations’ HealthAchieve conference, being held in H Toronto on November 3-4. n Stefanie Kreibe is the communications and public affairs consultant at Mackenzie Health; Madonna Gallo is head of public voice at Saint Elizabeth.

Focus 45


Fort Albany First Nation’s Elders receive care closer to home By Rob Gagnon he community of Fort Albany in Northern Ontario is home to 900 First Nations people and is located 1000 KMs north east of Toronto. Situated on the Albany River near the James Bay Coast, this remote community is accessible exclusively by air or winter ice roads. Due to the geographical isolation of this region, older adults in this community have particularly limited or no access to specialized care. In February 2013, the North East LHIN (NE LHIN) and a team of physicians visited the James and Hudson Bay Coastal Communities to inform the NE LHIN work as it moves forward with its 20132016 Integrated Health Service Plan priority of enhancing access and coordination of care for Aboriginal people living in the NE LHIN region. It also focused specifically on the care of older adults to help inform the NE LJHIN and Dr. Samir Sinha’s work in the development of Ontario’s Seniors Strategy and his call for better care for older aboriginal peoples. A series of dialogues in each community with the elders and local health care providers led to a particular understanding of the lack of access elders had in these communities to professionals with geriatrics expertise. As a follow up to the visit, the NE LHIN invited North East Specialized Geriatric Services (NE SGS) to lead the development of a specialized interprofessional Geriatrics Clinic in partnership with the Fort Albany community. To support a sustainable model of care, Dr. Jo-Anne Clarke, Geriatrician with Valerie Scarfone, Executive Director proposed the development of a collaborative model that would draw on the support of the NE LHIN, Weeneebayko Area Health Authority (WAHA), WAHA Fort Albany Hospital (FAH), Peetabeck Health Services (PHS), and NE SGS’ interprofessional staff including nurses, therapists and geriatricians. The objective of NE SGS is to assess and treat older adults with complex medical conditions throughout the north. The local coordinating committee for the inaugural Fort Albany Geriatrics Clinic consisted of WAHA and PHS staff. In collaboration with the local coordinating committee, NE SGS developed a culturally sensitive and appropriate geriatric screening tool to identify those who most need the service. From this screening tool, 33 older resi-


The Fort Albany Geriatrics Clinic Planning Team. dents, or just over half of the community’s older population, were identified as having complex medical and social needs and who could potentially benefit from the support of the FA Geriatrics Clinic.

The objective of North East Specialized Geriatrics Services is to assess and treat older adults with complex medical conditions throughout the north. The NE SGS developed a two day training session with WAHA, FAH and PHS staff to aid in building capacity with the clinicians working in Fort Albany and for the NE SGS team to learn about what services would be available and what additional supports they needed to fly-in. In this session, feedback was sought from WAHA and PHS on the cultural context and appropriateness of the geriatric assessments that could be offered. Following the training session, the identified older residents were pre-assessed by the local team. From the pre-assessment, the interprofessional NE SGS team gained valuable background information on the older adults they would be visiting with in person either at home, in the hospital or in the outpatient clinic. Through the support of WAHA, three Cree translators were also provided to work with the team so that everyone could receive care in their preferred language of choice.

Intergration engine

Continued from page 41

This population data then lends itself to a litany of trends like care coordination, as well as analytic phases and determining effective care pathways. The use of an integration engine allows for a fluid gathering of this information and improvement in their overall patient care. Quinte’s implementation of an integration engine enforces the fact that investing in an integration system should go beyond the consideration for short term financial gain. It has demonstrated that an integration engine is THE

backbone to the health care facility and should ultimately allow for continual efficient and effective access to clinical data. As the health IT field changes, Canadian healthcare will need to embrace evolving solutions like an integration H engine to ensure patient care success. n Gary Folker is the SVP and Country Manager for Orion Health Canada. For more information on Orion Health, visit or email at

On January 21, 22 and 23, 2014 the Fort Albany Geriatrics Clinic took place. A full inter-professional team with three geriatricians (including Dr. Sinha) got settled in with their local colleagues and met with community leaders to reaffirm their understanding of the purpose and importance of the work that lay ahead. Over the course of the three days, 27 of 30 older adults who signed up to be seen by the specialist were able to attend their appointments. The 90 per cent show rate reinforced to the team the value the elders placed on this initiative especially when current appointment show rates of 50 per cent occur in other settings. The ability to see so many elders was due to the preparatory work that had been done by the local clinicians, and the ability of the team to see patients where it was best – including in their own homes as well. The pilot project in Fort Albany, the first of its kind clinic model in Canada, was deemed to be extremely successful and has now allowed these older adults to be connected with geriatricians who can

follow their care either in person during future visits or via telemedicine as well. The fact that no one needed to leave the community to see a broad range of specialist providers also helped to achieve significant cost-savings and likely better advice to be provided by being able to see and treat patients in their own community. The NE-LHIN, WAHA and the communities from the James and Hudson Bay Region are now looking to expand this model to the other regional communities. The Geriatrics Clinic in Fort Albany provided older residents with the opportunity to receive much needed care closer to home. The impacts of the clinic are still being felt and the quality of life for those older adults attending the clinic has been enhanced due to effective and stable follow-up. The James and Hudson Bay Region are excited about the future prospects of this model and the positive effects it will have within each of its communities in the H years to come. n Rob Gagnon is Quality Coordinator, Weeneebayko Area Health Authority.

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46 Focus


7 luxury travel Educational experiences & Industry Events To list your event, send information to “”.

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 “” n November 3–5, 2014 HealthAchieve 2014 Metro Toronto Convention Centre, Toronto Website: n November 24–25, 2014 Leveraging Accreditation for Transformational Change Vancouver, B.C. Website: n November 26–27, 2014 Long-Term care: A Safe and Secure Environment Hyatt Regency, Toronto Website: n November 27–28, 2014 2nd Annual National Correctional Services Healthcare Conference Sheraton Ottawa Hotel, Ottawa Website: n November 30–December 5, 2014 RSNA 2014 McCormick Place, Chicago Website: n December 1–2, 2014 Western Canada eMedication Management Conference Hyatt Regency, Vancouver Website: n December 2–3, 2014 3rd Annual Data Analytics for Healthcare Summit International Plaza, Toronto Website: n December 3–4, 2014 2nd Annual National Operating Room Management Conference Vancouver Hyatt Regency Website: n January 27–28, 2015 11th Annual Mobile Healthcare Summit Eaton Chelsea, Toronto n February 25–26, 2015 National Canadian Forensic Nursing Conference Renaissance Horbourside, Toronto Website: n March 4–5, 2015 Offshore and Remote Workplace Health Conference Sheraton Hotel, St. Johns, Newfoundland Website: n March 23–24, 2015 Canadian Hip Fracture Management Conference Renaissance Downtown, Toronto Website: n April 19-21, 2015 HPCO (Hospice Palliative Care Ontario) Annual Conference Toronto Sheraton Parkway Toronto North, Richmond Hill Website: n April 27-28, 2015 2nd Annual National Telemedicine Conference Renaissance Downtown, Toronto Website:

To see even more healthcare industry events, please visit our website HOSPITAL NEWS NOVEMBER 2014

worth every penny By Erin Bender

f you had to spend the earth for the ultimate experience, would you? Where do you draw the line on luxury and extravagance? The perfect holiday is a fusion between accommodation, food, relaxation and attractions. From all the things we take away from our holidays only one really lasts: the experience we had. Over time the price will be forgotten and all you will have left is the memory. In that moment your luxury travel experience wasn’t an indulgence, but a pure pleasure. For memories that will last a lifetime try one of these 7 luxury travel experiences: Hot air balloon ride with Royal Balloon – Cappadocia, Turkey In the heart of Turkey is a sparse and barren land strewn with unique rock formations, unusual cave dwellings and vast open spaces. This ancient land is known as Cappadocia. And there is no better way to see it then climbing aboard one of the 90+ hot air balloons that climb into the sky every morning, just in time to see the breathtaking sunrise. Cost: Starting at US$220 per person.


Disneyland – Los Angeles, USA

If there is one dream in every child’s mind it is a visit to Disneyland, the happiest place on earth. And to be honest it makes most adults wishlists as well. Magical days spent cuddling favourite characters, riding thrilling rollercoasters and snacking on delicious food. The best way to finish a stay at Disneyland? With the most amazing fireworks display over the iconic fairytale-inspired Sleeping Beauty castle. Cost: A ticket to Disneyland will set you back US$265 for a 3-day pass (ages 10+).

Villa San Michele – Florence, Italy

Whether you choose to stay overnight at this ultra luxurious hotel or merely visit for a romantic dinner, this lavish 17th century monastery will leave you in awe. Set high above Florence it provides the most picturesque panoramic views of this romantic world-renowned city. Visitors have aptly described the decadently landscaped grounds as heaven on earth. Cost: One night’s accommodation starts from US$600 per night.

Royal Caribbean cruise – Mediterranean

Cruising in the US is actually quite affordable so for a real treat why not head to

Europe. Start your cruise in Italy and sail through the azure Mediterranean stopping in exotic locations like Greece and Turkey. Choosing an indoor cabin will save you money, but for the ultimate in luxury book a suite and enjoy the scenic views of the Mediterranean. Cost: Cruising costs depend on who you are cruising with and what time of year. Consider it a bargain if you can get it for $100 per person per night.

Aquaventure Waterpark at Atlantis, The Palm – Dubai, UAE

This man-made island in Dubai is home to Atlantis, a luxury hotel designed for the rich and famous. But within this hotel complex is a titanic water park with artificial beaches and heart-pumping slides. The exceptional experience you will take away from this waterpark, above any other, is Shark Attack – a waterslide that starts in a dark tunnel, and drops you and ends in a shark tank. Hopefully you can conquer any shark fears on this one. Cost: Adult tickets start at US$80 for a combo ticket to the waterpark and aquarium.

Catamaran snorkelling trip with seaduced by Belize – Ambergris Caye, Belize

The world’s second largest barrier reef resides just off the coast of Ambergris Caye in Belize. You take a luxurious sailing trip to snorkel with nurse sharks or glide with sting rays and soak up the kaleidoscope of colours of the reef. Complete the day with lunch on a sandy Caribbean island or make it a vacation and stay in your very own island paradise. Cost: Prices start at US$75 per adult.

Basketball game – New York, USA

There is nothing quite like a basketball game in New York City. Even if you are not a diehard sports fan, the atmosphere alone will have you on your feet cheering and booing with the rest of the crowd. Hot dogs plus a ridiculously oversized Coke and your own primordial scream are a recipe for the ultimate luxury sporting experience. Cost: Prime basketball tickets can set H you back up to US$2000 per ticket. n Erin Bender is Editor-in-Chief at Travel with Bender. Reprinted from www. with permission.

Focus 47


Spreading the hand hygiene message:

You’re part of our team – Scrub in! levators throughout London Health Sciences Centre’s Victoria Hospital and University Hospital are promoting an important message to patients, families and visitors – as well as a friendly reminder to staff: “You’re part of our team – Scrub in!” The message is found on front of door wraps and interior banners of the elevators. These wraps and banners remind elevator users to be vigilant about hand hygiene in the hospital environment. The elevator wraps are part of visitorfocused tactics for promoting hand hygiene and involve taking advantage of the captive audience waiting for and riding the elevator by making a simple and direct request to practice hand hygiene by using hand sanitizer. Sanitizer dispensers were placed at the elevators for easy access, and behavior change could be viewed in the first few days as people waiting for the elevator took the time to sanitize their hands


LHSC’s Victoria Hospital and University Hospital are using elevators wraps to promote hand hygiene. The slogan, “You’re part of our team – Scrub in!” was developed by LHSC employee Daniel Robinson.

Careers PD WORKSHOPS • Phlebotomy • IM • ECG • OSMT MLA/T exam prep • Urinalysis CALL ABOUT OUR DIPLOMA PROGRAMS Classes Starting Monthly 3025 Hurontario St, Mississauga, ON


1830 Bank Street, Ottawa, ON


Tori Laird is a Communications Associate at London Health Sciences Centre.


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At VHA Home HealthCare, more is not just our commitment to our clients, but to our incredible team of health care professionals. WE ARE CURRENTLY SEEKING: Registered Nurses (RNs) for full-time/part-time positions for the Child & Family program in the following areas: • Toronto • North York • Scarborough • Markham

RN Exam Review Class (CRNE) NCLEX RN Review RPN Exam Prep Class (CPNRE) Personal Support Worker (PSW) 26 Weeks-$1999

YOUR PASSIONS: • Supporting children with complex medical needs and their families • Working independently to provide spectacular individualized care • Community and paediatric best practices YOUR QUALIFICATIONS: • Nursing diploma or degree from recognized college or university • Current registration with CNO and First Aid/CPR • Fluent in written and spoken English • Paediatrics experience is an asset WE OFFER • Competitive compensation and flexible schedules • Continuous learning and professional development • Comprehensive benefits and Employee Assistance Program • A supportive team environment

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after seeing the elevator wrap. While this approach was directed to visitors, it also acted as an important prompt for staff and physicians. “Family and visitors play an important role in keeping patients safe by washing their hands before coming into contact with their loved one,” says Cathy Vandersluis, Director, Infection Safety. “Most germs in hospitals can be spread by unclean hands and each time a person touches an object or another person, germs go along for the ride.” The primary concern at LHSC is always the health and well-being of patients and staff. Improving and promoting hand hygiene is an important piece of this, which is why everyone in the hospital, visitors included, is encouraged to engage H in best practices and to “Scrub in.” n

d tiny step anp to see each elo It ’s moving y to help a child dev p her gives me jo hatever way will helwn life. a voice in we control over her o at the assert sommensely knowing th To touch It helps im supports all of this. r a life VHA team so closely makes fo A Nurse, human livesning.” e Little, VH —Catherin & Family Program full of mea ild

Please apply online at VHA Home HealthCare is an Equal Opportunity Employer Accredited by Accreditation Canada


VHA is a proud participant of the Health Force Ontario’s (HFO) Nursing Graduate Guarantee (NGG) Initiative Program and the Nursing Career Orientation (NCO) Initiative for Internationally Educated Nurses


48 Focus



Hospital News November Edition 2014  

Focus: Technology in Healthcare, Patient Experience & Infection Control. Special MEDEC Supplement: Canadian Medical Technology Companies

Hospital News November Edition 2014  

Focus: Technology in Healthcare, Patient Experience & Infection Control. Special MEDEC Supplement: Canadian Medical Technology Companies