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Improving care for people experiencing mental health crises FOCUS IN THIS ISSUE

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Canada's Health Care Newspaper OCT. 2015 | VOLUME 28 ISSUE 10 | www.hospitalnews.com

Developments in patient-safety practices. Advances in the measurements of patient outcomes and program metrics. New treatment approaches to mental health and addiction. An overview of current research initiatives.

New cancer treatment can destroy an existing tumour and prevent it from relapsing

Preventing injection drug use

INSIDE Legal ...................................................11 Nursing Pulse .....................................12 Ethics .................................................. 14 Safe Medication .................................19 From the CEO's desk..........................20 Evidence Matters ............................... 21

Breakthrough into the link between blood clots and cancer screening

Probiotics may hold key to improving mental health

Blood pressure drug shrinks cancer in ‘miracle’ clinical trial

Brain stimulation eases major depression

A way to prevent anemia in children

Achievements in health research See page 16

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In Brief

New study maps the progression of

Parkinson’s disease Scientists at the Montreal Neurological Institute and Hospital – The Neuro, at McGill University and the McGill University Health Centre, have made advances in understanding the process involved in the progression and spread of Parkinson’s disease (PD) within the brain. The study, published in the September issue of eLIFE Journal, focused on understanding the process that drives the disease’s progression by mapping the distribution and degree of atrophy, characteristic of the disease, in certain brain regions and identify the paths leading the spread from affected to healthy tissue. “Past studies have failed to consistently demonstrate regional brain atrophy in

earlier stages of the disease due to samples of subjects that were too small and to methods that were less sensitive in detecting all aspects of the disease’s impact on the brain. We now have the means to map the disease with greater sensitivity than previously possible,” says Dr. Alain Dagher, senior author of the study. The researchers had access to an unprecedented number of MRI scans and clinical data through the open source Parkinson’s Progression Markers Initiative (PPMI) database. Thanks to this wealth of data, researchers were able to analyze MRI scans which show the structure of the brains of 230 people in the early stages of Parkinson’s disease and compare them to those from age-matched healthy

individuals. This allowed them to identify the set of brain regions that show atrophy in the early stages of the disease. The findings add new evidence to the hypothesis that brain cells in Parkinson’s patients might deteriorate according to a prion-like mode of disease propagation, in which a toxic agent spreads from brain cell to brain cell utilizing the normal connections of the brain. Similar mechanisms have been proposed for diseases ranging from Alzheimer’s Disease to Bovine Spongiform Encephalopathy. The process would involve the spread of alphasynuclein, a toxic misfolded protein with the ability to make copies of itself and infect neighbouring cells while traveling H through the brain’s neuronal highways. ■

Malnutrition is a serious yet avoidable emergency in Canadian hospitals

A national study by the Canadian Malnutrition Task Force (CMTF) has revealed that an astonishing 45 per cent of patients admitted to medical and surgical units in Canadian hospitals are malnourished. The study also found that patients encounter avoidable issues that aggravate the problem of malnutrition during their admission. Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals and other nutrients it needs to maintain healthy tissues and organ function. “An unacceptable number of Canadians are not receiving nutritional care while hospitalized, and this is affecting patient recovery and could cost Canada’s health care system millions of dollars,” says Heather Keller, PhD, FDC and Chair of the CMTF Advisory Board. “Malnutrition increases morbidity, readmission rates and mortality. On average, each malnourished patient stays two-tothree days longer in the hospital than well-nourished patients, and this translates into about $2,000 more for each malnourished patient’s hospital stay.” In the landmark study – the first of

its kind in Canada and the world’s most comprehensive ever to focus on the issue – CMTF researchers gathered data from more than 1,000 patients in 18 academic and community hospitals spread over eight provinces.

An unacceptable number of Canadians are not receiving nutritional care while hospitalized, and this is affecting patient recovery and could cost Canada’s health care system millions of dollars It assessed nutritional status, evaluated the practice of nutrition care, identified potential ways to improve the situation as well as outlined the health care impacts of malnutrition and insufficient nutritional care. Other findings revealed about a third of hospitalized patients do not consume half of the food they are provided, which also increases their hospital stay as their

recovery is delayed. Many patients feel unwell and cannot eat. But, patients also do not consume all of their food because: (1) they have difficulty opening packages/unwrapping food; (2) they are interrupted during their meal; (3) are experiencing difficulty reaching their meal trays; and (4) do not find the food appealing. Ways of supporting their nutrition needs have to be started earlier. For the patients who also enter the hospital in a malnourished state, it makes the situation a two-pronged problem. Key recommendations brought forward by the CMTF include: endorsing and implementing nutrition screening for every medical and surgical patient at hospital admission to identify those at nutrition risk and to provide prompt and thorough nutrition care; raising awareness on the importance of food for patient recovery (missing a meal is like missing a medication or treatment); ensuring patients and their families are part of the solution and are involved in nutrition care; and providing access to training for health care professionals (HCPs) who indicate their nutrition H knowledge is not adequate. ■

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Letter to the Editor Re: Is Canada’s nursing supply set to shrink? Hospital News September 2015 The central question posed in your story should serve as a wake-up call for Ontario’s health minister and everyone with a stake in making sure that people’s access to healthcare won’t be short-changed as a result. Ontario’s nursing supply continues to lag behind other provinces when it comes to the number of RNs per population. In fact, we have the second lowest ratio in the country next to B.C. Our calculations put the number of RNs per 100,000 people at 714 compared to the national average of 836 per 100,000. The numbers are troubling for several reasons. First, unless action is taken, the gap will only get wider when older RNs close to retirement age eventually hang up their stethoscopes. Second, without a robust and ready supply of full-time jobs, newly graduated RNs like Samrinder Sahota will simply continue to look elsewhere for work. Third, the practice of replacing RNs with less experienced and cheaper health professionals undercuts the quality of care Ontarians deserve, and that the province says it is committed to providing. The challenges before us are serious. The good news is that we can reverse the dangerous trend we’ve been witnessing in health care organizations right across this province. We call on Premier Kathleen Wynne, Minister Eric Hoskins, the CEOs of Ontario’s LHINs CEOs and the CEOs of health organizations to immediately end the practice of RN replacement. The evidence is clear: More RNs means patients experience fewer complications and lower mortality rates. We can and must get the RN supply back on track. Dr. Doris Grinspun RN and CEO of the Registered Nurses’ Association of Ontario

Be their facilitator to living safely at home Join our team of solutions-driven Care Coordinators Be the health advocate clients count on to shed light on a complex health care system, identify their unique needs, plan their care and facilitate their access to timely, quality care so that they can live safely and independently at home or 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 ccacjobs.ca. 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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ccacjobs.ca OCTOBER 2015 HOSPITAL NEWS


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Guest Editorial

UPCOMING DEADLINES NOVEMBER 2015 ISSUE EDITORIAL OCT 9 ADVERTISING: DISPLAY OCT 23 CAREER OCT 27 MONTHLY FOCUS: Technology in Healthcare /Patient Experience/Hospital Performance Indicators

Digital health advancements and new technology in healthcare. Programs and initiatives focused on enhancing the patient experience and family centred care. An examination of health system performance based on hospital performance indicators. + CANADA’S MEDICAL TECHNOLOGY COMPANIES SUPPLEMENT

DECEMBER 2015 ISSUE EDITORIAL NOV 11 ADVERTISING: DISPLAY NOV 20 CAREER NOV 24 MONTHLY FOCUS: Year in Review/Future of Healthcare/ Accreditation/Pharmacology: Overview of advancements and trends in healthcare in 2015 and a look ahead at trends and advancements in health care for 2016. An examination of how hospitals are improving the quality of services through accreditation. Safe and effective use of medications in hospitals and clinical pharmacology.

THANKS TO OUR ADVERTISERS

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Let’s rid the world of

suicide

By Dr. Ian Dawe

want to rid the world of suicide. I know, on the surface, how ridiculous that may sound to people. After all, I am only one psychiatrist in a relatively small area and suicide has consistently remained a silent epidemic with little change in statistics in spite of the fact awareness and access to mental health services has never been greater. What difference can I possibly make? Well, there is a movement coming out of the U.S. which suggests you and I, as mental health professionals, can make a significant difference by shifting our attitude and changing our approach. On the surface, the Zero Suicide initiative sounds bold. It challenges the status quo in healthcare and takes direct aim at lowering suicide rates. At its core, Zero Suicide is a commitment to suicide prevention in health and behavioural health care systems, and also a specific set of tools and strategies. It is both a concept and a practice. The Zero Suicide initiative incorporates the following elements in its approach: • LEAD – Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include suicide attempt and loss survivors in leadership and planning roles. • TRAIN – Develop a competent, confident, and caring workforce. • IDENTIFY – Systematically identify and assess suicide risk among people receiving care.

I

ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

Barb Mildon,

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

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

www.hospitalnews.com

EDITOR

KRISTIE JONES

editor@hospitalnews.com ADVERTISING REPRESENTATIVE

DENISE HODGSON denise@hospitalnews.com PUBLISHER

STEFAN DREESEN CREATIVE DIRECTOR

LAUREN REID-SACHS SENIOR GRAPHIC DESIGNER

JOHANNAH LORENZO facebook.com/HospitalNews

HOSPITAL NEWS OCTOBER 2015

• ENGAGE – ensure every person has a suicide care management plan, or pathway to care, that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means. • TREAT – Use effective, evidencebased treatments that directly target suicidality.

Zero Suicide is a commitment to suicide prevention in health and behavioural health care systems, and also a specific set of tools and strategies. It is both a concept and a practice. • TRANSITION – Provide continuous contact and support, especially after acute care. • IMPROVE – Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk. In Canada, the suicide rate for adults has not decreased significantly since 2000, when it dipped less than two per cent from the previous year. Roughly, 3,500 Canadians die of suicide every year. To me, that number is astounding. Mental health in our society has never

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

GRAPHIC DESIGNERS

ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW RENATA VALZ JEFF CHARD ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER BILLING AND RECEIVABLES

MATTHEW PICCOTTI PHIL GIAMMARCO

Dr. Ian Dawe is the Physician-in-Chief, Ontario Shores Centre for Mental Health Sciences.

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

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

Akilah Dressekie,

Ontario Hospital Association

David Brazeau

Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System

been a more accepted topic of conversation. Today governments are recognizing the impact mental illness has on society and corporations are contributing to bring about positive change and eliminate stigma. Yet, still, the suicide rate remains virtually unchanged in spite of the significant strides mental health care has made in public perception in the last decade. In the U.S., health systems adopting the Zero Suicide initiative have witnessed real change. While the goal of eliminating suicides may seem lofty or unattainable, the impact of this aspiration goal has been paramount in building and maintaining a culture that refuses to tolerate suicide and strives to eliminate it. In places where the Zero Suicide initiative has been implemented, it has become a rallying call for health care professionals. In Ontario, we are on the verge on joining this challenge. It is time for us to begin the journey toward this refusal to accept the status quo. Whether it’s through the Zero Suicide initiative or through our own personal refusal to accept the norm, we have the ability to bring about real change to every issue impacting mental health. I encourage you to learn more about H the Zero Suicide initiative. ■

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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: subscriptions@hospitalnews.com Canadian Publications mail sales product agreement number 40065412.

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OCTOBER 2015 HOSPITAL NEWS


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PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Improving access to healthcare for mothers By Atifa Hamir s a mother, accessing healthcare and attending appointments can be challenging. The stress and associated costs of finding childcare and appropriate transportation can result in missed appointments and extended gaps in healthcare. However, two programs at Women’s College Hospital (WCH) – Mother Matters and Stella’s Playroom – are aimed at alleviating that burden and improving access to healthcare for mothers, especially those suffering from mental health issues. Both Mother Matters and Stella’s Playroom were created with the intent of getting mothers the help they need, when they need it. Mother Matters does this by giving new moms a forum to speak to a health care professional and their peers about issues such as post-partum depression and anxiety – all from the comfort and privacy of their own home. “The many challenges that new mothers face, both physical and mental, are not easy to talk about without fear of judgment,” says Greer Slyfield Cook, Social Worker/Mental Health Therapist in the Reproductive Life Stages program, in the Women’s Mental Health Program at WCH. “There is still a stigma associated with saying that motherhood is hard and may not be the best time of your life. That is why it is so important to have an outlet where new moms can speak to one another while knowing their privacy is protected.” The program, which runs two 10-week online sessions a year, is facilitated by two WCH therapists. Each week, readings about topics relevant to the transition to motherhood are posted in the private forum and discussion questions are posed to the group. Through these discussion threads, the therapists are able to provide

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Two programs at Women’s College Hospital (WCH)- Mother Matters and Stella’s Playroomare aimed at alleviating that burden and improving access to healthcare for mothers, especially those suffering from mental health issues.

(above) Patients can drop off their children here at Stella’s Playroom and attend their appointment, knowing that their child is taken care of by a registered early childhood educator, just a few feet away. clinical support and education to patients. Patients can also start their own threads regarding their own concerns and get support from their peers. All participants have the option of using their real name, or choosing an alias if they want their identity to remain private. The 24/7 online access means that the forums can be accessed at any time, whether during the day or in the middle of the night after a late feeding. “Being involved in Mother Matters has been an awesome way to stay connected to other mothers, especially when it’s difficult to leave your house in -30 Celsius weather with a new baby,” says Jane Smith*, a past patient of the program. “I felt that sometimes other people didn’t understand what it was like to be a new mom in this day and age. Being in a small northern Ontario community has some unique challenges, so being a part of Mother Matters has been a

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great way to get that experience from your own home at a time that is good for you.” One of the program’s objectives is to ensure that there is a noticeable improvement in patients’ mental state and in their risk for post-partum depression. To monitor this, each patient is asked to complete an Edinburgh Postnatal Depression Scale before and after the program. In the last four rounds, results have shown a consistent 50 per cent improvement of potential risk factors, proving that Mother Matters is dramatically reducing the chances of new moms developing such depression. Stella’s playroom targets a different issue that many parents face when trying to access healthcare – finding childcare. “As a patient, when you go to an appointment you want to be able to give your full attention and listen to what your doctor is saying. But when you have a bored or tired child at your feet asking for attention, it’s hard to think about anything else,” says Laura Carson, a Kids and Company RECE and Centre Director for Stella’s Playroom. “With Stella’s Playroom, patients can drop off their children and attend their appointment, knowing that their child is taken care of by a registered early childhood educator, just a few feet away.” The free program offers activities such as puzzles, games, books, arts and crafts and imaginative play for children up to the age of 13. Patients of WCH can book an appointment for their children for up to two hours while they attend appointments at the hospital. The program also accepts drop-offs if there is room. Although the program’s services were initially only offered to patients of WCH’s Women’s Mental Health and Headache programs, it soon expanded to all patients of the hospital.

“Once we saw the positive effects that Stella’s Playroom was having on children, parents and health care providers, we knew we had to expand,” says Carson. “We are constantly having parents thank us and tell us what a relief it is to have such accessible care for their children. We’ve also had doctors who have seen improvements during appointments, particularly when it comes to the attentiveness of the patients. It’s an amazing feeling to know that we are able to help moms who need help.” For the teams that run both Stella’s Playroom and Mother Matters, the hope is that awareness of their services grow and that patients continue to reap the benefits. For more information about other services offered at Women’s College Hospital, please H visit www.womenscollegehospital.ca ■ Atifa Hamir is a Communications Coordinator at Women’s College Hospital. www.hospitalnews.com


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PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

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Our healthcare system is under pressure. No one knows this better than nurses. Every day they deal with the effects of underfunding and squeezed resources. Fulfilling their role as advocates, Ontario’s nurses are speaking out on behalf of patients and their families. They want you to know what’s happening to your healthcare.

ona.org

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OCTOBER 2015 HOSPITAL NEWS


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PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Improving care for people experiencing mental health crises By Kristina Niedra and Linda Young

“T

oday, I was dead set on taking my own life and was certain beyond any doubt that anyone could possibly discourage me. I would like to thank the MCIT who managed to get me to take this one step at a time and to give myself credit, and for believing in me. It meant more than words can express. I can tell you without a doubt that having emotional support and protection available is more important than any of the medication being administered to help me emotionally.” MCIT Client Every year, Toronto Police Service (TPS) receives over 24,700 calls about incidents involving emotionally disturbed people, many who are facing mental health crises. Some incidents result in unnecessary emergency department use, incarceration, injuries or fatalities. One strategy to support such individuals in crisis is mobile crisis intervention teams (MCIT). The City of Toronto MCIT model partners a mental health nurse with a police officer as a secondary response unit to 911 crisis calls in the community. The teams are available for approximately 10 hours per day, 7 days per week. The team has

been found to respond to calls in a respectful and supportive manner. In a 2014 study, the Centre for Research on Inner City Health (CRICH) found that consumers valued the support and positive interactions they had with the teams. The City of Toronto MCIT program was developed through funding from the Toronto Central LHIN and in partnership with the Toronto Police services and six hospitals. The model was based on recommendations from a cross-sectoral steering committee that proposed the expansion of teams, increased standardization across existing teams and improved data collection for performance monitoring. Today 17 police divisions are covered by 10 MCIT teams, and a program dashboard is used to monitor key indicators. What are the outcomes of the MCIT model? Four clear benefits to clients and families have been identified. • Enhanced access to care. The city wide model provides access to an additional 1.3 million Torontonians. • Decreased stigma through the provision of sensitive care. The respectful

Sharon and the MCIT team and caring approach by the MCIT influences the way clients respond and together the nurse’s compassionate approach coupled with the officer’s firm authority make a difference in safely de-escalating crisis situations. • Avoidance of tragic outcomes. Timely intervention for clients who are suicidal makes a difference between life and death. Over 27 per cent of the calls in 2014 were associated with suicidality. • Support and capacity building for families in crisis. Letters from family members and research findings indicate that MCIT have helped them learn how to better manage a mental illness through role modelling, coaching by the nurse and referrals to community resources for ongoing assistance. Feedback indicates that the one-on-one care that the nurse is able to provide in a

crisis situation to both the individual patient and family members is invaluable in helping them to reshape their lives. The ability to link individuals to local community resources provides timely access to appropriate supports for both current and future crisis situations and in turn avoids unnecessary emergency department visits. The MCITs are increasingly being recognized for their contribution to the Toronto crisis response system. For more information on the MCIT Program, please visit http://www.torontopoH lice.on.ca/community/mcit.php. ■ Kristina Niedra is a Project Manager at Linda Young is Director of Maternal, Newborn, Mental Health, Organizational Learning and Interprofessional Practice at Toronto East General Hospital.

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Preventing injection drug use By Geoff Koehler r. Dan Werb wants to prevent potential injection drug users from ever starting, by limiting their exposure to experienced injection drug users. He also wants to increase the opportunities people who inject drugs have to find recovery support when they need it. Luckily, his new research may accomplish both. Dr. Werb heads a research project called PRIMER, or Preventing Injecting by Modifying Existing Responses. It was partly inspired by the successful Treatment as Prevention model for reducing HIV prevalence that uses antiretroviral drugs to reduce HIV viral loads to very low or undetectable levels, thereby reducing the risk that HIV-positive people will infect others. Instead of improving access to antiretroviral medication, however, PRIMER will test whether improved access to public health programs such as methadone clinics and supervised injection sites reduces the risk that people who inject drugs initiate others into injecting. “It seems that first-time drug injectors most often begin injecting because they’ve been exposed to veteran injectors and become desensitized – to the point where the drastic step of sticking a needle in your arm seems normal,” explains Dr. Werb, a scientist with the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. Dr. Werb – who has a PhD in epidemiology and expertise in HIV and addictions research – said the key to preventing this exposure is expanding existing public health services for the 100,000 Canadians who already inject drugs, typically cocaine, heroin or other opioids such as OxyContin. “This research will determine whether, by creating more supervised injection sites such as Insite in Vancouver, we can provide safe, private places for injection drug users, while limiting the exposure of those who have never tried injecting drugs,” says Dr. Werb. Scaling up public health services also improves the likelihood those who are injecting drugs may find recovery support. The more frequently that people who use drugs access public health services, the more frequently they interact with trained support workers. “Because timing is so important for recovery, increased services will also increase the opportunities people who use drugs are around someone they can ask for help at the moment they are ready,” adds Dr. Werb. “PRIMER will investigate a way to both prevent new cases of injection drug use and treat the harms experienced by people who have already started.” In 1993, Switzerland expanded supervised injection sites and methadone maintenance therapy as part of a comprehensive public health approach to reducing drug-related harms. At the time, new injectors comprised 18 per cent of all injection drug users in the country. “By 2000, new injectors only made up three per cent of all people who injected drugs in Switzerland,” says Dr. Werb. “This suggests that a comprehensive scale up of harm reduction services might actually reduce the socially contagious nature of injecting.”

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HOSPITAL NEWS OCTOBER 2015

Dr. Werb joined St. Michael’s in January. In July, he was appointed director of the International Centre for Science in Drug Policy. Previously housed in B.C. and now headquartered in the Li Ka Shing Knowledge Institute, the ICSDP is an international network of scientists seeking to improve the health and safety of communities and individuals affected by illicit drugs. Photo courtesy of Yuri Markarov, Medical Media

Dr. Dan Werb wants to prevent potential injection drug users from ever starting, by limiting their exposure to experienced injection drug users. The U.S. National Institute on Drug Abuse seems convinced by Dr. Werb’s plan. He was recently named one of four inaugural recipients of the institute’s US$1.5 million Avenir research award, a

fund set up to support highly innovative research from new scientific investigators. The PRIMER study will be carried out over the next five years with an international team of researchers across six

cities: Vancouver; San Diego, Calif.; Tijuana, Mexico; and Paris, Marseille and H Bordeaux, France. ■ Geoff Koehler works in communication at St. Michael’s Hospital.

Brain stimulation helping treat teen depression By Jenna McMurray

id you know only one out of two teens with depression responds to current frontline treatments? In Calgary, that translates to as many as 5,000 youth in urgent need of something else to help them deal with depression. Specialists at the Alberta Children’s Hospital are studying a very promising and non-invasive treatment for these teens and others just like them all around the world. A team led by Dr. Frank MacMaster is using transcranial magnetic stimulation (TMS) to stimulate a section of the brain called the dorsal lateral prefrontal cortex. It’s the part of the brain that regulates emotion, attention span and the ability to organize, plan and function as a responsible, productive adult. During TMS, a magnetic field targets a small section of the brain – pre-mapped by an MRI – and allows specialists to alter its level of stimulation. “This part is like the boss of the brain,” says Dr. MacMaster. “TMS allows us to make it work more effectively to control symptoms. So far we are seeing some incredibly positive results.” More than three quarters of the participants have responded to the treatment and more than half of them have had their symptoms reduced by over 50 per cent. This is an incredible success, considering these patients haven’t responded to traditional treatments, such as antidepressants and cognitive behavioural therapy. While developing TMS as a successful therapy for depression is one goal, Dr. MacMaster’s team is simultaneously iden-

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A team led by Dr. Frank MacMaster is studying a very promising and non-invasive treatment for teens with depression called transcranial magnetic stimulation. tifying factors that would help specialists predict how effective the treatment might be for individual patients. They have already found some potential indicators of how well patients will respond to TMS, including blood flow and the thickness of the cortex. Unlike drugs, which can take up to six months to show their effectiveness in youth with depression, Dr. MacMaster is able to tell as early as the second week into TMS treatment whether it’s making a difference for a patient. And, he says, relative to long-term and multiple-medication regimes or leaving depression untreated, TMS is a significantly lower risk option. Given its success so far, it may one day become the frontline treatment for depression in youth.

Dr. MacMaster’s group was approached by experts at the Mayo Clinic for help on two new collaborative projects. The first is a large-scale trial – with sites at the Alberta Children’s Hospital, the Mayo Clinic and the University of Cincinnati – to seek Food and Drug Administration (FDA) approval for TMS as a treatment for teens with depression. The second is to use the trial as a framework for a multisite study on biological predictors of TMS response rates in youth with depression. This could result in the validation of the first precision medicine identifier in psyH chiatry. ■ Jenna McMurray works in communications at Alberta Children’s Hospital Foundation. www.hospitalnews.com


Special Supplement

2015

<RXU*XLGHWR WKH6KRZ Legal Update 11

Hospital boards should harmonize their by-laws with College transparency initiatives By Michael Watts, Paula Trattner and David Solomon

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ince 2012, the College of Physicians and Surgeons of Ontario has been engaged in a transparency initiative to provide easy to understand information about Ontario physicians in order to assist patients with making informed choices and to enhance the College’s public accountability. At their Council meeting in May 2015, the College resolved to post a range of additional information on its public register, including criminal charges, cautions-inperson, mandatory continuing education or remediation programs, and licences and discipline findings in other jurisdictions. These changes represent not only a marked departure from what the College previously posted on the public register, but also from what many hospitals in Ontario currently require physicians to disclose when applying or re-applying for hospital privileges. The is because, historically, the view of many physician advocates was that information such as complaints or criminal charges are inappropriate and unnecessary to disclose unless and until there is a final unfavourable disposition, under the oftquoted legal maxim that the accused are “innocent until proven guilty.”

Take, for example, the Harmonized Physician Renewal Questions form of the Toronto Academic Health Science Network (TAHSN), which is an annual credentialing form used by many GTA hospitals. Currently, the form does not expressly require disclosure of licences in other jurisdictions and only requires disclosure of criminal charges “which may impact on the safety of the Hospital’s workplace or that may be relevant to the applicant’s a) ability and/or suitability to practice medicine, or b) abil-

ity to comply with the Hospital’s Policies.” Similarly, the Northwest Regional Appointment and Credentialing Policy and Procedure used by many northwest hospitals only requires disclosure of criminal proceedings “which may impact the Applicant’s professional practice or responsibilities pursuant to their appointment.” Given the scope of information that now appears on the College’s public register (which includes, for example, all criminal charges of any nature, without

qualification), these types of forms and policies have, respectfully, fallen below the standard of disclosure the College is now upholding. Moreover, because hospitals are better positioned than the College to oversee and safeguard the frontline delivery of healthcare, there is a compelling argument that they should go well beyond the College standard to request immediate disclosure of broader information such as criminal investigations. Continued on page 12

CLINICAL PRACTICE GUIDELINES

Interactive Tools and resources

The needle has now clearly shifted in Ontario in favour of greater transparency of information about physicians (and other regulated health professionals). This argument has historically been extrapolated to extend to pending reviews, investigations, and proceedings, whether by law enforcement, a regulatory college or board, a court or tribunal, or another hospital or health care facility. That is why our firm has, for many years, advised our hospital clients to require disclosure of much broader information regarding pending matters, not only annually on re-application forms, but also immediately, to the extent matters arise during the credentialing year. While the above maxim remains true in a court of law, it has perhaps never been true in the court of public opinion, and the needle has now clearly shifted in Ontario in favour of greater transparency of information about physicians (and other regulated health professionals). Accordingly, hospital boards should now, at a minimum, require immediate disclosure of any information that the College will make public, so that their by-laws are at least harmonized with the current College transparency initiative. Failure to do so would mean hospital boards and their medical advisory committees (MAC) are not necessarily considering publicly available information about physicians when deciding whether to appoint or re-appoint them to the medical staff. This could call into question whether the hospital board and MAC are acting in the best interests of the hospital or otherwise conducting reasonable due diligence on applicant physicians. www.hospitalnews.com

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OCTOBER 2015 HOSPITAL NEWS


Special Supplement

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<RXU*XLGHWR WKH6KRZ

12 Nursing Pulse

Ahead of the curve

By Daniel Punch

s a high school senior, Janson Chan remembers seeing a bully pick on a fellow student. “I walked right by because it wasn’t my problem,” he recalls. Only later did Chan learn that same bully was also tormenting his younger brother, Joshua, who has autism spectrum disorder (ASD). Like many autistic youth, Joshua has a hard time navigating social situations, leaving him isolated and an easy target for bullies. “That really hit home for me,” Chan remembers. He could no longer turn a blind eye, and has since made it his goal to ensure teens with autism are not overlooked or victimized. After graduating high school in 2009, Chan moved from Toronto to London to study medical science at Western University, where he launched an autism awareness club. Through the club, he got involved with Autism Ontario and its “teen night” for local autistic youth. When Chan moved back to Toronto to enter York University’s second-entry nursing degree program, he found a lack of similar programs for autistic teens. Inspired by Joshua, he launched his own program in July 2014. The result is the Autism Teenage Partnership (ATP), a volunteer-run community program where teens with autism can interact with their peers and develop their social skills in a safe environment. Participants meet weekly at Scarborough’s Milliken Park Community Recreation Centre for games, crafts, team-building activities and just to be themselves. “People come in from all over the city, from different backgrounds,” Chan explains. “They connect with their peers, make friendships, or just hang out and talk about video games.”

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I’m an

In June of this year, the program opened up its second branch in Kitchener-Waterloo, and a third location in Richmond Hill opened in September. “It’s unfathomable,” Chan says of ATP’s success. “It baffles me how big we got so quickly, starting from just one idea.” The idea for ATP came after Chan watched his family struggle to find support for Joshua. Programs for autistic youth are scarce, difficult to access, and tend to drop off after the age of 12. They can also be expensive – in fact, supporting an autistic child can cost families up to $60,000 per year. So as Chan developed the Toronto program, he wanted to ensure it was free, accessible, and could provide families with some respite. Chan recruited a group of student volunteers, including many of his peers in York’s nursing program. Autism Ontario provided training, and donations came in from York’s faculty of health and the Milliken Park advisory board. The program’s big break came in June 2014, just before its launch, when he submitted a proposal to the Registered Nurses’ Association of Ontario’s (RNAO) Region 7 (Toronto West), and was given a $3,000 grant to get ATP off the ground. “RNAO being able to put that... money forward was the real launch pad for ATP,” says Chan. “They’re nurses, so they understand the importance of creating a social support network and socializing in the community.” ATP gradually built a roster of more than 60 teen participants across Ontario, becoming a second home for many. The feedback has been all positive, Chan says, and the program has received rave – and sometimes tearful – reviews from grateful families. “I think (my son) feels enriched and more confident about himself (since

Programs for autistic youth are scarce, difficult to access, and tend to drop off after the age of 12. They can also be expensive – in fact, supporting an autistic child can cost families up to $60,000 per year. going to ATP). He feels like he belongs. I think he found himself somewhat,” one parent says. ATP also gives its volunteers the chance to make a difference and gain valuable experience. “It’s been really rewarding for me. I’m learning every week,” says Henry Chong, a York University graduate now working as a public health nurse for Durham Region. “It’s really applicable to my own practice as a nurse working in the community, learning how to build trust with all types of individuals.” What started as a summer project has evolved into a growing not-for-profit organization, and Chan is its 23-year-old founding director. He was featured in Maclean’s magazine and RNAO’s flagship publication, Registered Nurse Journal, this year. He spoke about autism at the Canadian Nursing Students’ Association’s national conference in 2014. And he currently represents RNAO on the Ontario Working Group on Mental Health and Adults with Autism Spectrum Disorder – an interdisciplinary group of experts seeking to guide the province’s autism policy. And he has accomplished all of this as a student with a full course load and a part-time job. “As

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a nurse, there are so many paths you can take,” Chan says. “It’s so great I went into a profession that gave me the skills I can use (for these projects).” With the launch of the Kitchener-Waterloo chapter in June and more growth on the horizon, Chan has his eyes on the bigger picture. Maybe ATP – which operated in Toronto for less than $4,000 in its first year – could serve as a model for a national network of programs that increase access for families of autistic teens across the country. To help make this happen, he plans to create a “franchise manual” outlining the tools and procedures for establishing new ATP chapters. Of course, none of this can happen without funding, and ATP got a lifeline in May, when the Laidlaw Foundation YouthLed Community Change program awarded Chan with a $25,000 grant. He says the money will help take ATP to the next level. “I want to create a movement where students can take ownership of these programs... and have an impact in their communities,” he says. At home in Scarborough, Chan sees his own community impact every week at ATP. And by his side, in charge of the food, is Joshua. “He absolutely loves it,” Chan H boasts. ■ Daniel Punch is staff writer for the Registered Nurses’ Association of Ontario (RNAO).

Legal update Continued from page 11 Indeed, some leading hospitals already do require immediate disclosure of criminal investigations, which is important for investigations that may take a long time to complete (e.g., billing fraud). The need and ability to make follow-up inquiries following disclosure should also be addressed in by-laws. Further, consideration of enhanced disclosure on the College’s public register does not eliminate the need to obtain a Certificate of Professional Conduct in appropriate situations, such as appointment or when concerning information appears on the public register. Finally, understanding that the consequences of disclosure can be severe, some physicians narrowly interpret their disclosure obligations. In amending their by-laws and application forms, therefore, Hospitals should be detailed and explicit in their expectations, and should specifically require physicians to discharge their disclosure obligations in a “candid, honest, thorough and accurate manner.” This is the standard that the Health Professions Appeal and Review Board applies when reviewing physician conduct during the credentialing process (see Rosenhek v Windsor Regional Hospital, 2009 CanLII 88685 (ON H HPARB) at para 18). ■ Michael Watts and Paula Trattner are both Partners; David Solomon is an Associate in the Toronto office of law firm Osler, Hoskin & Harcourt LLP. www.hospitalnews.com


Focus 13

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

One Patient One Plan boosts

recovery in mental health By Kathy Stackelberg

he voice of the mental health patient at the North Bay Regional Health Centre (NBRHC) is being heard now more than ever before, thanks to the One Patient One Plan (OPOP) program. It has changed the way staff and patients interact. The decision to create the OPOP program came about in response to the changes in mental health services across Ontario, with more focus on the recovery model instead of the traditional custodial model. There has been an increase in mental health patients being re-integrated into their communities with supports, rather than having them remain in hospital, sometimes for years. By moving away from custodial care, we must ensure that people with mental illness are capable of partnering in their care and ultimately living in the community. Through OPOP the hospital puts patients first, listening to their needs and thoughts, and helping them move on towards independence.

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There has been an increase in mental health patients being re-integrated into their communities with supports, rather than having them remain in hospital, sometimes for years. “When I think of self directed, personcentered, empowered, respectful care, One Patient One Plan does all of those things. It really helps to instill hope for our patients and their families that recovery is real and recovery is possible,” says Laurie Wardell, a Director of Mental Health at NBRHC. OPOP moves past the traditional way of patient planning, where many patients were placed in the same routine with the same expectations for everyone. One Patient One Plan provides a framework of how members of the clinical team can meet regularly with each patient, and create individual goals with the patient’s input. “Years ago, we implemented the recovery philosophy and it was a fantastic improvement and quite a dramatic departure from the custodial type of era,” says Helene Philbin Wilkinson, a Director of Mental Health at NBRHC. “One Patient One Plan helps us drill down even further in terms of the principle of being person centered and it really elevates the patient as a bit of the driver, in terms of how they see themselves moving through the mental health system.” Instead of meeting in large groups and discussing the patient without the patient present, clinical staff at NBRHC now meets regularly in small mini teams with the patient and their families. They create goals together based on the patient’s personal recovery needs, and also review the clinical picture of why they have been admitted to the hospital. The patient is at the table, included in frank, honest discussions about the reason for admission, what to expect during the hospital stay, and when they may be discharged. www.hospitalnews.com

Peer support worker Sandy Sikora takes time for a one-on-one with a patient As soon as a patient enters the hospital, staff connects with the community partners in order to paint the broad picture for the patient, so that he or she will look at their treatment with a view to being discharged. Gone are the days of being admitted to the hospital with the idea that the patient would remain there indefinitely with no set plan to return to the community. Through OPOP the staff keeps close tabs on each patient as his or her goal is achieved. This is pointed out to the patient who may not be aware of what they have accomplished. Gradually the patient’s self esteem is renewed, and reliance on staff is reduced. As goals are met, staff fades into the background and the patient becomes more self sustaining. Under OPOP, staff is no longer seen as the ‘care taker’, but more as the facilitator toward independence. Goals can be as big as wanting to return to school or as simple as showering and

dressing properly. Dr. Susan Johnston says upon arrival at the hospital one patient was feeling negative and not interacting with the team on any goals. However, following his OPOP team meetings this patient began to open up and speak and even laugh. He started to put his plan into action, achieving some of his goals. “That’s the wonderful part about OPOP,” says Dr. Johnston. “You get the patient’s feedback on how they think they are doing and we (staff) respond with how we think they are doing. With this particular patient we discussed withdrawing his reminders around showering, once he had achieved that goal, and he asked ‘why can’t I bring them home with me so that I can remember?’ That was an ah-ha moment because it was not often that we were getting direct feedback from the individual that it matters most to – about what they think will help them when they go home.”

Patients say One Patient One Plan is making a difference. They like going to their regular ‘check-in’ and getting the personal attention. Louise says, “The smaller one-on-one is a good way to deal with patients who have anxiety and have a hard time opening up.” Mary Jane says, “All in all I like it, and I think the healthier the patient gets, the more they realize that it’s important.” Family members say they are very appreciative to be involved in the OPOP meetings. They say it’s much less intimidating to meet with their loved one and two or three staff, rather than facing a team of fifteen or so health care professionals. Staff is also noticing the benefits of OPOP. Registered Nurse, Brad McBlaine, says, “The staff has done an amazing job at adapting to what is essentially quite a different process from what we had. I think that a lot of us feel that this is the way we were meant to interact with our patients.” As a former patient and current peer support worker in the hospital Drop in Centre, Ron Brusseau has been observing the OPOP process with enthusiasm. “It’s interesting to see,” he says with a big grin. “The patients have been coming in, grabbing a quick coffee and saying “well I’ve got to go, I’m going to my OPOP,” and then they come back later and they’re all talking about one another’s goals and who’s getting discharged next and where they’re going. They’re celebrating with handshakes and hugs. It’s really cool to see that they’re talking about it like that, saying: ‘So what are your three goals? Who do you have for support and are you getting a job, or going to school?’ It’s all part of the OPOP H experience!” ■ Kathy Stackelberg is a Sr. Communications Specialist at North Bay Regional Health Centre.

OCTOBER 2015 HOSPITAL NEWS


14 Ethics

“Grievous and irremediable” Are we as a society capable of ready remedies?

By Kevin Reel magine you are a mental health care provider and you meet a client you’ve known for years. The client has lived with treatment-resistant depressive illness for decades, and has often spoken of wanting to die rather than endure the regular psychological torment of trying to live with the illness. The client is about to start a trial of a new medication. You offer encouragement and hope, saying that you are aware that the medication has resulted in great improvements for some people. Your client replies: “That’s great, but how long must I live on your hope?” The Supreme Court of Canada (SCC) ruling of February 2015 striking down the Criminal Code’s total prohibition on “assisting suicide” applies only to capable adults living with intolerable suffering – physical or psychological – arising from a grievous and irremediable condition. Pondering this from a mental health perspective, a few thoughts come to mind. First is the name we choose to label this new sort of arranged death. It would appear to me essential to distinguish it from ‘suicide’. It should be seen as a qualitatively different thing. To this end, ‘death’ seems the most accurate term. This type of death is typically requested in order to curtail the dying pro-

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HOSPITAL NEWS OCTOBER 2015

A term such as ‘legal requested death’ may serve to distinguish these deaths from tragic suicides which must be held in an entirely different regard. cess. And given that so many health care providers, physicians especially, wish to minimize associations between their practice and such arranged death, let’s emphasize that it is ‘requested’ by the client/patient. Finally, recalling that not all requests will be granted, any added descriptor ought to clarify that we only act upon those requests that are ‘legal’ – i.e. they meet eligibility criteria and fall within established safeguards. A term such as ‘legal requested death’ may serve to distinguish these deaths from tragic suicides which must be held in an entirely different regard. Both are lamentable, but the latter are profoundly lamentable, typically borne out of despair and/or crisis and very often avoidable. This raises a second thought: Are we as a society capable of providing certain social

remedies that might avert legal requests for death? If not, do we honour these requests? This repeatedly crops up when listening to the stories from the Nunavut coroner’s inquest. The social determinants of health – decent housing, education, livable income, meaningful employment, social inclusion - are cited time and again as sorely lacking in the stories of youth and adults who die by suicide. Similarly, the numerous friends, family, clients and colleagues I have known to ponder death by suicide, and the smaller number that have died this way, typically identified these sorts of factors as part of their struggle. I cannot say how I would respond to living in such circumstances. But I do know that the reality of these missing factors is compromising the life chances of many people with both disabilities and mental illness. And I know some are remediable – not immediately, but fairly readily. This however, is not within either the scope or influence of health care providers working within the systems we have today. So back to that first client story and the question of hope – whose hope? When is continued hope realistic? If I have hope are you required to share it? How does my own hope affect my judgement about your health condition and the sum of its inter-

action with your social determinants of health? When can that sum be objectively understood to add up to irremediably intolerable suffering? Or should that judgement be a subjective one, made by the client/ patient? How will we feel if we find ourselves insisting that people hang in there until we eventually change longstanding resourcing structures so that the socio-environmental context in which they live changes the final calculus of their suffering? If we do, what obligations does that impose on us to make it happen faster? What will we expect of our new government in Ottawa when it rewrites the criminal code? Perhaps the advent of legal requested death may require us to face our failure as a society to do right by so many of our marginalized and stigmatized among us – often living on very low income in poor housing with inadequate supports and few prospects for improvement. This could be one element of a just and ethical framework implementing the SCC ruling – the social determinants of health safeguards. Are we capable of making this decision mean such H a difference? ■ Kevin Reel is an Ethicist, Centre for Addiction and Mental Health and Assistant Professor, University of Toronto.

www.hospitalnews.com


2015

November 2•3•4 2015 Metro Convention Centre Toronto, Ontario


H2

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Remarkable Keynote Speakers HealthAchieve is excited to introduce our line-up of keynote speakers for 2015. Be prepared to learn, laugh and be inspired on day one, day two and day three of HealthAchieve!

Feature Breakfast

Feature Session

No Standing Still with Jonny Harris Monday, November 2 at 7:30am

Steering Your Ship Through Rough Waters: Lessons on Leadership from Captain Phillips Tuesday, November 3 at 10:00am

Jonny Harris, is a Gemini-nominated actor and comedian who has been staff writer for This Hour has 22 Minutes and is currently writer, producer and host for CBC’s Still Standing. @JollyHarris

Official Opening A Conversation with Martin Short Monday, November 2 at 10:00am Martin Short, Tony and Emmy-winning comedian and actor will be sharing stories from his new book, “I Must Say: Life as a Humble Comedy Legend”, and talking about his very personal connection to health care during his late wife’s battle with cancer. @MartinShort_

Captain Richard Phillips, the “Hero of the High Seas” who offered himself as a hostage to protect his crew from a Somali hijacking, will be sharing his highly intriguing story and drawing lessons from his dramatic experiences that were transformed into an Academy-Award and Golden Globe nominated film. This amazing leader’s compelling story will teach the importance of leadership and teamwork to help organization’s survive and thrive.

Closing Session Harnessing Innovation: Turning Raw Ideas Into Powerful Results Wednesday, November 4 at 9:30am Josh Linkner, a four-time successful tech entrepreneur and investor in dozens of startups, has seen thousands of companies loaded with creative buzz and big ideas. Learn how these companies harness their imagination to create game-changing drivers of growth and innovation. @joshlinkner

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To learn more, or to register now, go to www.oha.com/conferences.

HOSPITAL NEWS OCTOBER 2015

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2015

H3

Be Inspired by Brilliance. Register today to hear thought leaders, visionaries, and creative minds share their words of wisdom, compelling ideas, and vision for the future at HealthAchieve. Robert Ghiz, Former Premier of Prince Edward Island Reflections from a Former Premier @RobertGhiz

Larry W. Walker, President of the Walker Company Healthcare Consulting Rewiring Governance: Connecting, Cooperating and Collaborating for a Healthier Ontario

Dr. Glenn Steele, Former President and CEO of Geisinger Health Patient Safety and Quality

Michelle Ray, Leadership Expert and Consultant, Lead Yourself First Institute Leading Yourself through Change and Uncertainty @MichelleRayCSP

John Nosta, Digital Health Philosopher The Digital Health Revolution! @JohnNosta Sherron Watkins, Former Vice President of Enron Corporation and Co-author of Power Failure: The Inside Story of the Collapse of Enron Ethical and Leadership Failures at Enron Corporation Michael Bungay Stanier, Champion for Great Work and Manager Development Expert How to Work Less Hard and Have More Impact: The Five Essential Questions to Change the Way You Work Forever @boxofcrayons

Sharone Bar-David, President of Bar-David Consulting and Author of Trust Your Canary – Every Leader’s Guide to Taming Workplace Incivility “How on Earth Do I Handle that?” – Tackling the Civility Challenge @sharonebardavid Natalie Panek, Rocket Scientist and Advocate for Women in Tech Learning Should Know No Boundaries @nmpanek Dr. Emily Hoffman, Vice President of Product and Development and Client Delivery, VitalSmarts The New Science of Leading Change – Maximizing the Influencer in You

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H4

2015

top 5

The

High-risk IPAC office practices

By Dr. Maureen Cividino

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rom hepatitis C cases linked to procedures in an endoscopy clinic to bacterial meningitis cases discovered in a pain clinic, serious infections can be prevented with the application of a few foundational infection prevention and control (IPAC) practices. Unfortunately, proper hand hygiene and safe injection practices recommended for over a century have yet to be adopted

universally. Health care providers need to make the connection between normalizing these simple IPAC practices and ensuring positive patient outcomes that avoid transmission of preventable infections. In May 1997, Health Canada published Infection Control Guidelines for Preventing the Transmission of Blood Borne Pathogens in Health Care and Public Service Settings, stating, “Single-use (disposable) needles and syringes should be discarded after one use. Changing needles between patients but not chang-

Integrated Pharmaceutical Supply Chain Model Overcoming the challenges of unsustainable cost and demand in the current health care system requires strategic solutions. The pharmaceutical supply chain is an area in which efficiencies will improve patient care and reduce costs. In 2013, McKesson Canada developed an integrated pharmaceutical supply chain model in partnership with the province of New Brunswick. The model is customizable, self-funding and ensures the best use of resources through a committed private/public sector partnership, which brings the following benefits: Decision support Collaboration and connectivity ensure best outcomes for patients and optimal use of time and human resources. Efficiencies Nursing and pharmacy staff more effectively use their time with patients, rather than doing manual checking, dispensing and ordering medication. Safety The management, tracking and dispensing of medication are more secure and efficient through the use of a single source supplier and barcode technology. Affordability Sustainable and self-funding, the model enables the best use of human, financial and technological resources to promote patient safety and cost avoidance. A single point of accountability McKesson Canada is solely responsible for recording and tracking medications throughout the supply chain.

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HOSPITAL NEWS OCTOBER 2015

ing syringes is not an acceptable practice.” A 1990 Canadian Journal of Anesthesia article highlighted the risk of “cross-infection related to the multiple use of disposable syringes,” but results of a survey indicated that almost half of anesthesiologists engaged in the practice. The good news is there is progress. Since the initial collaboration between Public Health Ontario (PHO) and the College of Physicians and Surgeons of Ontario (CPSO) to create the Infection Prevention and Control for Clinical Office Practice best practice document, there continues to be a keen interest in finding ways for clinicians to improve IPAC practices. Clinicians are engaging in the discussion to jointly make changes that will improve patient safety, while ensuring that these practices can be implemented in a practical manner. Integrating best practices into routine care and responding to infections appropriately will decrease the risk of outbreaks, elevate the general level of practice, and protect both the public and health care workers. The following recommendations address the top five practices that put patients and others at risk for infection in an outpatient clinical setting:

Lancets, insulin pens and glucometers

• Lancets must be single use only. • Lancet hubs (hold the lancet) must be single use only. • Insulin pens must be single-patient use only. • Blood glucose monitoring devices (glucometers) and other blood-testing devices should not be shared between patients. • If glucometers must be shared, they must be designed for multi-patient use and cleaned and disinfected after each use, as per the manufacturer’s recommendations. If the manufacturer does not have specific cleaning and disinfection instructions, the device must not be shared.

Blood collection tube holder

• Single-use blood collection tube holders are preferred. • If a blood collection tube holder must be reused, it must be cleaned and disinfected after each use as per manufacturer’s instructions.

Tonometers

• Tonometers and other ophthalmologic equipment that touches the eye must undergo high-level disinfection (for example, glutaraldehyde) between patients. Cleaning with alcohol is not sufficient.

Using syringes, needles and vials for intramuscular/ intravenous medications and vaccines

• All needles must be single-patient use only. • All syringes must be single-patient use only. • Single-use vials are preferred and should be used only once on a single patient. • When necessary to use a multi-dose vial, never re-enter the vial with a used needle or used syringe. • Once a medication is drawn up from a vial, the needle should be immediately withdrawn from the vial and never be left in a vial to be attached to a new syringe.

Maintaining sterilization logs

(meticulous cleaning must be done first) • Sterilization logs are required for all office/desktop autoclaves. • Logs must document the time, temperature, and pressure at the completion of each load. • An external chemical indicator must be used with each packaged item to indicate sterilization. • An internal chemical indicator must be placed inside each packaged item to be sterilized. • Daily testing of biological indicators (BI) is required. • SCOPE disinfection and sterilization logs must include test strip monitoring, concentration and exposure time, and disinfectant temperature for automated endoscope reprocessors (AER). All of these best practices are achievable. Be sure to reach out to your colleagues, stakeholders, and fellow health care providers to draw on the guidance that is available in PIDAC’s Infection Prevention H and Control for Clinical Office Practice. ■ Dr. Maureen Cividino is an IPAC Physician with Public Health Ontario and a member of the PIDAC Infection Prevention and Control Committee. Dr. Cividino will be speaking about high-risk infection control practices at HealthAchieve in Toronto on November 2, 2015. For more information visit www.healthachieve.com. www.hospitalnews.com


2015

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We’re proud

to sponsor OHA HealthAchieve 2015

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 2 Tuesday, November 3 9:00 a.m. to 5:00 p.m. Feature Session Steering Your Ship Through Rough Waters: Lessons on Leadership from Captain Phillips Tuesday, November 3 10:00 a.m. to 11:30 a.m. Room 105, 106, 107

Together for better health

www.mckesson.ca www.hospitalnews.com

Follow us

Health Links Session A look at International High Performing Health Care Systems Achievements; Key Strategies; Extended Learnings from abroad Tuesday, November 3 3:30 p.m. to 5:00 p.m. Room 104 ABC

OCTOBER 2015 HOSPITAL NEWS


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2015

The new science of leading change By Dr. Emily Hoffman hen we succeed at something, we like to believe it’s because we tried hard, overcame insurmountable obstacles, and were victorious in the end. While there is some

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truth in that, the fact is that we are driven by sources of behaviour around us, not entirely by our own choices or will. Your world is perfectly created to drive your current behaviour, so in many ways success

TRANSFORMING THE OR, TOGETHER

YOUR PASSION TO DELIVER THE BEST PATIENT CARE.

Today, we can leverage synergies that will help transform the surgical experience, drive better patient outcomes, and enhance economic value. From the world’s leader in medical technology comes Medtronic Surgical Synergy™—a synthesis of surgical, procedural, and therapeutic innovations from our Spine, Neuromodulation, and Surgical Technologies businesses. With the depth and breadth of our expertise and technologies, we RƪHULQWHJUDWHGSURFHGXUDOVROXWLRQVWKDWFDQKHOS support your goals of: • • • • •

OUR BREAKTHROUGH RESTORATIVE THERAPIES AND INNOVATIVE TECHNOLOGIES

Advancing patient care. Performing faster, more precise procedures. Reducing patient complications and improving clinical outcomes. Achieving better economic value. Enabling more minimally invasive and complex procedures.

Medtronic Surgical Synergy™ THE POWER OF INTEGRATION

HOSPITAL NEWS OCTOBER 2015

and failure are more about circumstance Carter Center in Atlanta, GA. He deand environment than choice. cided he wanted to eradicate GuineaKnowing this is important when it worm disease, a painful and incurable comes to leading change. The lens condition caused by the parasitic Guinea through which we see the world may worm. Endemic in 20 countries in Subbe impacting our behaviour, so if an Saharan Africa and the Middle East, it is organization wants to caused by drinking parcreate widespread, susasite-infested water and tainable change, it needs soaking affected limbs in to understand why its that same water to ease people are behaving the the pain of the disease, way they are in order to thus starting the cycle change the influences of all over again. that behaviour. Knowing there is no There are six sources of cure, Hopkins underinfluence that impact bestood that the only way to haviour: eradicate the disease was • Personal motivation: to change the behaviour whether or not we want of the people affected by to do something it by teaching them not to • Personal ability: whether drink or soak in parasiteor not we are capable of infested water. UnderDr. Emily Hoffman. doing something standing the influences • Social motivation: praise behind their behaviour and criticism from peers was all he needed to lead change and make • Social ability: the availability of help an astounding difference in the lives of and information from others those living in areas where Guinea-worm • Structural motivation: compensation, disease was once so prevalent. The disease perks and other incentives is down to fewer than 600 cases worldwide • Structural ability: tools and physical re- from 3.5 million in 1986 when Dr. Hopkins sources began leading the drive to eradicate it. This simple but powerful model is the Creating and managing sustainable basis for changing behaviour, and can be change seems to be a constant struggle used in both professional and personal set- for organizations, but achieving hardtings. It allows you to clearly map out and hitting business results in the areas of define current influences so you can better productivity, change management and understand who and what is impacting the leadership effectiveness is possible. behaviour you’d like to change. Knowledge is power, as the old saySustainable change happens when you ing goes, and knowing why behaviours can harness four or more of the six sources persist gives you the power to change H of influence to drive new behaviour. Doing them. ■ so can make the seemingly impossible hapDr. Emily Hoffman, Vice President, pen. We studied several change agents who attacked persistent, resistant and profound Product Development and Client Delivery, problems, and were able to make change VitalSmarts, will be speaking about the new happen by understanding the motivating science of leading change and maximizing your inner influencer on November 3 at factors behind the old behaviour. Consider Donald R. Hopkins, former HealthAchieve in Toronto. Learn more at director of all health programs at The www.healthachieve.com www.hospitalnews.com


2015

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INNOVATING WITH PATIENTS AND PROVIDERS IN MIND Together, we will collaborate with health systems and providers to help improve healthcareâ&#x20AC;&#x201D;to get the right treatment, to the right patient, at the right time in more places around the world.

www.hospitalnews.com

OCTOBER 2015 HOSPITAL NEWS


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2015

Must-See Attraction on Exhibit Floor: Intelligent Hospital Pavilion™ The Intelligent Health Association, in partnership with the Ontario Hospital Association, is excited to introduce the latest attraction to HealthAchieve’s award-winning exhibit floor – the Intelligent Hospital Pavilion™. This technology-equipped, destination pavilion is a must-see attraction for delegates that will help raise awareness and education the health care industry on the many applications of technology and innovation within a clinical setting. Delegates will get guided tours and live demonstrations of how a number of technologies, when integrated together in real-time, can result in improved patient care and patient safety, while helping the hospital produce better operating efficiencies. Don’t miss your opportunity to experience the first-ever technology destination on the exhibit floor and learn how these new technologies can be applied within your own health care setting!

INTELLIGENT HEALTH ASSOCIATION Healthier Living Through Technology

TM

healthachieve.com

Online learning that’s bottom line friendly. Train your staff with ease – and within budget – by taking advantage of the wide variety of health-based online learning options offered by the Ontario Hospital Association. Training Modules.

Harvard ManageMentor

Our online modules cover a multitude of topics, including Accessible Customer Service Standards, Freedom of Information, Hand Hygiene and Personal Protective Equipment – to name but a few.

From the legendary Harvard Business School comes Harvard ManageMentor (HMM): an online resource, with over 44 modules, that gives your employees the tools and resources they need to address everyday management challenges — with a click of a mouse.

Flexible pricing options are available. To learn more about this state-of-theart learning experience, contact Candace Simas at csimas@oha.com

FRIENDS AND COLLEAGUES IPAC Canada is a multidisciplinary professional association of those engaged in the prevention and control of infections in all healthcare settings.

Save 45% when you get 50 licenses for 50 users!

To learn more, go (where else?) online: to www.oha.com/trainyourstaff

IPAC Canada represents its members in the pursuit of patient and staff safety and in the promotion of best infection prevention and control practices. We work regularly with other professional associations and regulatory bodies to develop guidelines. Our members come from across the continuum of care. Visit our website www.ipac-canada.org to see the many benefits and resources that are available to members.

INFECTION PREVENTION AND CONTROL CANADA (IPAC CANADA) HOSPITAL NEWS OCTOBER 2015

www.hospitalnews.com


Special Supplement

2015

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Frontline innovation Patient health care and the future of health care delivery By Dr. Joseph Cafazzo

common theme in healthcare today is how to deal with growing chronic illness in an aging population, because the existing paradigm of care is straining to keep up with the demand. For the most part, we’re currently only set up to deal with acute exacerbations of chronic illness, not its daily management – that’s left to the patient and their family caregivers.

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Giving patients with chronic illnesses more information and the tools they need to manage and monitor their own care eases the burden on the health care system. More can be done by the patient, but so far we’ve done a pretty poor job of making that happen. If we truly believe in the notion of ‘patient-centered care’, there’s no better way to demonstrate this than by respecting a patient’s right to have access to their personal health information. This allows for the establishment of a new patient-provider relationship that’s based on mutual respect, and founded on the

www.hospitalnews.com

principle that patients have an immense capacity for self care. With this largely untapped capacity, it can be transformational to give them the tools needed to take a more active role of their own care and disease management. Consider home hemodialysis. The process involves setting up a dialysis machine in the patient’s home so they can dialyze during the night. In essence, this requires the patient to become their own nurse as they self-cannulate and monitor the process from start to finish. The benefits are impressive. Rather than giving up three days a week to travel back and forth to a hospital for up to four hours of hemodialysis at a time, the patient sleeps during treatment in the comfort of their own home. That means the potential for 50+ hours of dialysis per week instead of just 12 – and the ability to reclaim a much more normal lifestyle. It’s simply about giving patients an option and a chance, and if it can be done for something as serious as kidney failure, it can certainly be done for less serious chronic illnesses like diabetes, hypertension, asthma and even heart failure. Giving patients with chronic illnesses more information and the tools they need to manage and monitor their own care eases the burden on the health care system, lowers cost, and improves patient outcome

Dr. Joseph Cafazzo – all of which is evidence based, and not hypothetical. The key is convincing health care professionals to let go of control to a certain extent, and think of the doctor-patient relationship as more of a collaborative one. Boomers, the generation that developed and popularized the BlackBerry, are used to technology and are confident about accessing information. They have an expectation that they’ll have access to their

health information the same way they do any other part of their personal lives. H It’s time to give it to them. ■ Dr. Cafazzo, a biomedical engineer who works on ways to keep people out of hospital by creating technologies that allow for selfcare at home, will be speaking about why the eHealth Consumer is the critical ingredient in a high-performing health system on November 3 at HealthAchieve North. Learn more at http://www.healthachieve.com/north

OCTOBER 2015 HOSPITAL NEWS


Special Supplement

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2015

The HealthAchieve Experience If you’re planning to attend HealthAchieve this year, make sure you schedule ample time to visit the award-winning exhibit floor – featuring close to 300 exhibitors and special attractions – the HealthAchieve experience just isn’t complete without a visit to the exhibit hall.

healthscapejobs This designated career development space will feature three ‘Ask the Expert’ kiosks who will provide one-on-one expert consultations on career coaching, work-life balance and workplace mental health. Visitors will get a chance to navigate the healthscapejobs.ca career portal to search for their dream job in health care and have

Intelligent Hospital Pavilion™

MEDi the Robot

their make-up done and get a professional photo

HealthAchieve, in partnership with the Intelligent

This year, we are partnering with RxRobots Inc.

taken for LinkedIn!

Health Association, is excited to introduce the

to introduce a child-friendly humanoid robot

first ever Intelligent Hospital Pavilion™ (IHP)

named MEDi, shown to reduce children’s pain

to this year’s exhibit floor. This technology

by 50% during medical procedures. At this

equipped, destination pavilion will feature an

year’s HealthAchieve, ambassadors, MEDi and

Emergency Room and a Patient Room that will

his friends will educate, entertain and inspire

showcase the latest wireless technologies being

HealthAchieve attendees.

utilized in today’s hospitals. Guided tours, live

Hunt #HealthHunt We’re happy to announce that we’re bringing back the popular online scavenger hunt #HealthHunt!

demonstrations and partner kiosks make this a

Participants must complete 5 tasks on Twitter for

‘must visit’ destination on the show floor.

a chance to win an iPad stand padfolio!

Education Matters Stop by the OHA exhibit at the top of

HealthAchieve

November 2-4, 2015 Metro Toronto Convention Centre healthachieve.com

the escalators to learn about the new 12,000 sq. ft. state-of-the-art OHA Education Centre, located in downtown Toronto. Visit oha.com/educationmatters to enter the OHA’s Education Matters Sweepstakes for your chance to win a $2,000 OHA Education Scholarship

Passport Your Passport to Innovation, Discovery and Prizes

and a MacBook!

Passport Lucky Draw HealthAchieve Show Management is once again conducting the Passport Lucky Draw on the exhibit floor. Delegates are encouraged to visit participating exhibitors to win incredible prizes all worth more than $500 donated by participating exhibitors.

HOSPITAL NEWS OCTOBER 2015

www.hospitalnews.com


Special Supplement

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Green Pavilion

Hybrid Car Driving Test

Green Pavilion is a dedicated area of the

Complimentary Products and Services

exhibit floor where organizations providing

Delegates can look forward to the following

One of the best ways to experience the smooth,

environmentally friendly products and services

complimentary services:

quiet, powerful performance of an electric vehicle

gather together to showcase innovative ways to

Medical Cosmetics and Nutritionist Consultations

is to drive it for yourself. Schedule a driving test

Ask the Expert: Work/Life Balance, Mental Health and Career Coaching

Plug ‘N Drive booth.

Mobile devise charging stations

Flu Shot Clinic

Hybrid Car Driving Test

Professional make-up touch-ups

help facilities save energy, reduce pollution and make healthier, greener choices.

Take a spin in one of Plug ‘N Drive’s hybrid cars!

Professional photo for your Linkedin profile

Book Store and Book Signing

Seated massage

Several HealthAchieve keynote speakers’ books

BMI assessment

will be available for purchase at the book store

Water and caffeine intake assessment

and speak to one of the product specialists at the

located on the exhibit floor. We will be offering

New Product Showcase

special onsite pricing for books so come prepared

From one end of the show floor to the other,

to take advantage of the special offers and get

you’ll be amazed at the cutting-edge innovations

your booked signed by some of the authors!

in health care featured in the New Product Showcase spanning across the exhibit floor.

The Award-Winning Exhibit Floor Hundreds of exhibitors, showcasing the latest and greatest products and services extend a warm welcome to you – inviting you to visit their exhibit spaces for a chance to not only learn about the latest innovations in health care but also win some great prizes!

#healthachieve

www.hospitalnews.com

OCTOBER 2015 HOSPITAL NEWS


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2015

top 5

The

By Sharone Bar-David

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hen it comes to workplace incivility, we’re all sinners. We’re each fallible and we all come with our own blind spots. But workplace incivility is far from harmless, particularly in a hospital setting. Incivility often elicits our “Velcro response,” causing us to worry and obsess about the interaction in a way that wastes precious mental energy and distracts us from performing at our best. It can lead us to engage in getting even tactics, and it compromises teamwork, causing coworkers to become less inclined to work effectively together. In fact, the impact of being less than civil can actually be deadly. According to researcher Christine Porath, a large percentage of mistakes made by hospital personnel are due to the effects of incivility. It’s a glaring problem in terms of patient care, and its effect on service is palpable. A patient’s recovery is influenced by the quality of care he or she receives. Bad feelings and grumpy moods caused by instances of workplace incivility inevitably impact the quality of service. Whether you admit

ways to tame workplace incivility

Bad feelings and grumpy moods caused by instances of workplace incivility inevitably impact the quality of service. it to yourself or not, being uncivil or being preoccupied by an unpleasant interaction you just had with a coworker changes both your demeanor and performance. But here’s the good news: incivility can be tamed, and it begins with practical choices that you can make today and everyday. Here are five things that you can do to step up and create the workplace that you want to have, and that patients and their families expect and deserve: 1. Adopt the rule, “If it can’t be on our banner we’ve got to change the manner.” Think about the way you and your coworkers treat each other. Ask yourself if you’d feel comfortable if the behaviour in question were displayed on video screens above all entrances to the hospital. If the answer is no, initiate change. 2. Take an honest look at yourself. You are the part of the equation that you can control, so commit to being your best self. If you’re a physician, don’t take advantage

Emergency Management for Health Care Certificate

of your inherent power. If you’re a nurse, researcher, technician or allied professional, don’t assume that the high-pressure environment in which you’re working justifies a lack of cordiality. 3. Be the change you want to see. Practice what you preach. Strive to be more Teflon-like and give people the benefit of the doubt, for your sake and for the sake of your patients, coworkers and team members. Modeling is particularly important for those in leadership positions because it’s your responsibility to create a psychologically safe environment that paves the way for superior patient care. 4. Deal with issues constructively. Rather than resorting to dismissive comments, rolling your eyes or venting behind someone’s back, respond in an emotionally mature, constructive and professional way. 5. Trust your inner canary. Like canaries once used in coalmines to alert miners when the air became poisoned, trust your

inner canary to let you know when the line between what is respectful and what isn’t has been crossed. When you feel that inner sense of discomfort, step up and do something to respond and stop the incivility in its tracks. Hospitals are intense workplaces. The hours are long, the stakes are high, and the interdependence between professionals is ever present. It’s only human to let civility slip and forget that patients are affected, and that the person working right beside you might experience distress as a result of your fleeting lapse. The important thing is to continue making a conscious effort to make civility a priority in every interaction, even if you do falter every now and then. By doing so you’re committing to making yourself and your workplace better. H It’s worth the effort. ■ Sharone Bar-David, LLB, MSW, Canada’s leading expert on workplace incivility, president of Bar-David Consulting and author of Trust Your Canary: Every Leader’s Guide to Taming Workplace Incivility, will be offering her audience key strategies for maintaining civil work environments that result in exemplary care on November 3 at HealthAchieve in Toronto. Learn more at http://www.healthachieve.com/

CANADA’S HEALTHCARE LEADER Healthcare planning and design standards are set by Parkin Architects Limited through robust practical experience, independent research and active participation in provincial and national associations. Parkin is an EDAC Advocate firm, qualified in Lean consultation. An award-winning leader in institutional planning and design, Parkin serves Canadian and international clients, including some of the foremost institutions in Canada, many having relied upon Parkin people for over 20 years. We play significant roles in strategic and operational planning with many clients and our clinical planning and design influence can be found in hundreds of projects, ranging from individual hospital departments to some of the largest institutions in eight of Canada’s provinces, and Nunavut. Long-term hospital clients incluwwde:

Focused specifically on emergency planning and preparedness for hospitals and health care institutions, the Ontario Hospital Association’s new Emergency Management for Health Care Certificate is an emergency management credential recognized in health care settings in both Ontario and beyond. www.oha.com/EmergencyManagement

• Children’s Hospital of Eastern Ontario

• Ross Memorial Hospital, Lindsay

• Grand River Hospital, Kitchener

• St. Mary’s Hospital, Kitchener

• Hamilton Health Sciences Corporation

• SickKids Hospital

• Hotel Dieu-Grace Hospital, Windsor

• Southlake Regional Health Centre

• Orillia Soldiers’ Memorial Hospital

• Timmins and District Hospital

• Queensway Carleton Hospital, Nepean

• Trillium Health Centre, Mississauga

In the early 2000s, Parkin led the design for Canada’s first hospital P3 projects - Brampton Civic Hospital and the Royal Ottawa Hospital. Since then, Parkin has competed in the RFP stages on dozens of P3/AFP projects, in consortia that include: • Acciona

• Dragados

• Pomerleau Inc

• Bilfinger, Berger BOT Inc.

• Laing O’Rourke

• PCL Construction Inc

• Bouygues

• EllisDon Corporation

• SNC-Lavalin Inc

• Carillion

• OHL Group

• Stuart Olson

In addition to its traditionally-procured projects, Parkin’s $4 billion-plus P3/AFP projects, built or under construction include: • Brampton Civic Hospital

• Surrey Memorial Hospital, BC

• New Oakville Hospital

• The Royal Ottawa Hospital

• Restigouche Health Centre, NB • St. Joseph’s Healthcare. London

• University of Montreal Hospital Research Centre

• St. Joseph’s Healthcare, St. Thomas

• Woodstock General Hospital

• Providence Care Hospital, Kingston

• Royal Victoria Hospital Barrie, (contract admin)

Parkin is one of the few remaining independent Canadian healthcare architectural practices; it is wholly employee owned, so its owners personally invest in every project, providing a hands-on approach and customized design experience.

HOSPITAL NEWS OCTOBER 2015

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Awards at HealthAchieve HealthAchieve is proud to offer a number of awards that are presented at our annual convention and exhibition. The awards celebrate innovation and excellence in many diverse areas. Green Health Care Awards Monday, November 2 at 12:45pm Exhibit Floor Recognize leadership and excellence in Green Health Care and award recognition in the categories of Energy EfďŹ ciency, Water Conservation and Protection, Waste Management, Individual Leadership and Green Hospital of the Year.

Award in Leading Governance Excellence Monday, November 2 at 3:30pm Governance Session Designed to acknowledge hospital and/or health care boards that demonstrate best practices in governance.

Margret Comack Award of Excellence in Nursing Leadership Tuesday, November 3 at 3:30pm Nursing Leadership Session Designed to acknowledge the outstanding leadership of an individual nurse in a senior leadership position.

Quality Healthcare Workplace Awards Tuesday, November 3 at 8:00am Human Resources Session Recognizes organizational efforts to improve health care workplaces in ways that contribute to providersâ&#x20AC;&#x2122; quality of work life and the quality of the care and services they deliver.

healthachieve.com

www.hospitalnews.com

OCTOBER 2015 HOSPITAL NEWS


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Make a mentally healthy workplace a priority By Paula Allen

n organization that’s interested in the productivity of its workforce should absolutely be concerned about psychological health and safety in the workplace. A healthy workforce provides the right environment in which to grow a strong and profitable business, or, as in the case of a hospital, an organization known for the superior quality of its patient care. According to a study done by Morneau Shepell, employees who rated their workplace more favourably in the areas of mental health and safety said that they felt less personal stress and more engaged at work. They also indicated that their workplaces had less absence, less presenteeism and higher engagement, all of which are important to the health care sector. A psychologically healthy work environment isn’t just a “wish list” item that it would be nice to have because it makes people feel good. In fact, It’s a must have. There are definite risks associated with allowing an unhealthy work environment to persist because it promotes maladaptive behaviour that’s detrimental to peers and patients alike. Conflicts with coworkers may erupt more frequently, productivity is impacted, the quality of service and care may decline, and those with preexisting mental health issues may find that the environmental stress exacerbates their symptoms. Taken to the extreme, it can foster instances of violence and harassment. Sowing the seeds of change starts with strong leadership and training. On a foundational level, the corporate culture must

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be made very clear in terms of the kind of behaviour that’s expected from employees, particularly where stigma is concerned. Thorough and effective training allows leaders to model appropriate behaviour, recognize problems within their teams, reduce or eliminate personal bias where mental health issues are concerned, and understand how to support and promote a safe and healthy work environment.

...employees who rated their workplace more favourably in the areas of mental health and safety said that they felt less personal stress and more engaged at work... Due to the nature of the work that goes on in a hospital, it can be an incredibly intense and demanding environment, both physically and mentally. Inoculation training, a stress-management technique used to enhance performance under stress, can be particularly effective for those who work in a hospital setting. It’s often used by EMTs and other first responders who need to find ways to manage their anxiety and responses to a crisis situation, both during and after the event. It allows them to develop healthy, adaptive behaviors that make them better able to cope with workrelated stress. Peer support can also be an important resource, but only if it’s done well. A co-

worker who struggles with a similar mental health issue can be a great source of support to a peer in crisis, and having someone available for a debriefing after dealing with a difficult work-related situation can be invaluable. However, it’s critical to ensure that this kind of support system is well monitored so that those who are being called upon to provide support aren’t stretched too thin themselves. Ultimately all employers want their staff to feel safe and cared for. If you feel you need additional mental health support, look into the services provided by your

Employee Assistance Program or approach Human Resources to find out what can be done to change the way you are feeling about your work environment and the way H it’s affecting your mental health. ■ Paula Allen is Vice President of Research and Integrative Solutions for Morneau Shepell, a provider of consulting and outsourcing services. A workplace mental health expect from Morneau Shepell will be providing one-on-one expert consultations at one of three “Ask the Expert” kiosks on the exhibit floor this November at HealthAchieve in Toronto. For more information visit www.healthachieve.com

define your course MICHENER.CA/CE

Continuing to meet the health system needs This is a pivotal time in the evolution of health care delivery. We are seeing more chronic illnesses, like respiratory problems and diabetes, accounting for more than half of all direct health care spending. As the general population ages, we need to rethink the way we deliver health care.

Decrease Cost. Increase Efficiency. The Ontario Hospital Association in partnership with the Leading Edge Group now offer a suite of online and in-class lean education and training programs to help you and your organization decrease cost while increasing efficiency, quality and safety. Programs include: Lean Yellow, Green and Black Belt, Six Sigma and Value Stream Mapping. Get started today at www.oha.com/Lean

As the education solution provider for Ontario’s health care system for 60 years, The Michener Institute has dug deeply into these and other challenges to identify how to add the most value to the Ontario health care system. While health care providers and decision-makers work to adapt to these changes, Michener is designing curriculum to ensure that current and future health professionals are equipped to lead in their field of practice and in health system improvements. Continuing Education programs at Michener are meeting this need for health professionals who want to develop the skills required in today’s health care environment. For example: • To better prepare health care professionals to work with the rapidly-growing senior population, we recently introduced the ‘Working with Seniors’ primer with Baycrest Health Sciences. This program gives health professionals the foundational knowledge to meet the unique needs of our aging population. • We expanded our Diabetes Educator and Specialty programs and are reintroducing our Asthma and COPD Educator Certificate to address these high-priority chronic illnesses. • Quality improvement runs through all of our management programs to support this crucial mandate in every corner of Ontario’s health system. Visit Michener’s booth #10 at HealthAchieve 2015 in Toronto and Michener.ca/ce to see how we can prepare you for the future of Ontario’s health system.

HOSPITAL NEWS OCTOBER 2015

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2015 H15 CO N T I N U I N G E D U C AT I O N AT T H E M I C H E N E R I N S T I T U T E

Supporting Ontarioâ&#x20AC;&#x2122;s health system E C

Aging population Seniors curriculum

Chronic illness

Diabetes specialty programs

Quality improvement

Management & Leadership Cer tificates

Weâ&#x20AC;&#x2122;re proud to sponsor HealthAchieve 2015 Meet us at booth #10! MICHENER.CA/CE 416.596.3117 OR 1.800.387.9066 ce@michener.ca

Visit michener.ca/ce-brochure to view the full course brochure

MICHENER.CA/CE www.hospitalnews.com

The Michener Institute 222 St. Patrick Street Toronto, ON, M5T 1V4

facebook.com/ TheMichenerInstitute

twitter.com/ MichenerInst

youtube.com/ TheMichenerInstitute OCTOBER 2015 HOSPITAL NEWS


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2015

It’s Time to Get Social #HealthAchieve is once again getting social, and you should too because we’re giving away tons of great prizes for our social media friends! Here are the many ways you can participate: #HealthHunt

Instagram Photo of the Day

Take part in the online scavenger hunt on the exhibit floor. Complete 5 tasks on Twitter for a chance to win! All tweets must include #HealthHunt and #healthachieve to qualify.

Share your #healthachieve experience on Instragam for a chance to win and be featured in our daily recap email on the Monday and Tuesday!

Most Notable Tweet

Watch Your Posts Live on Screen

We’ll be watching for the best tweet live from our keynote sessions! Use #healthachieve to share your thoughts, insights and key takeaways. The winner will be announced on Twitter with details on where and when they can pick up their prize.

Check out your tweets and Instagram pics on the large social media screen in booth #1118.

#healthachieve

healthachieve.com

OHA Broadcasts. Making Education Accessible for You!

Your Key To Success. 7RGD\¶VPRVWVXFFHVVIXOKRVSLWDOVDUHLQYHVWLQJLQRSHUDWLRQDOHI¿FLHQFLHV that improve productivity and promote quality care. While often not directly related to patient care, these critical investments support leading practices that drive quality and cost-effective care.

Your Employees are the Key. Your staff represents more than 60% of your total costs1. And studies show that an engaged and empowered staff has a positive, measurable impact on the quality of care your patients receive. Patient Services, Finance, and HR are affected by this reality in different ways, yet are linked across the organization. This makes a compelling case for time management processes, tools, technologies, and insights WKDWEHQH¿WDOORIWKHVHNH\IXQFWLRQV Hospitals that have invested in comprehensive workforce management VROXWLRQVDUHUHDSLQJEHQH¿WVDFURVVWKHLURUJDQL]DWLRQV

With the aid of modern communications technology, the OHA can easily connect with its members across the province and other health care professionals globally via webcasts and videoconference. With more than 60 broadcasts per year on a variety of health-related topics – plus access to past broadcasts that are just a click away – it’s more convenient than ever to keep up-to-date on the latest health care issues and trends.

• Increased transparency, compliance, and employee satisfaction – thanks to centralized, automated scheduling and self-service tools that empower employees • Reduced payroll errors and payroll processing time – thanks to automated, accurate timekeeping • Improved attendance policy compliance and measurable savings – thanks to real-time, actionable attendance reporting Learn more about how Kronos can help you unlock the value of comprehensive workforce management in your organization. Visit the Kronos booth at HealthAchieve 2015. Not going to HealthAchieve? We’ll come to you. Visit Kronos.ca or call 1 800 225 1561 to request an appointment with an account executive and receive your complimentary information package, complete with examples of measurable results achieved by some of your peers.

For information on our upcoming broadcasts, visit www.oha.com/webcasts.

HOSPITAL NEWS OCTOBER 2015

1

National Health Expenditure Trends, 1975 to 2014, October 2014, p. 47, Canadian Institute for Health Information

www.hospitalnews.com


2015 H17

e H E A LT H AC H I E V E Digital Health: Taking Health Care to the Next Level HealthAchieve and COACH – the voice of health informatics in Canada – are once again partnering to deliver eHealthAchieve, a stronger than ever eHealth Forum. Be sure to participate in the following sessions on November 2 and 3: MONDAY, NOVEMBER 2

TUESDAY, NOVEMBER 3

The Digital Health Revolution! eHealthAchieve Keynote: John Nosta 3:30pm – 5:00pm

Enabling eHealth eHealthAchieve: Early Riser 7:30am – 8:30am CHIEF - Canada’s Health Informatics Executive Forum Working Groups eHealthAchieve: Morning Session 8:45am – 10:00am eHealth 2.0 Strategy eHealthAchieve: Afternoon Session 1:00pm – 2:30pm

Visit healthachieve.com for more information.

TIME & ATTENDANCE

SCHEDULING

ABSENCE MANAGEMENT

HR & PAYROLL

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Focus 15

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Eliminating preventable harm to patients and staff By John Pires he Hospital for Sick Children (SickKids) has launched an ambitious patient and staff safety initiative that will have a significant impact in making care better and safer across the hospital and also make SickKids an even safer place to work. SickKids has always been a leader in advancing safe and high-quality care for children and providing a safe working environment for staff. There have been steady improvements in safety at SickKids as a result of various structures and processes that have been put in place and the great work and commitment of its staff. While that effort is having a positive impact on key safety indicators, there are still opportunities to make care even safer and to be even better at learning from preventable safety events. Through its recent strategic planning process, SickKids has renewed its commitment to safety and quality with a plan that makes “eliminating preventable harm” a key strategic focus of the organization. A new safety initiative, Caring Safely, is the driving force. “Caring Safely is a perpetual effort, a relentless pursuit to eliminate preventable harm to patients and to staff,” says Dr. Mike Apkon, President and CEO, SickKids. “It will enable us to strengthen many things that we already do well and drive further improvements to safety.” SickKids has set an ambitious set of targets – reducing preventable harm to patients by two-thirds over three years and reducing serious harm to employees by 20 per cent over the same time frame. The ultimate goal is to eventually eliminate preventable harm altogether. Caring Safely focuses on four priority areas: reducing the occurrence of specific hospital-acquired conditions; reducing the occurrence of serious safety events; enhancing an organizational culture of safety that will build on the first two priorities; and ensuring care is provided in a manner that is safe to staff so that work-related injury and illness are reduced. For Apkon, safety is really about two things – staying out of trouble by doing things in the safest way possible and by anticipating the various ways that things might go wrong, and getting out of trouble as quickly as possible when something happens that threatens safety. A number of hospitals around the world do this by employing the cultural transformation strategies of other high-reliability industries, such as the airline industry, to significantly reduce harm in their institutions. High-reliability organizations are preoccupied with how things might go wrong – how people might make mistakes, how communications might be misinterpreted and how things might not work the way they were intended. These organizations endeavour to have people work in a way that is mindful and in the moment – stopping to think very deliberately before taking action and then reflecting on the actions taken to make sure they went as intended. They actively learn from their failures to make sure that similar failures don’t happen a second time. “We have a strong culture of that kind of learning at SickKids and we will only enhance that as we adopt new approaches to reviewing and learning from events where things didn’t go the way we hoped,” says Apkon.

T

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Stuart Tammadge, Inpatient RN, and Dr. Trey Coffey, Medical Officer for Patient Safety at SickKids, review a patient’s chart. Through its recent strategic planning process, SickKids has renewed its commitment to safety and quality with a plan that makes “eliminating preventable harm” a key strategic focus of the organization. A big part of being safe, both staying out of trouble and getting out of trouble fast, requires that people feel free to speak up when they see something concerning and that others take notice and pay attention, regardless of who is raising the concerns. As part of the Caring Safely strategy, SickKids introduced new forums for staff to surface any safety-related concerns. One such forum, launched in December of 2014, is the Daily Safety Briefing, where a hospital executive leads managers and directors from across the organization on a daily call to conduct a quick look back at the last 24 hours and a look forward at the next 24 hours to identify any threats to safety. SickKids also introduced a structured approach to patient handoff, the critical point when one

SickKids has set an ambitious set of targets – reducing preventable harm to patients by twothirds over three years and reducing serious harm to employees by 20 per cent over the same time frame. health care provider’s shift ends and a colleague takes over the care of a patient, and now conducts nursing handovers at the bedside so that children and families can raise concerns they might have.

These have been great ways to quickly identify problems and find fixes before they cause serious issues. To advance the rate of improvement, SickKids has joined the Children’s Hospitals’ Solutions for Patient Safety (SPS) Network, marking the first time this network has opened up to a hospital outside of the United States. The SPS network consists of over 85 children’s hospitals that have adopted a high reliability strategy and are sharing safety successes as well as failures transparently. The network is helping them learn from one another, driven by the shared goal to urgently reduce and then eliminate preventable harm for the children in their care. “The network is not a competition between participating hospitals to see who is the best at patient safety, it’s about all of us being transparent with our data and sharing learnings, so we can eliminate preventable harm,” explains Dr. Trey Coffey, Medical Officer for Patient Safety at SickKids and Medical Lead for Caring Safely. “If you are the best, you teach the rest; if not, you learn from the best.” SickKids is collaborating with other hospitals in Ontario and Canada to share learning and accelerate efforts related to the safety movement. “All the work that we are doing around patient and staff safety, all the work that will be done as part of our Caring Safely initiative, all the learning, is a real opportunity for us at SickKids to continue to lead the evolution of paediatric care in Canada and around the world,” says Apkon. “Our ability to transform care will depend on the SickKids team making a collective commitment to embracing this high-reliability mindset but I know this kind of commitment to children is already very much a part of the SickKids culture. Our ultimate goal is to eliminate H preventable harm.” ■

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John Pires is Manager, Communications and Public Affairs, The Hospital for Sick Children.

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16 Focus

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Health research:

Some of the year’s most remarkable achievements By Claire Samuelson anada’s health care organizations are home to advances in patient care that enhance the lives of Canadians and people around the world. Our research hospitals and academic regional health authorities generate research and innovation successes at a remarkable rate. Between 2014 and 2015 over 1,800 stories highlighted the research and innovation taking place at Canada’s leading health care organizations. HealthCareCAN, the national voice of health care organizations, tracks these stories in an award-winning tool called Innovation Sensation, a searchable database that highlights the research and innovation successes of our members. For this special Research Edition of the Hospital News, HealthCareCAN is delighted share some highlights of the last twelve months. This selection from Innovation Sensation is the author’s, so visit www.healthcarecan.ca to view thousands of other research and innovation achievements and choose your own favourites.

C Cover story

Leading journal features Sudbury cancer research

Study finds paramedic care delivered on-scene for 10-35 minutes leads to better outcomes

Date: August 25, 2015 In the largest paediatric cardiac arrest study to date, a team of researchers at Lawson Health Research Institute found that survival was the highest with 10 to 35 minutes on the scene in the care and under the treatment of paramedics. The study also found that improved survival was associated with intravenous access and fluid administration, whereas advanced airway attempts and resuscitation drugs were not.

New treatment offers hope for an incurable disease

Date: August 23, 2015 After 10 years of research, a scientist and respirologist from St. Joseph’s Healthcare in Hamilton has found a way to help those with idiopathic pulmonary fibrosis find relief. About half of IPF patients die within three years, but the drug, approved by Health Canada in June and now being evaluated for coverage by OHIP, has been shown to slow the illness by 50 per cent.

Date: August 17, 2015 A study led by a researcher at Health Sciences North in Sudbury looking into a potential breakthrough treatment for cancer is being published in leading cancer journal, Cancer Research. The research team have created a small synthetic chemical molecule that kills cancer cells and avoids non-cancerous cells. The treatment can boost the effectiveness of other drugs, but also has the potential to be used as a stand-alone drug for cancer treatment.

New genetics testing at CHEO could save lives

Date: August 13, 2015 New genetic testing by researchers at CHEO is making it possible for those with inherited heart conditions to attain more complete testing results that could help manage their disease and minimize the chance of death. With this testing, researchers hope to find a genetic explanation in people who have heart conditions.

HIV treatment has social and socioeconomic benefits, as well as improved health: study

Date July 21, 2015 New research at Providence Health Care shows that HIV treatment for illicit drug users improves their social and socioHOSPITAL NEWS OCTOBER 2015

economic wellbeing as well as their health. This research illustrates how HIV care and treatment can open doors to improvements in other areas relevant to people’s social determinants of health.

Promising Hamilton cancer treatment being tested in patients

Date: July 10, 2015 A cancer treatment discovered by a team of researchers at Hamilton Health Sciences that doubles as a vaccine to prevent the disease from reoccurring is being tested in patients. The vaccine is powerful enough to destroy an existing tumour and prevent it from relapsing. While chemotherapy will still play a role in cancer treatment, researchers have reached a plateau, and this novel treatment is yielding promising results.

What’s the link between blood clots and cancer screening? Ottawa study may surprise you

Date: June 22, 2015 Researchers at The Ottawa Hospital have discovered a breakthrough into the link between blood clots and cancer screening that will save millions in unnecessary and potentially harmful tests. A new study concluded that there was no difference in the number of new cancers detected in those who received extensive screening and those who did not, leading to the conclusion that more screening isn’t always better.

Signs of female heart disease often ignored Molecules hold promise for detecting, treating cancer and neurodegenerative diseases

Date: June 29, 2015 A clinician scientist at the Kingston General Hospital Research Institute is studying select cancer and neurodegenerative diseases and the ways in which ribonucleic acid (RNA) control is disturbed. RNA possesses lot of information, so it is a good diagnostic and therapeutic target. This research holds tremendous promise as researchers attempt figure out ways to use it to cure disease.

Date: May 7, 2015 Researchers believe that when it comes to heart attack symptoms, there are disparities in care between men and women. Women who experience symptoms such as chest pain and shortness of breath aren’t often flagged as potential heart attack victims. To the contrary, researchers at Vancouver Coastal Health have found that young women are more likely to die after a heart attack than men. This discovery will revolutionize the way women are treated for heart disease.

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MEDEC – Showcasing The Value Of Medical Technology

Focus 17

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Researchers examine brains of people who can’t form memories to relive past

Date: April 28, 2015 Scientists at Baycrest in Toronto are discovering that not all brains remember key life events, such as a first kiss or the birth of a child. The Baycrest team has named the condition lifelong severely deficient autobiographical memory, or SDAM, and has reported on their findings in the journal Neuropsychologia. Theirs is only the second report in the medical literature of this memory condition and the first to involve using brain imaging techniques to test people with the condition.

Zebrafish offer hope for treatment of rare cancer

Date: April 23, 2015 A researcher at the IWK Health Centre in Halifax has developed an innovative treatment that promises to help those suffering from a rare and aggressive form of leukemia. The treatment involves the transplantation of human leukemia cells from bone marrow biopsies into zebrafish embryos. When observed through a fluorescent microscope, the human cells are easily visible through the transparent fish’s body. Within only a few days, scientists are able to see whether cancer cells grow or shrink in number as different drugs are added to the fish tank.

Medical researchers tackle silent epidemic of fatty liver disease

Date: April 9, 2015 Non-alcoholic fatty liver disease is now the most common form of liver disease in Canada and part of a larger liver-disease epidemic. It is estimated that 25 to 40 per cent of Canada’s adult population has fatty liver to a degree, while about five per cent of adults have fatty livers that have progressed to the point of inflammation, known as steatohepatitis.

Thunder Bay Regional Health Sciences and computer coding

Date: March 20, 2015 A clinical researcher at the Thunder Bay Regional Health Sciences Centre has developed a novel clinical documentation tool which will allow teams of health care providers to collectively maintain medical documents containing an up-to-date summary of the patient in front of them. The patient’s records can be digitally stored, accessed, and edited by authorized health care professionals caring for the patient.

Study disputes ‘not criminally responsible’ myths

Date: March 19, 2015 A study led by researchers at the Royal Ottawa Health Care Group finds that it is easier for people with serious mental illness to access treatment after they are charged with a crime than it is for them to get professional help before. The findings suggest that more can be done to prevent “not criminally responsible” crimes from taking place, and underscores the need for provinces to bridge gaps between their civil mental health systems, where patients first seek help, and forensic systems, where they end up after committing an offence.

Robots used to comfort sick kids at Alberta Children’s Hospital

Date: February 19, 2015 Clinicians at Alberta Children’s Hospital are using childlike robots to comfort young patients during stressful medical procedures. A study conducted by Alberta Health Services showed that children who interacted with the robots reported 50 per cent less pain compared to those who received vaccinations with little or no distraction. The robot is programmed to imitate the actions of a child and can help calm nervous young patients by chatting and offering high-fives. The robot is primarily used during uncomfortable procedures such as vaccinations and blood tests.

App bridges the gap for youth with mental health concerns

Date: January 30, 2015 Eastern Health has launched its first health-related mobile app, called Bridge the gAPP. The app aims to support and promote mental wellness amongst youth in Newfoundland and Labrador. Bridge the gAPP is a free mobile app that covers a variety of topics that are important to youth who are experiencing mental health issues.

Probiotics may hold key to improving mental health Blood pressure drug shrinks cancer in ‘miracle’ clinical trial

Date: March 9, 2015 A break-through clinical study led by a team of scientists at Provincial Health Services Authority has dramatically reduced a patient’s cancer to barely detectable in just a few weeks. The world-leading study, involving genomic sequencing of a patient’s aggressive form of cancer, identified a unique protein function at play. This critical detail pointed to a unique treatment option, a medication commonly used to treat high blood pressure—that effectively targets the protein.

Just a sprinkle: Kids worldwide helped by Canadian MD’s invention

Date: March 9, 2015 A peadiatrician researcher at Toronto’s Hospital for Sick Children has developed an inexpensive means of preventing anemia in children by providing iron and other micronutrients through “Sprinkles”, a sachet of micronutrients in powdered form that can easily be added to a baby’s or toddler’s meals.

Unveiling B.C.’s first digital mammography vehicle

Date: February 24, 2015 Vancouver Island Health Authority, with the BC Cancer Agency, has unveiled a mobile coach that is the first of three Screening Mammography Program vehicles in the province to transition to digital mammography mobile testing centre. Converting the mobile coaches to digital mammography offers greater efficiency in reporting, that will ultimately result in better health outcomes for women at risk of breast cancer.

New hope in the fight against pain

Date: February 19, 2015 An international study led by scientists at McGill University Health Centre has discovered a novel drug that could be used to treat patients with neuropathic pain, a disorder characterized by severe and persistent pain that often develops following nerve damage. There are very limited treatments available for neuropathic pain, and a lot of patients use opioids, which can lead to addiction and severe side effects in the long term. For these reasons, identifying novel pain relievers is of keen interest in the medical field today.

New procedure a ‘major breakthrough’ in stroke treatment

Date: February 11, 2015 Scientists at Sunnybrook Health Sciences Centre have discovered a new stroke treatment that has been shown to be so effective that Canadian researchers say it will be used as part of standard stroke care. The treatment, which involves removing blood clots in the brain with a retrievable stent, has nearly doubled the percentage of patients who experienced positive outcomes from 30 per cent to 55 per cent.

Date: January 29, 2015 In a world-first study, researchers at Women’s College Hospital are exploring whether probiotics, the stomach bacteria that aid digestion, regulate the immune system and reduce inflammation, may be an effective treatment for those with bipolar disorder, depression and anxiety.

Too much sitting could be deadly, study says

Date: January 20, 2015 Researchers at University Health Network in Toronto say that even with a regimen of daily exercise, excessive sitting could be deadly in the long run. UHN researchers have found that regardless of exercise, the amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer and death. Continued on page 18

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OCTOBER 2015 HOSPITAL NEWS


See our Special Supplement coming in our November issue

MEDEC – Showcasing The Value Of Medical Technology

18 Focus

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Health research Continued from page 17

Home is where your heart is monitored

Date: January 19, 2015 Researchers from Bruyère Research Institute will study technology intended to help seniors with unobtrusive health monitoring that requires nothing from the patient and its potential to help seniors. The project will focus on the design and testing of sensors that can be built into common, everyday household objects, from tiles to doorknobs and beds to appliances.

Winnipeg researchers believe they’ve found way to curb side-effects on heart from a chemo drug

Date: December 15, 2014 Researchers at Winnipeg Regional Health Authority believe they have discovered a way to prevent the toxic effects on the heart of a widely used chemotherapy drug used to treat cancer. The research has huge implications for cancer patients who are currently undergoing treatment because clinicians can now develop therapies that will prevent heart failure or the damaging effects of the drug on the heart.

HOSPITAL NEWS OCTOBER 2015

Canadians score a stem cell breakthrough

Date: December 12, 2014 A team of researchers at Toronto’s Mount Sinai Hospital have mapped the complex process by which stem cells evolve and, along the way, discovered a new type of stem cell that may be better suited for therapeutic use. This discovery has led scientists to a new type of stem cell that appears to grow faster and is easier to work with than other stem cells, making it a strong candidate for use in future studies.

Technology breakthrough reveals cellular transcription process

Date: December 4, 2014 A new technology, developed by a team of researchers at the Centre hospitalier de l’Université de Montréal, reveals cellular gene transcription in greater detail than ever before. The new research tool offers clinician scientists a more insightful view of the immune responses that are involved in a range of diseases, such as HIV infection. The application of the technology

promises to have a huge impact as ultimately it will enable researchers to better understand the cause of diseases and to establish the effectiveness of the drugs used to treat them.

Brain stimulation eases major depression

screening was one of the most effective ways of limiting Ebola’s spread. With no effective exit screening, estimates indicate that three Ebola-infected travelers a month would board international flights from the West African countries suffering epidemics of the deadly virus. The study showed that it was far more effective and less disruptive to screen travelers from the affected countries in West Africa as they leave, rather than when they land, as many Western countries do.

Date: November 19, 2014 Doctors at the Centre for Addiction and Mental Health in Toronto are utilizing a brain stimulation therapy to treat severe depression that doesn’t respond to standard antidepressant medications and psychotherapy. Known as repetitive transcranial magnetic stimulation, or TMS, the treatment is a non-invasive procedure that uses electromagnetic energy to “exercise” an area of the brain thought to be underutilized in people with depression.

Autism study suggests parents could treat early symptoms at home

Study shows exit screening vital to halting global Ebola spread

Claire Samuelson, MA is Policy Analyst, Research and Innovation at HealthCareCAN – SoinsSantéCAN.

Date: October 20, 2014 A team of researchers at St. Michael’s Hospital in Toronto discovered that exit

Date: September 8, 2014 Researchers at Holland Bloorview Kids Rehabilitation Hospital are encouraging parents to treat early signs of autism at home. The research suggests that if symptoms are diagnosed quickly enough, the at-home treatment may significantly minimize symptoms of the disorder later in life. Parents require just 12 one-hour training sessions to learn the techniques used to H treat symptoms. ■

www.hospitalnews.com


Focus 19

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Mental health therapy beyond the hospital By Lisa Cipriano

T

he Scarborough Hospital’s (TSH) Mental Health department is taking mental health therapy beyond the bricks and mortar of the hospital, becoming the first and only hospital in Canada to deliver Internet-Assisted Cognitive Behavioural Therapy (iCBT) (as part of its Adult Outpatient Program) and a one-of-a-kind Mental Health App Library. Individuals in need of cognitive behavioural therapy typically face challenges like long wait lists, a shortage of therapists, and a lack of access to a therapist outside of regular business hours. Now, adult outpatients of TSH’s Mental Health department can access treatment for anxiety and depression wherever and whenever it is most convenient for them. “By offering this therapy through the Internet, along with our recommended mental health apps to support the process, patients are empowered to get the care they need on their terms and on their schedule,” says Dr. David Gratzer, Psychiatrist, TSH. “It means that more people will get access to evidence-based therapy.” TSH recently launched iCBT2, a revamped version of iCBT that was originally developed through a partnership with Queen’s University. It uses traditional (face-to-face) CBT modules adapted for email and was recently redeveloped to make it more flexible, engaging, and patient-tailored.

Individuals in need of cognitive behavioural therapy typically face challenges like long wait lists, a shortage of therapists, and a lack of access to a therapist outside of regular business hours. Here’s how it works: A TSH therapist (who is dedicated to providing online services) emails outpatients one module per week. Patients can complete them on their own time, and then email them back to the therapist. The therapist blocks off time to review the work and provide written feedback to the patient. Available through a physician’s referral, iCBT2 includes more substantive content, interaction, and videos, as well as aesthetic improvements, and takes only six weeks to complete (instead of the previous eight). The retention rate for iCBT2 has increased to approximately 80 per cent – an impressive improvement from its previous rate of approximately 10 per cent. “Our iCBT clients have indicated that the program has been beneficial,” says Shawnna Balasingham, Therapist and Social Worker at TSH. “Most report that the skills they learned through the program have helped www.hospitalnews.com

them to effectively manage their distressing moods. Overall, those who have completed the program show significant reductions in their symptoms of depression, anxiety, and stress.” For Ashley King, who has suffered from anxiety and depression for many years, iCBT2 was a game-changer. “It helped me understand why I was experiencing certain symptoms, and taught me strategies about managing my anxiety,” she says. “There’s a weekly activity sheet, which is useful in encouraging me to try things out of my comfort zone.” In addition to providing online therapy, TSH now offers a Mental Health App Library. While many patients already use

mental health apps and websites, not all of them are created equally. With this in mind, the Adult Outpatient Program curated a Mental Health App Library consisting of 18 TSH physician-and therapist-approved apps for Android and Apple operating systems. The free apps are designed to help improve mental health. They are meant to complement prescribed treatment plans, and are not intended to replace professional treatment. “For example, a patient could use a relaxation app while taking transit to a mental health appointment,” explains Faiza Khalid-Khan, Director, Mental Health, TSH. “In this example, the app walks the

patient through relaxation exercises, and the patient arrives at their appointment already prepared with thoughts and questions, helping them to get the most out of their therapy session.” With the Mental Health App Library, patients can access trusted apps for support with anxiety, relaxation, depression, sleep, and post-traumatic stress disorder. TSH is a leading provider of individual and group programming for those living with a major mental illness in Scarborough, Ontario. For more information, H visit www.tsh.to. ■ Lisa Cipriano is a Communications Officer at The Scarborough Hospital.

Safe Medication

Medication incidents related to drug-induced allergies By Leo Kim and Certina Ho

W

e all know someone who suffers from allergies, whether it’s a friend who cannot consume peanut-containing products or a cousin who sneezes uncontrollably in front of your dog. But what if the allergy was related to a medication? Would you know what symptoms to expect and which medications to avoid? Drug-induced allergic reactions generally occur independently of the dose; they are separated from the pharmacologic actions of the drug, and occur selectively in susceptible individuals. They account for approximately five to 10 per cent of all adverse drug reactions and range from mild local discomfort to life-threatening systemic anaphylaxis. Fortunately, many medication incidents involving drug allergies can be preventable, especially in cases where the patients’ allergies have been previously and properly documented. Given the frequency and potentially serious nature of drug-induced allergies, it is important to consider why these incidents occur and how they can be prevented. To examine medication incidents in the community related to drug-induced allergic reactions, the Institute for Safe Medication Practices Canada (ISMP Canada) performed a multi-incident analysis to identify contributing factors from these reported events. Voluntary reports of medication incidents were extracted from the Community Pharmacy Incident Reporting (CPhIR) program (http://www. cphir.ca), a database designed by ISMP Canada with support from the Ontario Ministry of Health and Long-Term Care. After reviewing 273 medication incidents, we were able to categorize them into three major themes based on com-

Table 1 – Themes and Subthemes of Potential Contributing Factors for Drug Allergy-Related Medication Errors

THEMES

SUBTHEMES

Missing Documentation

• Prescriber-related • Pharmacy-situated

Computer Detection Incapacity Alert Bypass

• Inactive or non-medicinal ingredients • Cross-reactivity • Free-form entry of patient’s allergy information • Alert fatigue

mon characteristics and further divided into subthemes, as shown in Table 1. Missing Documentation – Drug allergy information should always be obtained and recorded in the patient’s medical profile. Furthermore, it is important to engage in a dialogue with the patient and/or the patient’s caregiver as a way to prevent potential incidents. For example, as an additional check before providing a medication to a patient, ask the patient about his/her allergies. Computer Detection Incapacity – It may be helpful to consider enhancement of the functionality of the pharmacy computer system for allergy detection, with elimination (as much as possible) of the need for “free-form texting or inputting” of allergy information in the patient profile. This would include ensuring that inactive or non-medicinal ingredients are also included in the computer allergy database. To avoid incidents related to documented drug allergies that are undetected by the computer, independent double checks should be performed for each prescription during the order entry and dispensing process.

Alert Bypass – Electronic prescription order entry systems require continuous quality improvement in order to minimize the potential for users’ “alert fatigue” with drug allergy warnings. For instance, information regarding the number, frequency, and timing of manual alert overrides may be collected and used to inform updates to the computer system. It is also prudent to ensure that a pharmacist reviews the alerts that are being removed by the manual alert override function. Drug-induced allergic reactions can occur unexpectedly with various medications and can have serious consequences to patient care if not recognized and prevented in an appropriate manner. Learning from medication incidents and identifying potential systems-based contributing factors are key steps for facilitating continuous quality improvement in H medication safety. ■ Leo Kim is a consultant pharmacist at the Institute for Safe Medication Practices Canada (ISMP Canada); Certina Ho is a Project Lead at ISMP Canada. OCTOBER 2015 HOSPITAL NEWS


20 From the CEO's Desk

Inspiring cultural commitment By Dr. Dave Williams

hen I joined Southlake Regional Health Centre (Southlake) four years ago, it was the incredible passion of the staff to provide people centred care that drew me to the organization. After joining the team, it was evident that there was something deeper about Southlake. For anyone who has ever visited Southlake, it is felt through each and every interaction and something that has become an integral part of the Southlake experience. “It” is defined as our culture, something we like to call The Southlake Way. It is characterized by the way we interact with each other; the way we think; the approach we take to problem solving; and our commitment to living our Core Values, each and every day. It’s a culture that encompasses the qualities of compassion, innovation, excellence, and the ability to create opportunities out of seemingly impossible challenges.

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stop them and ask that they perform hand hygiene. It means that if you notice inefficiencies within the Hospital, you tell your supervisor so that we can work together to find a solution. It means that every member in our Hospital Family – from patients and front-line team members to those in management positions – has the ability to provide valuable feedback and improve any given situation. Integral to installing Speak Up into the Southlake culture is empowering our staff to view their roles as part of a larger team – a high functioning, interprofessional team that has a responsibility to protect and promote the best interests of the patient and make Southlake its best. By working together, every team member is accountable for the role they play in making this a reality, and are expected to bring forward attitudes, actions and behaviours that are aligned with our corporate Values.

Every member in our Hospital Family – from patients and front-line team members to those in management positions – has the ability to provide valuable feedback and improve any given situation.

Speaking Up

Deeply rooted within our culture is our commitment to living and breathing our Core Values. Organizations, like anything, evolve over time, and while our Core Values have served us well over the years, we saw an opportunity to evolve. This past year, we introduced a new corporate value. Speak Up is one way in which Our People can speak up respectfully, listen up carefully, and respond appropriately to the input of others without fear of reprimand to ensure the safety and protection of our patients, our community, and each other. Speak Up also empowers our patients and their families as well as our partners to share their perspective on their Southlake experience. Many may wonder what Speak Up means in a practical application? It means that if you see someone approaching a patient without cleaning their hands, you

Southlake is on a journey to deliver shockingly excellent experiences to patients and families while incorporating best practices to be a leader in safety and quality. To do so, we must ensure that we are embracing every opportunity to proactively address serious issues. We’re already seeing examples of Speak Up emerging within our culture at Southlake. These “speak up” moments are inspiring change

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Dr. Dave Williams throughout the organization. Our People are invigorated and inspired to realize they play an integral role in ensuring the delivery of safe, quality care and in creating an environment that they are proud to be a part of. Garnering buy-in for our new Value was an important element to ensuring our success. In keeping with The Southlake Way we took an innovative and edgy approach to introduce this new value across the organization by launching our very own music video. We re-wrote a popular Taylor Swift song and created “Speaking Up” – a fun and catchy video outlining what Speak Up means and how it inspires us in our everyday work. The reaction from Our People was astounding and has provided everyone across the organization with an unforgettable reminder of why speaking up is so important. (If you haven’t seen it already, check out our YouTube channel at youtube.com/SouthlakeRHC.)

Creating a Performance Culture

Speak Up is already becoming an important element of Our Culture. And it is through Speak Up that I’ve heard from many members of the Southlake team about the pressures and challenges they feel and their ideas on how we can work together to improve the experience for our patients, their families and just as importantly, the experience for our own people. Working in healthcare can be a very rewarding, yet challenging career. Spend just 10 minutes in any Emergency Room in the Province of Ontario and you’ll have a sense of the increasing demands on our health care system and the workers who support it. That’s why our culture has become such an important element of our success here at Southlake. We want Our People – staff, physicians, and volunteers – to feel good about coming to work each day; to be a part of a

team where they can thrive despite the challenges and the pressures they may face; to feel they have the tools, resources and the supports to be able to provide their patients with the very best. Part of creating that culture is identifying opportunities to recognize and celebrate the contributions of Our People, whether it is through our annual Recognition of Excellence awards, our in-themoment recognition with our Shockingly Excellent forms, or through our annual celebration events, such as our Summer BBQ, Holiday Party and our monthly 3C Rounds, which stand for Culture and Conversation with the CEO. This year, we introduced our first-ever culture book. Contained within the book are tales from and about Our People, as well as a condensed history of Southlake. Each story is unique; yet a common theme of pride and commitment emerge throughout. Our culture book celebrates the unique passion of the Southlake team, and through its words and photos, allows us to reflect upon where we have come, where we are today, and where we are going the future. When I came to Southlake, I came into my role with my own beliefs about what culture means based on my varied work and life experiences. Through my time here, I have shared those experiences with our team and we have learned to grow our culture, to evolve every day, in meaningful ways inspired by those who live and breathe it. I am thrilled with the strides we’ve made as an organization and am excited to lead an organization with such passion and commitment to high quality people centred care. The Southlake Way is a journey I am proud to be a part of. Culture Book – hyperlink: http://issuu. com/southlakehealth/docs/sl_culture_ H book_working_singles ■ Dr. Dave Williams is CEO, Southlake Regional Health Centre. www.hospitalnews.com


Evidence Matters 21

Therapy for PTSD

– Drugs, counselling, and… yoga? By Eftyhia Helis

ost-traumatic stress disorder, widely known as PTSD, has received increased attention over the past few years. Although a relatively new medical term, many claim that the concept has been known since ancient times. The Greek historian Herodotus described in his writings the psychological fatigue Spartan commander Leonidas recognized in his soldiers during the war at the Thermopylae Pass (480 BC). Others claim that descriptions of psychological symptoms due to war were also mentioned by Hippocrates, who talked about “frightening battle dreams,” and by other Greek, Roman, and Egyptian writers centuries ago. Much later, Charles Dickens also wrote about his own PTSDlike symptoms after he experienced a traumatizing railway accident in 1865. In 1980, PTSD was recognized as a diagnosable mental health disorder with specific symptoms, and it was added to the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Prior to this, PTSD was known as, among other things, “shell shock” (to describe a psychological condition of combat veterans who were “shocked” by their experiences on the battle field), “combat fatigue,” and “soldier’s heart” (to describe symptoms of rapid heartbeat, anxiety, and shortness of breath). Today, in the fifth edition of the DSM (DSM-V), PTSD is classified as a traumaand stress-related disorder that is characterized by intrusive or distressing thoughts, nightmares, and flashbacks of past exposure to traumatic events such as the sudden death of a loved one, serious accidents, natural disasters, sexual or physical assault, child sexual or physical abuse, combat exposure, and torture. The symptoms of PTSD tend to last for more than a month, and women are generally more likely to develop PTSD after exposure to traumatic events than men. While PTSD is often associated with war and members of the military, emergency workers and first responders (i.e., police, firefighters, and other emergency workers) are also highly vulnerable for experiencing “critical incident stress” or “operational stress injury”, broader terms that include PTSD symptoms. The evolution in the diagnosis for PTSD has been followed by an evolution in treatments for the disorder. Today, an array of options that include pharmacotherapy (treatment using medications), psychotherapy (counselling), and other alternative and complementary interventions are available for people with PTSD. Psychological treatments such as cognitive behavioral therapy or pharmacological treatment with antidepressant medications (such as selective serotonin reuptake inhibitors, or SSRIs, and serotonin norepinephrine reuptake inhibitors, or SNRIs) are recommended as first choice treatment options for PTSD by Canadian and international clinical practice guidelines. While there is strong evidence indicating cliniwww.hospitalnews.com

P

The evolution in the diagnosis for PTSD has been followed by an evolution in treatments for the disorder. Today, an array of options that include pharmacotherapy (treatment using medications), psychotherapy (counselling), and other alternative and complementary interventions are available for people with PTSD.

cally meaningful improvements for many patients with PTSD as a result of these approaches, some individuals continue to have symptoms. In the last two years, the Rapid Response Service at CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, and procedures – has received an increasing number of requests by health decision-makers across Canada on the clinical effectiveness of alternative treatment approaches to PTSD. These have included yoga, meditation, mindfulness, and energy balance methods. We often associate these methods with relaxation and stress reduction, but what is the evidence about their impact in the treatment of PTSD? Yoga is an ancient eastern practice that has been widely adopted by western populations and is often associated with stress reduction and enhanced well-being. It is believed to enhance the interaction between the body and the mind and can take on many forms, but it generally consists of poses or postures, breathing techniques, and/or meditation. Yoga has previously been studied in a number of therapeutic areas including low-back pain, falls prevention, insomnia and mental illness. While there is some evidence for the use of yoga in treating depression, there is limited evidence on its use as a treatment for PTSD so its effectiveness is currently not known. However, some clinical practice guidelines recommend that yoga may be useful in combination with other treatments for PTSD. Another CADTH review on the effectiveness of transcendental meditation as a treatment for PTSD also revealed a lack of evidence. In transcendental meditation, a word or a phrase (called a mantra) is silently repeated until the mind is free of thought. It is practised for 15 to 20 minutes twice daily, in a sitting position. Whether or not it is effective in the treatment of PTSD is not known at this time.* Mindfulness is an integrative, mind– body based approach that helps people change the way they think and feel about their experiences. It is a way of paying attention to the present moment by using meditation, breathing techniques, and yoga. It involves consciously bringing awareness to thoughts and feelings, with-

out making judgments, thereby allowing the individual to become less enmeshed in their thoughts and feelings and better able to manage them. The CADTH review of mindfulness found that while the strongest evidence base exists for the use of mindfulness in treating depression, the effectiveness of mindfulness for treating PTSD is unclear. However, one clinical practice guideline recommends that mindfulness be considered in conjunction with other treatments for hyperarousal symptoms (increased psychological and physiological tension) in patients with PTSD. The Emotional Freedom Technique (EFT) is based on the idea that imbalances in the body’s energy system have an effect on an individual’s psychology. The technique aims to correct these energy imbalances by having the patient recall a traumatic memory while repeating a selfacceptance statement and tapping on a sequence of points on his or her body. The CADTH review on EFT found that while

the evidence is limited, available studies have shown that EFT may be effective for reducing the symptoms of PTSD.* Further research into alternative therapies that may be used instead of current standard care or to complement existing PTSD treatments is needed. A review of the clinical evidence on such alternative, non-drug treatments will help to inform treatment decisions for people with PTSD. *The review of the evidence on these technologies was performed in 2013. The evidence base may have changed since then. For more evidence on treatments for PTSD from CADTH, visit https:// www.cadth.ca/search?keywords=PTSD. To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: https://www.cadth. H ca/contact-us/liaison-officers. ■ Eftyhia Helis, M.Sc. is a Knowledge Mobilization Officer at CADTH.

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22 Election Coverage Party leaders were invited to provide a column addressing health professionals. At press time, no material was provided by The Conservative Party of Canada.

Tom Mulcair Leader of the NDP Party of Canada Canada’s next Prime Minister will face significant challenges. Among the most important will be ensuring our health care system has the resources and leadership it needs to continue providing quality, public healthcare for all Canadians Stephen Harper walked away from his responsibilities to Canadians by cutting health transfers and ignoring the Canada Health Act. And let’s not forget that it was the Liberals before that who cut billions of dollars in health transfers starting in the 1990s. And you know the result – too many of you are struggling to provide quality care in under-staffed and under-resourced conditions. Aging seniors who have nowhere to go, and little options for care at home, are left for you to care for in a hospital bed. We’ve seen too few resources focused on prevention, so you’re left struggling to treat health challenges that should never have gotten so bad in the first place. You’ve been doing a monumental job – and I will roll up my sleeves and work with you to make our health care system better. I’ve outlined my vision for better healthcare, not just to undo the damage Stephen Harper has done, but to move our health care system forward. Just as Tommy Douglas did, I will usher in the next era of quality public health care. We will ensure that health transfers to the provinces grow at a rate of six per cent a year to keep pace with health needs, while we negotiate a new health accord with the provinces that focuses on expanding drug coverage, improving senior’s care, and ensuring access to primary care – all while enforcing the Canada Health Act. Canada is the only developed country with universal healthcare that does not have universal prescription drug coverage. And, as you see every day, one in four Canadian households includes someone who cannot afford to take their drugs as their doctor prescribed. We will step forward and work with provinces to develop universal public drug coverage, to ensure every Canadian, regardless of age or health condition, has access to the medicines they need at little to no cost. With this $2.6 billion commitment to expand universal coverage, we can leverage our combined strength across the country so that together we can bulk purchase and negotiate lower drug prices, saving provincial health budgets up to $3 billion each year. To support this partnership, we have dedicated an additional $80 million to ensure better oversight and safety in drug approvals, and implementing a national strategy on appropriate prescribing. We will work with the provinces to improve care for seniors across the spectrum of home care, long term care, and palliative care. This $1.8 billion commitment will expand home care for 41,000 seniors, and provide 5,000 desperately needed spaces in long term care. And, in doing so, we’ll relieve pressure on overcrowded hospitals so they can provide urgent care to patients who need it most. We will invest $500 million directly in primary care – to work with provinces to build or expand 200 team-based primary care clinics across Canada, including community health clinics and mobile rural clinics, and set up training and recruitment grants to help provinces hire over 7,000 needed doctors, nurse practitioners, nurses and a full range of health professionals where they are needed the most. We will establish a $100 million Mental Health Innovation Fund for Children and Youth. This four-year fund will contribute $15 million annually for health care providers and community mental health associations to implement best practices that reduce wait times and provide appropriate care, and $10 million annually for research and sharing information among health care providers across the country. Working with the provinces, this Fund will prioritize high-risk populations, including First Nations, Inuit and Métis, and youth transitioning out of foster care. Some provinces have taken action to fill the void created by the Liberal cuts of the 1990s and Conservative inaction on healthcare. Strategies to deal with illnesses like diabetes, dementia and other major health challenges are a good start – but they need to be available to all Canadians. We will expand these programs and target them to those most at-risk. It’s clear there is much to be done. Canada needs a long-term vision, not more shortterm thinking – and no more Band-Aid solutions from Conservatives and Liberals. That’s why Canadians want change. For a lot of Canadians, healthcare will be the defining issue in this campaign. That’s why we’ve made the choice clear – New Democrats have the vision and commitment to make the changes needed in our public health care system.

HOSPITAL NEWS OCTOBER 2015

Justin Trudeau Leader of the Liberal Party of Canada Caring for one another is an essential part of being Canadian. That shared value of compassion is reflected in the work done every day by healthcare providers, who help Canadians live healthier, happier lives. They are there to help when people need it most. We value that contribution to our society and to the success of our country. We also know you need a partner in Ottawa to ensure health care’s continued success. A new Liberal government will be your partner. We will work to help provide Canadians with a more patient-oriented and compassionate health care system. I have spent the last three years as Liberal Leader travelling our country. I have had conversations from coast-to-coast-to-coast with Canadians, civil society, industry partners – including in healthcare – and provincial and territorial governments. I have heard firsthand that Canadians are losing trust in a national vision of healthcare that includes equal, timely, and compassionate care when they need it most. A Liberal government will improve our health care system in areas of federal jurisdiction and work with our colleagues in provincial and territorial governments on a national direction for healthcare. Our health care system must be modernized to ensure it continues to deliver high-quality, effective, efficient care for Canadians when they need it, where they need it. Liberals believe in supporting home care, lowering drug costs, supporting family caregivers, fulfilling our obligations to veterans and public safety officers by providing them with the mental health services they need, and ensuring that Employment Insurance is there for Canadians when they need it. A Liberal government will introduce a more flexible and accessible Employment Insurance Compassionate Care Benefit to support caregivers, available to any Canadian who provides care to a seriously ill family member. We will invest $150 million a year, with no increased EI premiums, to build a more flexible program that will allow the six months of benefits to be claimed in blocks of time over a year-long period and allow family members to share the six months. Further, we believe that investing in home- and community-based services is more cost effective and provides better patient outcomes. This will also free up overcrowded hospitals so that they can better provide urgent, acute, and emergency care. A Liberal government will work with provinces and territories to develop long-term care infrastructure and community-based services and go further to invest in the long-term health of Canadians. Canada faces challenges in the coming years due to changing demographics, including an aging population. We will ensure that Canadians have the tools they need to make more informed decisions about their health by rebuilding the federal government’s capacity to deliver on evidence-based decision-making, mobilizing the experience and knowledge of Canadians, and incorporating their input into our decisions and evaluations of existing programs and policies. Since the Conservatives have been in office, health has been virtually absent from the federal agenda. They have failed to show leadership and done little to move issues forward. They reneged on their commitment to collaborate to improve patients’ quality of care and cut funding for mental health and suicide prevention. For years, Mr. Harper has refused to meet with the Premiers and unilaterally made major changes to the Canada Health Transfer. It is not surprising that their record in areas in their jurisdiction – including Indigenous Peoples, the Canadian Forces, RCMP, veterans, and correctional facilities – have some of the worst mental health outcomes in the country. Unlike Mr. Harper, we will not deal with these issues unilaterally. A Liberal government will meet with provincial and territorial governments to discuss and find solutions for the challenges they face when trying to ensure Canadians have the best care possible, including the increasing health care costs of an aging population. A Liberal government will call a federal-provincial meeting to reach a long-term agreement on health care funding and tackle critical needs like community-based care, elder care, mental health, and reducing drug costs. As part of a renewed health partnership, innovation will be critical to achieving concrete results for improved health care access and quality across the country. That’s why Canadians not only want a different government, they want – and deserve – a better government. In the coming days, I look forward to releasing the rest of the Liberal Party of Canada’s plan for healthcare. Liberals know that better is always possible. We will work hard, together, to build a better country for all Canadians. www.hospitalnews.com


PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Focus 23

New program delivers timely mental health care for youth By Ania Basiukiewicz t is estimated that 10-20 per cent of Canadian youth are affected by a mental illness or disorder at some point in their life, with the most common being depression and anxiety. Today, approximately five per cent of male youth and 12 per cent of female youth, age 12 to 19, have experienced a major depressive episode. In Peel Region, eight per cent of students had seriously considered suicide in the past year, with three per cent having attempted suicide in the past 12 months. At Trillium Health Partners’ Mississauga and Credit Valley Hospitals, the majority of all mental health visits come through the Emergency Department (ED), with seven per cent being patients under the age of 17. In just the past three years, there has been a significant increase in mental health visits to the hospital. As a result, the hospital’s long-standing Child and Adolescent Mental Health Program recently added the Paediatric Mental Health Urgent Care Program, supported by the RBC Foundation. The program opened its doors in November of 2014, and provides rapid support to children and youth who come through the hospital’s emergency departments with a mental health concern.

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www.hospitalnews.com

“We started this program with the goal of preventing hospitalization for children and youth with acute mental health conditions; our interprofessional urgent care team is often ready to support these patients within less than 72 hours. The short response time can make the difference between life and death for some patients,” explains Dr. Louis Peltz, Lead Psychiatrist, Trillium Health Partners’ Paediatric Mental Health Urgent Care Program. Children and youth treated through Trillium Health Partners’ Paediatric Urgent Care program can quickly see a crisis social worker, occupational therapist, psychologist, and speech language pathologist, without having to be admitted into the hospital. “Urgent care is often the most effective care, especially for teenagers; it is when they are at a tipping point that they are commonly most receptive to treatment,” says Jennifer Wowk, Social Worker with Trillium Health Partners’ Paediatric Mental Health Urgent Care Program. The hospital’s new interprofessional Paediatric Urgent Care Program allows families in crisis to receive the support they need away from the busy ED, offering a comfortable, safe environment.

The Paediatric Mental Health Urgent Care Program team at Trillium Health Partners. “Chronic school absenteeism, lack of friends, poor social skills, isolation, family stress, in some cases suicidality, the list of complications for youth suffering from anxiety and depression is long and daunting to handle,” adds Wowk. “When patients come in to see us, things have often escalated to a critical point, and we need to do all that we can to respond in the most timely way to support these patients and their families.” “Mental health difficulties in childhood and young adulthood can significantly impact a person’s ability to cope and enjoy life even in adulthood,” says Dr. Peltz. “Seeing our young patients recover so that they have fun again, suc-

ceed in school and in their relationships, and get back to the things they enjoy has been the most rewarding part of helping them through our program.” In the words of one of the patients, “People at the Trillium Health Partners Paediatric Mental Health clinic were very helpful and nice. I felt like they really understood me.” Together with our community partners, Trillium Health Partners supports over 6000 children and youth in the region through its Mental Health and Paediatric Urgent Care ProH gram. ■ Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

OCTOBER 2015 HOSPITAL NEWS


24 Focus

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

It takes a village By Suzanne Rhodenizer Rose

A

of a substance abuse issue and their consultation interview. “This new technology gives patients a timely intervention that would not have been possible in the past,” says Cappuccio. “This makes a big difference as it increases the chances of successful entrance into and completion of an addiction recovery program.” Patients have been pleased with their care at MSH using OTN Addiction Services. They are finding it a less intimidating process and a more progressive delivery of care. An MSH patient who greatly benefited from having a consultation with Dr. Perusco via videoconferencing expressed his satisfaction with the service: “I found it very user-friendly. I felt safe and open… you are on the right track using this type of service. I was given several options by Dr. Perusco for my care at the click of a button, which was validating and engaging.” The challenge MSH faced in the past was the need for an addiction specialist to consult the patients who needed it in the hospital, and the scarcity of addiction specialists in the region made that very difficult. By utilizing OTN/PCVC, partnering with ASYR and having Dr. Perusco on board, MSH has managed to overcome this barrier. “This collaboration works extremely well because each party brings their strengths to ensure patient safety and best practices,” says Cappuccio. By bringing this service right to MSH patients – instead of the other way around – they experience a holistic and patientcentered approach to their care. “The future of healthcare isn’t solely about the innovation of medicine,” says Janet Wilson, Patient Care Manager of Mental Health at MSH. “It is equally about the innovation of delivering it. We have to get very clever now about how we deliver care, and how to build on existing technology like OTN/ PCVC to solve the current problems we face to provide excellent patient care.” With these valuable partnerships, MSH is looking to pave the path for new initiatives like this one that find unique ways to provide patients with the right care, in the right place and at the right time. This is H the future of healthcare. ■

s a nation, and I would argue, as a global village, health care delivery systems and organizations struggle with preventing health care-associated infections. Objectively, can any of us (providers) say that the standard education on hand hygiene is truly working? Or that we routinely adhere to Routine Practices? If it was as inherent now as fastening our seatbelts when we get in a vehicle, our rates would be through the roof for hand hygiene and statistically insignificant for central line-related bacteremias. Everyone would “just do it” instinctively. But they don’t…and rates remain a concern in many instances. Infection Prevention and Control professionals (ICPs) continue to deliver education to providers in the earnest hope that it will make a difference. I give you a famous Einstein quote... Insanity: doing the same thing over and over again and expecting different results. As practitioners, administrators and leaders in healthcare, we are insane (well, at least according to Einstein). We need a different approach. We need to turn best practices into daily practices and become part of the expectation. We can educate, train, and cajole health care providers to wash their hands, wear their personal protective equipment appropriately, and to stop eating lunch from cleaning and medication carts; however, if we only do this, we will be fighting the same fight for best infection prevention and control practices five years from now. From where I sit, culture is the single most important prevention method for preventing transmission of infection. We need to understand current organizational culture so that we can improve it and leverage it to make those best practices more than just academic musings based on scientific evidence. It’s sadly not enough to think people are going to embrace best practices consistently because it’s the right thing to do. Therefore, if the overarching culture is one of safe practices, this “cult following” will ultimately translate into improved individual behaviors in making best practices part of one’s daily practice. This brings me to the role of the ICP and what it needs to embody in the prevention of health care associated infections and what other health care providers’ roles are subsequent to that. The role of the ICP is to provide the tools, education, surveillance/ audit data for decision-making, foundational elements and supports so that other providers/ support workers can easily implement infection prevention and control best practices. The fact that an outbreak of Norovirus has occurred on 5 South is not the ICPs’ responsibility – it’s a collective effort to manage (and ultimately prevent) and the entire team needs to be engaged and involved in the solution and the execution of that solution. I would challenge all providers and support workers to do an honest self-appraisal of what their own infection prevention and control practices typically are and how well they dock up with those H best practices supported by those ICPs! ■

Peri Elmokadem is a Corporate Communications Associate at Markham Stouffville Hospital.

Suzanne Rhodenizer Rose RN BScN MHS CIC, is President, Infection Prevention and Control Canada.

Gary Edney, Registered Social Worker with the Mental Health Crisis Team, and Ann Marie Havery, Professional Practice Leader for Clinical Telemedicine in the OTN Addiction Services consultation room at Markham Stouffville Hospital.

Videoconferencing technology to bridge the gaps in mental healthcare By Peri Elmokadem or a patient with an addiction problem, timing is everything. The sooner their health care professionals can get them on their way to recovery, the higher their chance of success. With their very specific care needs and the unique set of challenges they face, patients suffering from addiction require extensive support and resources from professionals trained to manage addiction throughout their treatment journey. However, there are very few physicians in Ontario who specialize in addiction. This means that Ontario hospitals – with the exception of those with addiction centres – don’t have specialists who can help patients with their treatments on-site. It also means that specialists in the hospital’s surrounding areas are scarce. Markham Stouffville Hospital (MSH) is a leader in recognizing and bridging this gap in mental health and addiction care. Through establishing a partnership with Addiction Services of York Region (ASYR), the mental health team at MSH is now able to provide addiction assessments with a specialized physician to its patients – without actually having one in the building. In June 2014, MSH collaborated with ASYR to streamline addiction consultations using Ontario Telemedicine Network’s (OTN) Personal Videoconferenc-

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ing Service (PCVC). Dr. Ivan Perusco, Consulting Addiction Physician at ASYR, and leading addiction specialist in Canada, conducts assessments over OTN/PCVC for patients with substance abuse problems who were screened by MSH staff. Any patient within the hospital – either inpatient or outpatient – can be referred for this addiction assessment. By utilizing the OTN/ PCVC system, real-time consultation can occur even though the addiction physician is not in the hospital, increasing the chances of successful addiction recovery.

There are very few physicians in Ontario who specialize in addiction. This means that Ontario hospitals—with the exception of those with addiction centres—don’t have specialists who can help patients with their treatments on-site. “Before we started this at MSH, we knew we could not get our patients with addiction issues the consultation they needed in a timely fashion,” says Paul Cappuccio, Director of Mental Health and Family Medicine at MSH. “When they left us with a referral, we were never confident they would follow up with the addiction services they needed.” Cappuccio believes that patients’ fear, uncertainty and discomfort guide their reluctance to reach out to the addiction specialists on their own. OTN Addiction Services at MSH were built on the foundation of empowering patients to take the next essential step in their care by helping them create the connections they need. “Now we say hey, just before you go, we would like to conduct an addiction assessment with Dr. Perusco to get you on the right track for recovery,” says Cappuccio. “When you already have a connection, you’re not scared to walk up to addiction services to start your journey.” Another benefit patients experience when they are offered OTN Addiction Services at MSH is a significantly shorter wait-time between their initial recognition

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Focus 25

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

Taking the measure of international nurses By Tina Novotny n the medical field, breakthrough research means better health outcomes for Canadians. There is also important research news about how health human resources can be greatly improved by providing diverse, culturally competent professionals to the workforce. In the case of the largest employee group in healthcare, nurses, the Conference Board of Canada has released a report on the return on investment in supporting internationally educated nurses (IENs) back into practice. The report, titled Measuring Returns: Valuing Investments in Internationally Educated Nurses was produced in collaboration with CARE Centre for IENs, Ontario’s first government-funded bridging program for internationally educated professionals. The study was funded by the Conference Board of Canada’s Leaders’ Roundtable on Immigration. The Roundtable engages business and government leaders in developing and implementing effective strategies for attracting, integrating and retaining immigrants in order to ensure sustainable competitiveness. It was authored by Dr. Michelle Parkouda, Senior Research Associate, and Janneka Beeksma, Research Associate, of the Conference Board of Canada, and Janet Kwansah, an IEN from Ghana who was involved in developing health policies at a national level and taught at university. As a new-

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comer, Kwansah completed the CARE Centre program, and previously worked as a CARE Centre case manager. She is just one of the success stories that reveals how investing in IENs yields significant returns for the Government of Ontario and the federal government, as well as the IENs themselves.

Nurses always refer to their profession as a calling, and that’s true in any part of the world “We’re extremely proud to have collaborated with the Conference Board of Canada on this report, which clearly proves the value of bridging programs like our own,” says Acting CARE Centre Executive Director Joanne Roth. “On average, for every dollar the government invests in bridging IENs to licensure and employment as registered nurses (RNs), they recoup 9:1; for every IEN who passes their exam to work as a registered practical nurse, the return is 3:1. With the looming nursing shortages we know are coming as the boomers retire, IENs can not only fill that labour market gap, they reflect the increasingly multicultural patient population.”

Kwansah is now working as a public health nurse at the Brant County Health Unit, and though she has previously worked at a senior policy level, she enjoys her job promoting health in the community. “Nurses always refer to their profession as a calling, and that’s true in any part of the world,” she says. “The IENs I have met since coming to Canada have a passion to use their skills in a country they have chosen as their new home. Helping them gain recognition for their credentials and experience, and with bridging any educational gaps, will consistently pay huge dividends to that investment.” Rola El Moubadder is an IEN from Dubai who obtained her RN with CARE Centre’s support. Like Kwansah, she was a government advisor in the United Arab Emirates, and a university-level nurse educator. She is currently a clinical instructor at Centennial College, York University, and CARE Centre, where she is also co-chairing the annual Conference for IENs which will take place November 19th and 20th in Toronto. “IENs share their knowledge from established careers in their home countries, but you always hear how much hardship they face to return to nursing in Canada,” says Moubadder. “Those who are lucky enough to find a bridge training program like CARE Centre attest to the difference it made in their eventual success. To have concrete research published in the Measuring Re-

turns: Valuing Investments in Internationally Educated Nurses report confirms what IENs know personally: the return on investment for their wealth of global experience is worth every dollar. CARE Centre was the first to provide a bridging model for any of the registered professions.” CARE Centre was founded in 2001 and has assisted over 1,700 nurses from more than 140 countries to become registered in Ontario. CARE Centre provides IENs with one-on-one case management, specialized language and communication training, exam preparation, professional development, workplace mentoring and job search support. Newer offerings include a workplace transition program for both employers and IENs, and a pre-arrival support service for IENs in their home countries. CARE Centre was previously profiled by the Conference Board of Canada for organizational excellence (2012). Reports can be downloaded from their e-library at www.e-library.ca where the Measuring Returns: Valuing Investments in Internationally Educated Nurses is now available for purchase. Registration is now open for the 2015 Conference for IENs through the CARE Centre website H at www.care4nurses.org. ■ Tina Novotny is a Communications Specialist at The CARE Centre for Internationally Educated Nurses.

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26 Focus

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

New strategies for child and youth mental health By Dr. Kathleen Pajer

outh are our future, and their physical and mental health should be everyone’s concern. Yet the World Health Organization (WHO) estimates that by 2020, the number of children and youth suffering from mental illness around the world will have increased by 50 per cent. At the Children’s Hospital of Eastern Ontario (CHEO), we are seeing this firsthand. Since 2009, there has been a 75 per cent increase in the number of children and youth coming to the CHEO Emergency Department seeking help for mental health issues. The picture is similar at The Royal Mental Health Centre, with significant growth of inpatient numbers and referrals, as well as increases in acuity. It is possible that this increase is partially the result of successful efforts to destigmatize mental illness. This is definitely good news because the earlier we can treat mental health problems in children and youth, the better are their outcomes in adulthood. But we also think that this increase is due to a real rise in the development of mental health problems that are occurring at younger ages. This is worrisome, particularly in the context of long wait times for child

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and youth mental health services. Patients and their families in Eastern Ontario can wait as long as 10-12 months for services in the community or at CHEO. This wait can make their problems worse, put extra strain on families, and lead to a downward spiral of ever-worsening function in school, social relationships, and self-esteem. The lack of timely treatment can also drive children and youth to the use of drugs and alcohol to self-medicate their symptoms, and substance use can cause further deterioration in function. The need for timely diagnosis and intervention prompted CHEO and The Royal Mental Health Centre’s Youth Program to strengthen their collaboration into a new partnership called Young Minds and to codevelop a new strategic plan for our shared specialty psychiatric services for children and youth. CHEO currently offers specialized psychiatric services to thousands of children 0-18 years of age every year. Our services include 19 inpatient mental health beds, emergency and crisis intervention services, and a six-bed Eating Disorders Unit. We also offer day and outpatient treatment options for struggling youth, as well as out-

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reach and community services. The Royal offers intensive and specialized mental health services to youth (ages 16 to 18) with early onset major psychiatric disorders, and/or complex psychiatric illnesses that are resistant to treatment.

The World Health Organization (WHO) estimates that by 2020, the number of children and youth suffering from mental illness around the world will have increased by 50 per cent.

From October 2014 to March 2015, four leaders in mental health from CHEO and The Royal’s Youth Program conducted focus groups, round table discussions, consultations, interviews, and surveys across Eastern Ontario to inform a new collaborative Strategic Plan. Information was collected from over 800 staff, physicians, community providers, educators, police, juvenile justice specialists, children, youth and families. The resulting new strategic plan focuses on ensuring high quality patient care; increasing partnerships with community providers and non-mental health professionals; increasing our research efforts and measuring how well our interventions help

patients; and increasing staff, patient and family engagement. By 2020, we will address key gaps in service and ensure that a strong continuum of mental health services is available and accessible to children, youth and families. In 2015/16, CHEO and The Royal will launch the first of the new strategies, including instituting dedicated mental health beds for children younger than 13 years, decreasing wait times for outpatient services, developing new ways to detect and help youth who have substance use problems with their mental health problems, and new methods for getting mental health services to patients who live in areas outside Ottawa. We also plan to improve services available when children and youth are in crisis. We will develop a new evidence-based model for assessing and treating psychiatric emergencies, which may include 48-hour crisis stabilization beds, a self-harm clinic, an urgent care clinic and innovative use of telemedicine to reach community hospital Emergency departments. Another key strategy is to engage children, youth and families in their care. We want to ensure that children, youth, families and caregivers participate in the planning and design of system improvements. Recognizing how important families are to the mental health of kids and youth, we want to help parents and caregivers navigate adult mental health and addictions services to H foster the health of the full family. ■ Dr. Kathleen Pajer is Chief of Psychiatry, Children’s Hospital of Eastern Ontario, and Professor of Psychiatry, University of Ottawa Faculty of Medicine.

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Reporting on best practices in Canada, including new equipment and technology and the people that make a difference. CAPHC SUPPLEMENT See page C1

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PAEDIATRICS/AMBULATORY CARE/ NEUROLOGY/HOSPITAL-BASED SOCIAL WORK:

Paediatric programs and developments in the treatment of paediatric disorders. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders, traumatic brain injury. Social work programs helping patients and families AUGUST 2015 | VOLUME 28 ISSUE 9 | www.hospitalnews.com address the impact of illness.

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INSIDE Safe Medication .................................12 From the CEO’s desk .........................13 Evidence Matters ............................... 14 Legal Update ...................................... 17 Nursing Pulse .....................................23

Celebrating Over 25 Years!

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Lyme disease Why Canada needs to do more By Sarah Quadri Magnotta

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Health Care Technology 27

Empowering patient advocacy through technology By Janet Balfour

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hat does it take to care for someone you love? More than 25 per cent of Canadians are involved in providing informal care for a family member or close friend, and over 500,000 Canadians receive some form of private healthcare at home. The reality of the Canadian health care system today is that a significant portion of home healthcare is now being paid for privately, requiring families to shoulder the responsibilities of finding, managing and paying for care. As homecare trends toward a more selfdirected model, there is an increasing need to provide families with more information, transparency, affordability, as well as more choice and control when choosing home health care options. Frequently, one family member takes the lead ‘advocate’ role in making the choices for a patient. This advocate needs to navigate the complexities of transitioning from publicly funded health care institutions to what is often a public/private hybrid system of homecare, while also managing the emotions, stress and time management of coordinating the best care options for their loved one.

Increased accessibility and current advances in technology, allow patient advocates to leverage online resources to be better informed about health issues, access more research about patient options, know what questions to ask Without a doubt, access to effective care planning, coordination and communication are crucial to the success of transitioning home or into the community. Although many hospitals and health care facilities have adopted best practices to improve discharge planning and transition processes, many caregivers could still benefit from further tools and support to ensure best practices follow them home. Having a skilled advocate involved in the process of care is a common theme for successful patient outcomes. These patient advocates listen, counsel, offer support, information, resources and references, as well as facilitate communication between patients, families and caring professionals. Some families may choose to hire an advocate (or care coordinator), but for many patients an immediate family member or close friend assumes this critical role. The advocate role requires helpful tools and supports to be effective. Increased accessibility and current advances in technology, allow patient advocates to leverage online resources to be better informed about health issues, access more research about patient options, know what questions to www.hospitalnews.com

ask, and be more aware of their care options. Advocates can seek health advice from resources such as Telehealth Ontario and increasingly have much better access to Patient Health Records (PHRs) as our health care system becomes more digitized and patient access to this information is more available. There are also important innovations within the private ehealth sector that are designed to complement public systems and support more seamless transitions to care in the home. These systems are designed to empower family and patient advocates to find, organize and obtain the quality care options they need. Caring is often a team effort. Effective communication and coordination between patients and informal caregivers such as friends and family, as well as caring professionals is critical for delivering the best possible care. Advances in online and mobile technology allow for much improved coordination and communication of care. Online ehealth platforms, can allow families and patients the opportunity to organize digital care teams, while controlling their privacy and the sharing of important health information to their benefit. Patient advocates can now utilize online health services to communicate patient needs directly through digital intake forms, can amend care plans online as care needs evolve, send and receive real-time care updates on their mobile devices or tablets, as well as electronically monitor a patients status from home. They are also able to provide online feedback about the quality of care being provided. Many families can also access innovative online options to facilitate quick care assessments or develop comprehensive care plans, by talking with an experienced health care practitioner over the phone or by online videoconference. New health care marketplaces allow families and patients to find, screen, hire and coordinate health care practitioners directly. This increases the transparency, accountability and outcomes of homecare options. These marketplaces are helping make private home healthcare more affordable by eliminating many of the traditional overhead and administrative costs, allowing a much greater portion of the cost of private care to go directly to caring professionals, and enabling families to more wisely manage their care dollars for the long term. Meeting the substantial challenges of delivering home healthcare to an aging population requires that we find new and innovative ways to deliver care. Combining innovative technology with a firm commitment to advocacy, fostering better collaboration between public and private health care systems, as well as empowering families and patients to do more for themselves are critical components of finding new ways H to provide better care for less. ■ Janet Balfour, PhD is the President eAdvocate.com – the Caring Marketplace and Part-time Instructor, School of Social Work, Ryerson University.

Educational & Industry Events To list your event, send information to “events@hospitalnews.com”. We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com”

QSeptember 30-October 1, 2015 3rd Annual National Forum on Patient Experience Toronto Airport Marriot Hotel Website: www.patientexperiencesummit.com QOctober 5-6, 2015 Innovations in Laboratory Management for Lab Leaders Conference Marriott Bloor Yorkville Toronto Website: www.exec-edge.com QOctober 25-28, 2015 Critical Care Canada Forum Sheraton Centre Toronto Hotel Website: www.criticalcarecanada.com QNovember 2-4, 2015 Health Achieve 2015 Metro Toronto Convention Centre, Ontario Website: www.healthachieve.com QNovember 5-7, 2015 12th National Respiratory Care & Education Conference Niagara Falls, Ontario Website: www.cfhi-fcass.ca. QNovember 16-19, 2015 World Forum for Medicine Duesseldorf, Germany Website: www.medica-tradefair.com QNovember 17-18, 2015 Rx&D Annual General Meeting Hyatt Regency, Montreal Website: www.canadapharma.org QNovember 23-25, 2015 This is Long term Care 2015 Toronto, OntarioWebsite: www.cfhi-fcass.ca. QNovember 29- December 4, 2015 RSNA Annual Meeting 2015 McCormick Place, Chicago, United States Website: www.rsna.org QDecember 1–2, 2015 Data Analytics for Healthcare International Plaza Hotel Toronto Website: www.healthdatasummit.com QDecember 1, 2015 Health Canada: Financial Models and Fiscal Incentives in Health and Health Care InterContintental Toronto Centre Hotel, Ontario Website: www.conferenceboard.ca QJanuary 26-27, 2016 12th Annual Mobile Healthcare Toronto, Ontario Website: www.mobilehealthsummitdata.com QMarch 1-5, 2016 13th Annual Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca

To see even more healthcare industry events, please visit our website www.hospitalnews.com/events OCTOBER 2015 HOSPITAL NEWS


28 Focus

PATIENT SAFETY/MENTAL HEALTH AND ADDICTION/RESEARCH

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HOSPITAL NEWS OCTOBER 2015

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Hospital News 2015 October Edition  

Focus Patient Safety, Mental Health & Addiction/Research. Including Special Annual Health Achieve Guide Supplement!

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