Hospital News January 2020

Special Focus: Professional Development + Education Inside: From the CEO’s Desk | Evidence Matters | Nursing Pulse | Long-Term Care | Careers

January 2020 Edition

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Is the Ford government listening?

Year one has seen the Doug Ford Conservatives cut too much, too quickly, without meaningful consultation. Premier Ford says he’s listening now.

Actions speak louder than words. If Doug Ford is serious about ending hallway care in Ontario’s hospitals, nurses and health-care professionals need to be heard.

Tell your MPP, the Health Minister, and Doug Ford that open dialogue with front-line nurses is vital to successful health-care reform.

Contents January 2020 Edition

IN THIS ISSUE:

Creating a safe space for healthcare workers

5 ▲ Cover story: Workplace violence: What we’ve learned

10

▲ Augmented reality in healthcare

34 ▲ Survival tips for agency nurses

COLUMNS Guest editorial .................4

52

In brief .............................6 Nursing pulse ................22 Doctors without Borders . 40 Evidence matters ...........42 From the CEO’s desk .....43 Ethics ............................ 44 Long-term care ...............46 Careers ...........................54 www.hospitalnews.com

▲ Supporting employees mental health

50

Virtual reality is shaping the future of dementia care

46

▲ Professional development and education Supplement

17

Demographics and disruption

will shape the future of work in the healthcare sector

O

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By Niranjan Vivekanandan ur country’s ability to thrive and prosper requires our hospitals to do the same.

Their importance to our economic and social well-being cannot be understated.

Nor can the challenges they will face in the next decade. Demographics and technological disruption represent two forces that will have a profound impact on the shape of things to come.

Hospitals will be on the frontlines of an aging population, which will place greater strains on the healthcare system, and the resources required to sustain them. Ten years from now, about one-quarter of our total population will be 65 or older, earning Canada the international distinction as being a “super-aged society.”

Caring for our elderly will ensure the pace of jobs in this sector will exceed the overall economy in the coming years. But the same demographic trend will mean fewer people will be in the workforce to take

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on these roles. Even under the most optimistic scenario, demand will outstrip supply by almost 20,000 positions. The gap needs to be closed.

Yet the challenge goes deeper than that. Institutions must also adapt to a new set of skills brought on by technological disruption that is transforming the way we treat and care for people. For instance, data scientists will need to be employed to mine a hospital’s growing databases for key insights on how to improve patient outcomes. So too, 3D printing technologists to create anatomical models for surgical planning.

There is reason to be optimistic. A new report – developed in collaboration with RBC Healthcare – suggests the impact of automation will have a muted effect in healthcare settings. Some roles will be automated – in areas where processes can be simplified or streamlined, such as administrational functions or lab diagnostics.

Continued on page 6

Lauren Reid-Sachs

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Johannah Lorenzo

ADVISORY BOARD Barb Mildon,

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

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Publicist Health-Care Communications

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President Brainstorm Communications & Creations

Bobbi Greenberg, Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON

Niranjan Vivekanandan is Vice-President, RBC Healthcare.

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NEWS

Creating a safe space: Psychological safety of healthcare workers

By Markirit Armutlu he Canadian Patient Safety Institute has created a comprehensive guide and toolkit that provides Canadian healthcare organizations with the resources they need to develop and sustain a peer-to-peer support program (PSP). Creating a Safe Space: Strategies to Address the Psychological Safety of Healthcare Workers provides a broad overview of what peer support is available in Canada and internationally.

The guide outlines best practices, tools, and resources. These help policy makers, accreditation bodies, regulators, and healthcare leaders assess what healthcare workers need in terms of support, and to create PSPs to preserve their emotional well-being. The result enables healthcare organizations to provide the best and safest care to their patients.

Some healthcare organizations are unable to provide the support needed to their staff and managers to maintain a healthy and resilient workforce.

Albert Wu coined the term “second victim” to describe a healthcare worker after a patient safety incident. The “second victim phenomenon” describes healthcare providers who are psychologically traumatized by events during the provision of care, resulting in anxiety and depression, decreased performance, high turnover rates, and increased patient safety incidents.

Various studies estimate that the prevalence of the second victim phenomenon ranges from 10.4 per cent up to 43.3 per cent.

Healthcare is a high stress environment. Healthcare providers are expected to work efficiently and safely in often difficult and pressured settings.

Over the past decade, research has identified the clear link between a provider’s mental health and healthcare outcomes, including patient safety, with the probability of contributing to a preventable incident increased when the provider is suffering from psychological distress. For example, a healthcare professional may feel emo-

confidentiality and legal privilege for peer support programs. It provides clear explanations about what is and is not privileged information and how best to strengthen confidentiality. Section 4 provides a step-by-step approach to help healthcare organizations succeed in creating a PSP. It includes recommendations on how to recruit and train peer supporters and how to ensure spread and sustainability of the program. A webinar series has also been created to learn from others who have implemented PSP programs.

In partnership with the Mental Health Commission of Canada, the Canadian Patient Safety Institute has compiled the Creating a Safe Space Toolkit with input from experts and contributing organizations.

“The Toolkit is an excellent source of information for healthcare workers, leaders, regulators, and policy makers that includes templates, examples, and recommendations for anyone who is embarking on creating a PSP,” says Armutlu. “The searchable database provides links to documents and examples from existing peer support proH grams for healthcare providers.” ■

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CREATING A SAFE SPACE: PSYCHOLOGICAL SAFETY OF HEALTHCARE WORKERS IS A COMPREHENSIVE GUIDE AND TOOLKIT THAT PROVIDES CANADIAN HEALTHCARE ORGANIZATIONS WITH THE RESOURCES THEY NEED TO DEVELOP AND SUSTAIN A PEER-TO-PEER SUPPORT PROGRAM. tionally traumatized after a sudden or unexpected bad outcome, a patient safety incident, the loss of a patient with whom they feel close, workplace conflict, or dealing with multiple trauma cases.

“While patients and families will always be the first priority in healthcare, workers also need to be supported as a result of what they experience in their profession,” says Markirit Armutlu.

“Peer-to-peer support programs, where health professionals can discuss their emotional distress in a nonjudgmental environment with colleagues who can relate to what they are going through, are now seen as an effective approach to helping health professionals cope and provide a safe space where they can get extra support.”

Creating a Safe Space is divided into four sections: Section 1 provides the results of a pan-Canadian survey of healthcare workers to determine what support they needed and identified gaps in that support. Section 2 includes knowledge from international

literature so that we can learn from those who have established or studied healthcare PSPs. Section 3 addresses

Markirit Armutlu is a Senior Program Manager with the Canadian Patient Safety Institute.

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JANUARY 2020 HOSPITAL NEWS 5

IN BRIEF

Almost 12,000 Canadian children and youth readmitted to hospital last year

n 2018, almost 12,000 Canadian children and youth age 17 and younger were readmitted to hospital within 30 days of their initial hospitalization. According to the latest information published by the Canadian Institute for Health Information (CIHI), 60 per cent of these pediatric patients were age four and younger.

These numbers were consistent over the previous six years.

The top three reasons for pediatric readmissions were pneumonia and respiratory tract infections, digestive conditions, and complications following procedures. The data also shows that the average length of hospital stay for pediatric readmissions was typically short: approximately 50 per

I

READMISSION IS FRUSTRATING AND INCONVENIENT FOR FAMILIES, AND POTENTIALLY CARRIES SOME RISK. cent of readmitted patients stayed in hospital for one or two days. In comparison, 35 per cent of readmitted adults age 18 to 64 and 20 per cent of readmitted seniors 65 and older stayed in hospital for one or two days.

In 2018, there were 171,786 hospitalizations for children and youth under 18 years. The main reasons for

hospitalizations were surgical procedures, diseases of the respiratory system (such as pneumonia, bronchitis and asthma) and conditions occurring shortly after birth (such as neonatal jaundice).

“Having a child admitted to the hospital is a stressful event, and having an urgent readmission adds to a patient’s and family’s stress. Our data on the frequency and causes of pediatric readmissions can provide hospitals and health system planners with information to help strengthen both discharge planning within their hospitals and transitions to primary care for the younger patients in their health region,” says Mélanie Josée Davidson, Director, Health System Performance, CIHI.

“The decision to discharge a child from hospital can be tricky. The clinical team makes a judgment call about the health status of the child, the resources within the family and community, and the availability of medical follow-up, and then weighs these against the sometimes-urgent need to find a bed for the next acutely ill patient. Readmission is frustrating and inconvenient for families, and potentially carries some risk. While we can’t eliminate readmission, we can seek best practices through transparent measurement, comparison and discussion from multiple jurisdictions,” adds Dr. Brett W. Taylor, MD, FRCP, MHI, Emergency Pediatrics and Health Informatics, IWK Health CenH tre/Dalhousie University. ■

Demographics and disruption Continued from page 4 But the profoundly human nature of work means the majority of healthcare jobs aren’t going away anytime soon. Indeed, we believe automation will enable healthcare practitioners to do the essential, human part of their jobs better than before. Human connection and bedside manner is vital but arguably even more so as we care for older patients, who often need help navigating and interacting with different parts of the healthcare system.

Actions are already underway.

Educators, for instance, are already incorporating “soft skills” training into the curriculum. The University of Toronto is moving away from a focus on the perfect GPA and looking at medical school candidates’ social and inter-personal skills. The Medical Council of Canada is also re-thinking the way it evaluates physicians-in-training, placing a greater focus on the ability to problem-solve in new situations.

New sources of labour may also be available to fill many of the 370,000 6 HOSPITAL NEWS JANUARY 2020

WE BELIEVE AUTOMATION WILL ENABLE HEALTHCARE PRACTITIONERS TO DO THE ESSENTIAL, HUMAN PART OF THEIR JOBS BETTER THAN BEFORE. new jobs that Employment and Social Development Canada estimates will be required by 2025. RBC research found there are currently one million Canadians in occupations deemed at “high-risk” of being disrupted through automation who possess a number of the vital skills required in healthcare, such as active listening, service orientation, and social perceptiveness and monitoring.

For instance, the rise in autonomous vehicles, and the implementation of drone delivery, will shift employment away from human delivery. But some of these displaced workers could find employment as a paramedic, who administers pre-hospital emergency medical care to patients with injuries

or medical illnesses and transports them to hospitals for further care.

Helping workers make the transition will be one of the critical challenges of our time. It will require government and professional bodies to challenge themselves to think well beyond traditional career paths and compensation models. But building these pathways to our sector will help us attract and retain the right kind of workers we will need for the 2020s while providing a remedy to the challenges brought on by changing demographics in an age of disruption.

The RBC report offers a way forward. A national skills strategy for healthcare led by the provinces is a good step. A dashboard of public

labour market information detailing the location of labour shortages across the Canadian healthcare sector would also help provide vital data for policymakers.

The creation and expansion of second-career bridge programs to attract professionals into healthcare is important to find ways to minimize years of additional schooling. There are also opportunities to create more work-integrated-learning opportunities in healthcare for workers in non-health disciplines, to inject new ideas and ways of working into the sector.

As with any plan, it’s important to start with your end destination, work backwards and check progress throughout your journey. In our experience, this vision is often shaped by a blend of insights and imagination. The same is true as we rethink healthcare in the 2020s. We must seize this opportunity to sustain and enhance our healthcare system as well as ensure our country remains prosperous for H years to come. ■ www.hospitalnews.com

IN BRIEF

Brain surgery for alcohol use disorder O ne year after undergoing brain surgery to battle alcohol use disorder (AUD), the first patient to participate in a ground-breaking North American first trial is speaking out about his experience.

“I hope that sharing my story will help destigmatize the conversation about alcohol use disorder, as well as improve the science and understanding around it,” says Dr. Frank Plummer, a world-renowned researcher, best known for his leadership and work in Kenya during the HIV/AIDS epidemic.

AUD occurs when an individual is unable to control how much alcohol they consume. AUD affects approximately nine per cent of North Americans, according to the National

Epidemiologic Survey on Alcohol and Related Conditions-III. Conventional treatments include detoxification, psychotherapy, and medication. The rate of relapse is 75 per cent.

In December 2018, Dr. Plummer was the inaugural patient in the first trial in North America to investigate deep brain stimulation for treatment-resistant alcohol use disorder (AUD), at Sunnybrook Health Sciences Centre. Frank now reports that he is drinking less and in moderation.

Currently, Sunnybrook is the only centre in the world actively performing DBS for AUD. The study is investigating the safety of DBS for treatment-resistant chronic alcohol dependence.

DBS can be explained as a type of pacemaker for the brain. The neurosurgery involves implanting electrodes

Prescribing anticoagulants in the ED for atrial fibrillation increases long-term use by 30 per cent atients prescribed anticoagulants after a diagnosis of atrial fibrillation in the emergency department are more likely to continue long-term use of medications to treat the condition, according to research published in CMAJ (Canadian Medical Association Journal).

“In this multicentre study in Ontario, Canada, providing an oral anticoagulant prescription in the emergency department to patients with atrial fibrillation who were older than 65 years was associated with a marked increase in long-term use of this therapy,” writes Dr. Clare Atzema, a senior scientist with ICES and the Division of Emergency Medicine, University of Toronto, with coauthors.

More than 33 million people around the world have atrial fibrillation, that is, an irregular heart beat that is associated with a fivefold increased risk of stroke as well as other cardiac issues.

Use of oral anticoagulants can decrease stroke risk by 60 per cent.

Usual practice is to refer patients seen in the emergency department for

P

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atrial fibrillation to primary care or a cardiologist for anticoagulant prescription and follow-up.

In this study performed at 15 centres in Ontario, researchers found that if an oral anticoagulant was prescribed in the emergency department to patients aged 65 years or older who were not at high risk of bleeding, there was a 31 per cent absolute increase in the tendency to fill the prescription at six months, compared with referral to the patient’s physician to consider starting the medication.

“Physicians working in the emergency department should consider initiating oral anticoagulants in similar patients [patients with atrial fibrillation] who are being discharged home, because this action is associated with improved use of stroke prevention long after the patient leaves the emergency department,” the authors recommend.

“Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation” was pubH lished December 9, 2019. ■

to stimulate circuits of the brain where there is abnormal activity. For AUD, researchers are targeting an area of the brain called the nucleus accumbens which plays a role in addiction and managing alcohol cravings, as well as mood and anxiety.

“Despite advances in AUD interventions in the last half century, we have a long way to go in developing direct-to-brain treatments that make a significant impact on outcomes,” says Dr. Nir Lipsman, director of Sunnybrook’s Harquail Centre for Neu-

romodulation. “By directly targeting dysfunctional ‘wiring’ in the brain, the hope is to influence these circuits to a healthier state,” explains Dr. Benjamin Davidson, study co-investigator and surgical resident at Sunnybrook.

“In Frank’s case, we saw significant improvements in mood and alcohol consumption. The nucleus accumbens is not only an addiction-related area of the brain but also involved in mood, anxiety and depression. Helping to relieve symptoms may have helped play H a role in his progress.” ■

Case report describes suspected new type of vaping-related lung injury team of authors from Lawson Health Research Institute and University Health Network (UHN) have released details on Canada’s first published case of suspected vaping-related lung injury. Published in CMAJ, the case study may be the first to describe a new type of injury from vaping products.

The case differs from those described in the recent rise of vaping-related lung injuries called EVALI (e-cigarette or vaping product use associated lung injury), which are characterized by a specific type of damage called alveolar injury. This case instead represents a lung injury that appears similar to “popcorn lung,” a condition seen in microwave popcorn factory workers exposed to the chemical diacetyl.

The condition causes bronchiolitis where the small airways in the lungs become inflamed and damaged.

The authors describe a case of life-threatening bronchiolitis in a 17-year-old Ontario male who initially sought care after a week of persistent cough. He was eventually hospitalized needing life support in the intensive care unit. After ruling out other causes in the previously healthy teen, the authors suspected flavoured e-liquids as the culprit.

The patient had been vaping daily

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using a variety of flavoured cartridges and tetrahydrocannabinol (THC).

The youth narrowly avoided the need for a double lung transplant.

He spent a total of 47 days in hospital and suffered chronic damage to his airways. He is currently recovering from his lengthy intensive care unit stay and is abstaining from e-cigarettes, marijuana and tobacco.

“This case highlights significant harm that could come from vaping.

This risk is particularly specific to teens and young people who are the largest users of these products,” says Dr. Inderdeep Dhaliwal, Respirologist at LHSC. “Now with awareness, we hope this work stimulates further research on the mechanisms and causation of vaping-associated lung injury.”

Earlier this fall, the Middlesex-London Health Unit reported on the youth’s condition as the first case of vaping-related lung injury in Canada as an early warning. This research case study provides detailed medical information on the extent and type of injury, as well as treatment. Emerging reports indicate that e-cigarettes are causing a variety of lung illnesses and injuries. According to a 2017 report, e-cigarettes are the most commonly used nicotine products by Canadian youth with an estimated 272,000 reporting use H within the last 30 days. ■ JANUARY 2020 HOSPITAL NEWS 7

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Maintaining a safe, clean and hygienic environment, and minimizing microbial contamination of surfaces, items and equipment within the healthcare environment are increasingly recognized as an essential approach to reducing the risk of healthcare-associated infections.1,2 Pathogens can spread easily in high-traffic facilities. Cleaning and disinfection of equipment (medical, clinical) are important components of preventing the spread of microorganisms that can cause infections; however, such equipment is often composed of many different materials, each of which may respond differently to disinfectants used in healthcare and fitness facilities. 3 Pathogens such as Clostridium difficile, vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) can persist on surfaces and items for prolonged periods of time, sometimes up to several months.4 Healthcare providers who come in contact with surfaces in the room of a patient colonized with MRSA or VRE have a 42% to 52% risk of subsequent hand or glove contamination with the same organism; this risk is similar to the risk seen following direct contact with the patient. 5,6 After contact with a VRE-contaminated surface, healthcare providers transmit VRE to the next clean surface or skin site they come in contact with approximately 10% of the time.7

Optimize your disinfection strategy.

Studies show that up to 85% of wheelchairs in hospitals are contaminated with pathogens such as MRSA. 8 A newly released Canadian report suggests that antibiotic resistance is expected to have a stark impact over the next three decades, with superbugs estimated to lead to 400,000 deaths, resulting in $120 billion in hospital costs by 2050. 9

The cornerstone of efforts to reduce the risk of transmission of microorganisms from the environment is the cleaning and disinfection of all surfaces, items and equipment in the healthcare setting on a regular and systematic basis.10 In its recent report, Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, the Provincial Infectious Diseases Advisory Committee (PIDAC) suggests the following should be considerations when deciding upon an effective cleaning and disinfection strategy:11

Know your high-risk surfaces.

• Frequency of cleaning

• Surface compatibility

High-touch surfaces and items require more frequent cleaning and disinfection than low-touch surfaces and items, for example, patient beds and surrounding equipment, light switches, blood pressure and ECG carts, nursing stations, call bells, door handles, washrooms, etc.11

• Cleaning method

• Alcohol-free

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• Contact and drying times of cleaning solutions

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Additionally, to prevent the transfer of pathogens from the previous room occupant to a new patient, the room or bed space must be cleaned and disinfected thoroughly.11 Only about 50% of surfaces in hospital operating or patient rooms are effectively disinfected.12

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1. Dancer SJ. Eur J Clin Microbiol Infect Dis 2011;30(12):1473-81. 2. Weber DJ, Rutala WA. Infect Control Hosp Epidemiol 2013;34(5):449-52. 3. Lankford MG, et al . Limiting the spread of infection in the health care environment. Assessment of materials commonly utilized in healthcare: Implications for bacterial survival and transmission. Concord, CA: Coalition for Health Environments Research (CHER) and The Center for Health Design; 2007. http://www.healthdesign.org/sites/default/files/limiting_the_spread_of_infection.pdf. Accessed November 20, 2019. 4. Kramer A, et al . BMC Infect Dis 2006;6:130. 5. Hayden MK, et al . Infect Control Hosp Epidemiol 2008;29(2):149-54. 6. Boyce JM, et al . Infect Control Hosp Epidemiol 1997;18(9):622-7.

7. Duckro AN, et al . Arch Intern Med 2005;165(3):302-7. 8. Hakuno H, et al . J Hosp Admin 2013;2(2):55-60. 9. Council of Canadian Academies, 2019. When antibiotics fail. Ottawa (ON): The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada, Council of Canadian Academies. 10. Donskey CJ. Am J Infect Control 2013;41(5 Suppl):S12-9.

11. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings, 3 rd edition. Toronto, ON: Queen’s Printer for Ontario; 2018. 12. Bhalla A, et al . Infect Control Hosp Epidemiol 2004;25(2):164-7.

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COVER

Workplace violence: What we’ve learned

By Henrietta Van hulle n emergency room nurse is attacked by a patient.

She is punched, kicked and threatened. On top of her physical ailments, she suffers longterm effects from depression, panic attacks and stress. She questions her future in nursing.

By now, regrettably, it’s a familiar story.

Workplace violence continues to be one of the most pressing concerns facing health care workers, patients, residents and clients across our health care sector. In 2017, health care received 18 per cent of total lost-time injury claims in Canada, more than any other industry (AWCBC, 2017).

In Ontario alone, violent-related incidents made up 10 per cent of all losttime injury claims in hospitals in 2015, costing these institutions over $23 million that same year (Ontario Ministry of Labour, 2015). Workplace violence is a serious concern leading to physical, psychological, interpersonal and financial harms for health care workers (Brophy et al., 2018).

There’s no question that attitudes toward workplace violence are shifting. As associations and unions roll out public awareness campaigns, health care workers are becoming less willing to tolerate violence as just “part of the job” and are raising more concerns about safety. The issue has prompted governments and health care organizations across the country to make prevention a priority.

Between 2015 and 2017, Public Services Health & Safety Association (PSHSA) developed a series of free tools and resources in partnership with stakeholders across health care and labour to support health care workplaces in reducing and preventing the risk of workplace violence. The Violence, Aggression and Responsive Be-

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AS ASSOCIATIONS AND UNIONS ROLL OUT PUBLIC AWARENESS CAMPAIGNS, HEALTH CARE WORKERS ARE BECOMING LESS WILLING TO TOLERATE VIOLENCE AS JUST “PART OF THE JOB” AND ARE RAISING MORE CONCERNS ABOUT SAFETY.

haviours (VARB) toolkits focused on: Workplace Violence Risk Assessment, Individual Client Risk Assessment, Risk Communication (Flagging), Security and Personal Safety Response System. These first five toolkits were

designed for use in hospitals, longterm care, community care and emergency medical services to protect those workers who are most at risk of workplace violence, including nurses, nurses’ aids and orderlies, other allied

health care staff, community and social service workers, and visiting home care workers.

An evidence-based evaluation was recently completed to better understand the VARB toolkits’ awareness,

Henrietta Van hulle is the Vice President of Client Outreach at Public Services Health & Safety Association, and holds a Masters of Health Services Management. www.pshsa.ca 10 HOSPITAL NEWS JANUARY 2020

www.hospitalnews.com

COVER impact and effectiveness on workplace violence prevention and controls, and to identify lessons learned about toolkit design and use. The evaluation findings were based on an inventory of toolkit use at all Ontario hospitals, in-depth case studies at six hospitals, and interviews with a small number of hospitals that were not using, or not sure if they would use, the toolkits. The results are compelling, and provide further insight into how we can begin to affect positive change when it comes to addressing such a pervasive, systemic issue.

The evaluation revealed promising uptake and awareness rates. The study found that 75 per cent of Ontario public hospitals are aware of at least one of the VARB toolkits, and that 67 per cent of Ontario public hospitals are using at least one of the VARB toolkits within their organization. The toolkits have also been accessed and used beyond Ontario, by health care organizations in other provinces and in the United States.

The reasons driving health care organizations to implement the toolkits largely revolved around two major themes: concerns over mounting incidents and enforcement events. “Our organization decided to apply these tools as we saw our incidents of violence on the rise and we wanted to have a better grasp on what our gaps were so that we could reduce these incidents in frequency and severity,” as one regional hospital explains. “The Ministry of Labour had also made this a priority focus. They performed several inspections using PSHSA’s tools. Using these tools helped us to be well-prepared for these visits and allowed us to have a better organized plan, response and documented strategy to reduce violence in the workplace.”

Further to uptake and awareness, the study also found that the toolkits had a positive impact on how hospitals prevent and manage workplace violence.

89 per cent of hospitals reported that use of the toolkits ended up improving their processes, programs and systems to prevent and manage workplace violence. Hospitals used the VARB toolkits to identify and address safety risks, consider safety proactively in planning (i.e. new builds, units or programs), and validate or improve existing prac-

tices. The in-depth case studies provided more insight into how organizations were implementing the toolkits along with some initial impacts.

A regional hospital uses the Workplace Violence Risk Assessment in every department at least once a year.

“It helps us to identify risk and develop an action plan. The categories were helpful in educating our staff on risk of violence and things to look for, as well as potential solutions. These have been helpful in putting recommendations forward for change and we have seen several positive changes as a result of using these risk assessments.”

A large community hospital recognized that its existing patient alert code system was not helpful for communicating the risk of violence on a day-to-day basis. They used the Risk Communication toolkit to refine the system and add alert codes which were much more effective in communicating real-time risk.

A teaching hospital was preparing to establish a new program within a different hospital site. Before the site opened, they used the Workplace Violence Risk Assessment so that appropriate controls could be implemented ahead of time.

A specialized mental health hospital used the toolkits as a best practice reference for assessing the comprehensive mechanisms they already had in place to ensure a safe environment, including policies, risk assessment processes, security and risk communication programs, and personal safety response systems. This helped to identify some improvement opportunities to their existing practices.

A small hospital carried out a Workplace Violence Risk Assessment of all departments which delivered an action plan. As a result, the hospital has implemented a new communication system, introduced a new system for tracking staff training and launched an awareness campaign.

Several organizations within the health system across Canada are putting out toolkits and guidelines each year, but few have achieved the kind of uptake and impact as the VARB toolkits. The evaluation credited this strong uptake to the high quality of the toolkits and the endorsement from the Ontario Ministry of Labour.

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JANUARY 2020 HOSPITAL NEWS 11

NEWS

Finding solutions to workplace violence

By Michael Rosenberg and Jana Bartley nn’ is an emergency room nurse at a busy downtown hospital. She is approximately 5 feet 1 inch tall and weighs somewhere around 120 pounds. She was working the overnight shift when a homeless patient came in. This patient was former military and suffered from PTSD and drug abuse. He was approximately 6’2” inches and weighed over 230 pounds.

As Ann took this patient into the examination room and closed the door, he went into relapse. He grabbed Ann, lifted her up and ripped off her blouse.

She kept hitting the panic button in the room but it either did not work or there was no immediate response. Ann then kicked him in the genitalia and ran out of room yelling. The police, who were fortunately at the hospital at that moment, were able to subdue and restrain the patient. When I asked Ann about reporting the incident, she told me “I never reported it.” I asked her why and she told me, “I was at the end of a 12 hour shift. I was physically exhausted, probably suffering from shock myself and all I wanted to do is go home. I really did not want to spend 30 minutes logging into the hospital system to go through the paperwork and file an incident report. My next shift was a week later and by that time, I just moved on.”

Stories like this are far too common.

According to a study by the Institute of Work and Health across six hospitals in Ontario, between 37.5 and 72.7 per cent of all physical assaults are NOT reported.

We see it in healthcare every day.

Workplace violence and harassment have become so pervasive that there is a feeling of helplessness. ‘What can we do about it?’ people sigh. ‘What is

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ACCORDING TO A STUDY BY THE INSTITUTE OF WORK AND HEALTH ACROSS SIX HOSPITALS IN ONTARIO, BETWEEN 37.5 AND 72.7 PER CENT OF ALL PHYSICAL ASSAULTS ARE NOT REPORTED. the point of reporting it? Nothing ever gets done.’ another person comments.

The ramifications of this go beyond the hospital. Incidents of workplace violence that hospitals report to the government significantly underestimate the problem. Without accurate information, the problem will not be fully understood nor resolved and the resources necessary to address the problem will not be sufficiently provided by either the government or the hospitals themselves.

WHY PEOPLE DO NOT REPORT INCIDENCES OF WORKPLACE VIOLENCE Studies have found three major reasons that people do not want to report workplace violence. They are: 1. It is too onerous to report Most reporting systems are on internal hospital servers and have to be accessed through logging in onsite.

They are inaccessible off site, unless the person is allowed to access the system through a Virtual Private Network (VPN). Most hospital personnel, however, do not have permission for this type of access, so they have to stay late on their hospital workstations to submit an incident report.

2. Nothing is done about it anyway Neither follow-up nor communication is provided by management about what has happened in the incident

report. Even when action has been taken or an investigation completed, the person who initiated the incident report usually has no idea if anything has happened to the incident or why.

3. There is a belief that the issue is too insignificant The only thing the people feel is worth the time and effort to report are major incidents. An example of a minor incident is the lights in the parking garage. A person goes to their car after the end of a long shift and notices that the light is out in the garage. Although they may feel uncomfortable about the light, they really do not want to drop everything, go back to their work station and put in a report. Instead they go to their car and go home. A period of time passes and nobody reports the light being out in the garage because it is too minor and too inconvenient.

One day somebody is assaulted in the garage because it has become unsafe and a minor issue has become a major crisis. It is important to encourage people to report all potential health and safety concerns, even ones that appear minor.

THE SOLUTION The solution can be broken down into 3 components: 1. Encourage reporting When in doubt – report! Should be your new motto. Even though you need clear standards on what to

report, encourage people to report even minor incidents. The reporting system should also allow for incidents to be categorized by importance.

2. Use validated risk assessments Validated risk assessments can be used as a snapshot in time to identify potential risks that can lead to workplace violence and health and safety issues. Using validated risk assessments allows you to be preventative instead of just reactive to health and safety issues, such as workplace violence.

3. Use easily accessible incident reporting technology with tracking Use incident reporting systems that can be accessed through any electronic device, such as smart phones, tablets or personal computers/laptops. As the research indicates, people do not want to stay late at the end of a long shift to put in an onerous incident report. By allowing them to access it through their own personal electronic devices, they can submit an incident report when they get home and are able to relax. The technology should also feature the ability to track the incident report they have put in. Then, employees can see its progression through the system and know that their concerns are being addressed and taken seriously.

THE DATA TELLS A STORY Combining risk assessments with real time incident reporting creates data. This data allows the hospital to know how safe they really are. It also provides them with the tools that they need not just to respond to health and safety concerns, but to H prevent them as well. ■

Michael Rosenberg, MBA, is the President of WPV Corp., a company that specializes in technology solutions to workplace violence issues. Jana Bartley, RN, MBA, LNC has been a registered nurse for over 25 years and is the President of Integrity Healthcare Consultants.

12 HOSPITAL NEWS JANUARY 2020

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NEWS

Workplace violence Continued from page 11 Key factors contributing to the effectiveness of the toolkits were their credibility, comprehensiveness, flexibility, ease of use and the collaborative stakeholder engagement approach that was employed when designing the toolkits.

In terms of whether toolkit implementation has resulted in an overall reduction in incidents, we know this will take more time to validate. However, some participating health care organizations are already seeing positive shifts in this direction. “While some violent incidents continue, such as patients with cognitive disruptions acting out on staff – it is the nature of the condition of the patient and there are some risk factors we are unable to eliminate – we have been able to reduce our risk levels by better preparing our staff to watch out for and address these aggressive behaviours, such as with training,

patient flagging and alerts,� explains a Director from one of the case study sites. “So, although the frequency of violent attempts or incidents has not decreased as of yet, we have seen the severity of violent incidents reduced.�

The evaluation results will be used to optimize and improve the current five VARB toolkits and related processes, as well as inform future resource development as it relates to workplace violence prevention in health care and beyond. Throughout the evaluation process, emerging findings were shared with PSHSA, who has already begun work improving the current toolkits.

These insights will also inform the development of the next four VARB toolkits, set to be released in early 2020.

Overall, the VARB project serves as an example of a successful approach with leaders coming together from

across the system to address a systemic issue. While the positive results are certainly encouraging, there is still work to be done. This is especially true given that reported incidents are expected to spike in the immediate future as awareness around the issue increases and health care workers are further encouraged to report.

There is no doubt that resolving this issue requires a multi-faceted approach. As these early results demonstrate, continued partnership and collaboration among system stakeholders, including government, labour unions, professional associations, patient advocates, and representatives from community, home and hospital settings is integral. We will also need to continue advancing public awareness of the issue of workplace violence in health care, and encourage adoption and continued use of available and validated

prevention resources and supports, such as the VARB toolkits. Another priority will be extending this work and support outside hospitals to the long term care and community and home care sectors who also struggle to assess and control the risk of violence within their organizations.

Our health care system’s greatest asset are the committed, skilled and compassionate individuals that dedicate their careers to the care of others.

Let’s attain a future where violent incidents aren’t status quo, and shift the culture so that our health care workers come to expect protection, safety and security in the workplace.

Together, we can change the story for the emergency room nurse.

You can access the full evaluation report and case study summary, along with the VARB toolkits and additional reH sources at www.workplace-violence.ca. â–

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NEWS

Telehealth for a new reality

By Dr. Sandy Buchman few weeks ago, the Centre hospitalier de l’Université de Montréal (CHUM) held interesting discussions on health innovation. The objective: to reinvent health with artificial intelligence, therapeutic innovation, 3D printing and telehealth. A whirlwind of innovation surrounds us and a revolution is knocking at the door of our health system. However, an important question arises: What added value do these technological innovations bring to patients?

An Ipsos survey conducted on behalf of the Canadian Medical Association (CMA) last summer provides some very interesting answers. According to the survey, more and more Canadians are welcoming the advent of technology to facilitate access to a health care system that is struggling to fulfill its mandate. Nearly seven in 10 respondents would like to have virtual consultations with doctors and two in three believe that virtual health consultations would lead to faster care.

However, as physicians, we still have a long way to go to meet the expectations of users of the health care system. According to a national survey of physicians in 2019, less than one in five physicians use an interface to transmit prescriptions to pharmacies, one of the most fundamental tasks in medicine.

And although the public is increasingly interested in the opportunities that artificial intelligence may offer within the next 10 years, only 1.3 per cent of physicians say they have incorporated artificial intelligence into their practice at this time. If we add to this the omnipresence of fax machines – the venerable fax – in doctors’ offices and health care facilities, the technological gap seems immense.

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ACCORDING TO A NATIONAL SURVEY OF PHYSICIANS IN 2019, LESS THAN ONE IN FIVE PHYSICIANS USE AN INTERFACE TO TRANSMIT PRESCRIPTIONS TO PHARMACIES, ONE OF THE MOST FUNDAMENTAL TASKS IN MEDICINE. BREAKING POINT IN SIGHT The health system is unique. In a world where the GAFA (Google, Amazon, Facebook, Apple) offers services that the user can evaluate and even improve, the health system does not provide such an attractive online experience. And because they are so connected, the members of the Google generation are major consumers of health care. They visit a doctor on average 11 times a year, which represents more visits than the average for seniors. We will soon reach a breaking point, with the health care system offering no more than its traditional level of access to care to connected patients who want to see their

doctor more often, in the midst of an aging population with an increasing life expectancy.

For too long, transformation of health systems has been largely achieved through technological and organizational transformation. We must not forget to strike a balance in the management of these transformations so that the patient is at the heart of the value proposition.

Technology is a solution, but it is imperative to incorporate the human element and make it a core consideration in any plans for change. Since the time of Hippocrates, the patient– physician relationship has been the cornerstone of the medical profession, and as physicians we must do everything in our power to ensure that com-

passion and listening remain in that relationship. In-person consultation will always have its place and nothing can completely replace it, not even a conversation on FaceTime.

When it comes to virtual care Canada is lagging behind many other countries in its adoption. To look at what’s standing in the way, the CMA joined forces with the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada in March 2019 as part of a new task force.

The group’s mandate will be to identify the regulatory and administrative changes needed to support virtual care in Canada, and to allow physicians to deliver care to patients within and across provincial/territorial boundaries.

The task force will also include members of the eHealth industry and other major Canadian medical and health care associations. The task force is expected to complete its work by the end of 2019, and to have a set of recommendations ready to present to stakeholders in early 2020.

We understand that everyone needs to be included in this endeavour for changes to be lasting and impactful.

The Virtual Care Task Force also created four working groups to examine how payment models, licensure and quality standards, interoperability and governance, and medical education will need to be adapted to support virtual care in Canada. As well, the task force is integrating the patient perspective, with a patient advocate member, and at least one patient representative on each working group.

In the coming months and years, many changes will occur in the health system. It will be essential to define the new value proposition not for the paH tient, but with the patient. ■

Dr. Sandy Buchman is President of the Canadian Medical Association and an associate professor in the Department of Family and Community Medicine at the University of Toronto and provides home-based palliative and end-of-life care through the Temmy Latner Centre for Palliative Care, Sinai Health System, in Toronto. He also practises palliative care with the Palliative Education and Care for the Homeless (PEACH) program under the auspices of Inner City Health Associates and St. Michael’s Hospital in Toronto.

14 HOSPITAL NEWS JANUARY 2020

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NEWS

Caring for each other:

The Peer Support Program

nterprofessional staff working in the emergency department (ED) are exposed to repetitive traumatic adverse events throughout their careers, resulting in decreased physical and mental health of the provider.

Critical Incident is the term used to refer to the particular circumstance that can result in feelings of distress such as tension, anxiety or pressure (Wuthnow et al., 2016). Stress, burnout, compassion fatigue and Post Traumatic Stress Disorder are often manifested by increased sick days, reduced job performance and job satisfaction, greater staff turnover, and lower quality of patient care (Lavoie et al., 2011).

Peer support describes a relationship between people who have a common lived experience. Types of peer support fall along a spectrum ranging from informal support to formal peer support within a structured organizational setting. Informal peer support occurs when colleagues who notice the similarity of their lived experience, listen to and support each other.

Peer support within a clinical setting can involve programs where peer support workers offer opportunity for a supportive, empowering relationship (Mental Health of Canada, 2012).

Talking with colleagues about a critical incident has been identified as an important coping mechanism, as it helps alleviate self doubt and isolation features common after exposure to an adverse event (Chan et al., 2016).

Trillium Health Partners Credit Valley Hospital is an urban community hospital that has a visit volume of 100000+ annually. In 2017 it was realized that there were challenges to facilitate staff attendance to critical incident debriefings, particularly on night shift and on weekends. When debriefs were offered, they were poorly attended, and there was limited follow up for staff after the debriefing. Senior Nursing Staff, Nursing Leadership,

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Jackie Rodricks, unit manager and Barb McGovern interim Clinical educator, emergency department at Trillium Health Partners.

PEER SUPPORT DESCRIBES A RELATIONSHIP BETWEEN PEOPLE WHO HAVE A COMMON LIVED EXPERIENCE. TYPES OF PEER SUPPORT FALL ALONG A SPECTRUM RANGING FROM INFORMAL SUPPORT TO FORMAL PEER SUPPORT WITHIN A STRUCTURED ORGANIZATIONAL SETTING. and the ED Physician group had realized that challenges existed in which strategies were available to support the psychological health of emergency department staff after a Critical Incident.

Nursing Champions approached leadership with a mandate to create a Peer Support Group. Manager Janet Cadigan, Clinical Leader Jackie Rodricks, and Interprofessional ED team members came together, to create the ED Peer Support Group as researched and described in the literature. Technology was utilized to create a WhatsApp™ group connecting all peer support members. A distribution group was created using Trillium Health Partners email to allow for no-

tification and communication among peer support members. Staff were consulted and given an opportunity to ‘opt out’ of the distribution list. No ‘opt out ‘ requests were received, indicating that the program was a priority for staff.

The process to initiate Peer Support is as follows. Every shift the charge nurse (CN), completes a shift report that includes the question, “Is peer support required?” If yes, the names of the team members involved are noted. The event that triggers a critical incident can vary from person to person, therefore peer support is initiated anytime staff indicate that they would like follow up, as well as for significant adverse events. The man-

ager and clinical leader receive the CN report and initiate the fan out on WhatsApp™, notifying the peer support team that an event has occurred and peer support is required. Peer support members then refer to their corporate email for details of the event, and communicate via WhatsApp™ to identify which member is contacting which staff person involved in the incident. If allied health are involved in the incident, they are contacted as well. Initial contact can be via phone call or text utilizing staff fan out lists within 24 hours of the event. A second follow up contact is initiated at the 72 hour mark. The Peer Support Group does not provide counseling.

Rather, they provide an opportunity to talk and check in. If the staff member requires more assistance, the peer support member immediately contacts the manager, and the manager reaches out to the staff member directly.

The Peer support program has been initiated at least monthly since it began, and on occasion several times a month to respond to critical incidents experienced in the emergency department by staff. Feedback from staff who have received a contact from the Peer Support Group has been positive. A brief survey was given to 30 staff members who had received a Peer Support contact after a critical incident. All 30 agreed or strongly agreed to the following questions: “I feel it was helpful having a peer connect with me after a critical incident,” and “I feel like the peer support team cared about me and was willing to listen to my feelings.”

Peer Support has now become part of our ED culture. It is introduced in our departmental orientation of new staff. Peer support does not replace formal debriefing or Employee Assistance Plan (EAP), but has been a successful addition that has heightened the awareness of acute and cumulative stress putting in place a safeguard of care for ourselves, each other, and H our ED family. ■

This article was submitted by the emergency department team at Trillium Health Partners.

16 HOSPITAL NEWS JANUARY 2020

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18TH ANNUAL

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JANUARY 2020 HOSPITAL NEWS 17

PROFESSIONAL DEVELOPMENT AND EDUCATION

De-escalation training stops violent behaviour before it starts

By Michael Oreskovich iolent behaviour needs to be carefully managed in a healthcare setting. It poses a danger to patients, families and staff and interferes with care delivery. Runnymede Healthcare Centre has addressed this issue with hospital-wide violence de-escalation training. By recognizing when people are at risk of aggressive behaviour and understanding its root causes, the hospital’s staff are empowered with strategies to safely resolve potentially dangerous situations.

During a hospital stay, stress, anxiety and certain medical conditions may trigger some patients and visitors to use physical force or make threats against others. In 2005, more than one-third of Ontario’s nurses

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reported being physically assaulted by a patient over the year, according to the Workplace Safety and Insurance Board. Healthcare workers have the second-highest rate of lost time due to injury from workplace violence among all labour sectors in the province.

“A safe and respectful environment is fundamental to the delivery of quality healthcare, and we have zero tolerance for violence at Runnymede,” says Catherine Fitzpatrick, Runnymede’s Director of Flow, Quality, Pharmacy and Privacy. “Although measures were already in place to protect patients, families and staff, our hospital was committed to identifying proactive approaches to workplace violence prevention.”

Hospital-wide violence de-escalation training was launched at Run-

Organizational Programs to Improve Patient Safety Improvement to hospital culture can substantially improve patient safety.

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Through violence de-escalation training, Runnymede Healthcare Centre empowers staffto safely resolve potential conflicts before they escalate. nymede in May, 2019. The aim was to provide staff with knowledge and techniques to safely resolve potential conflicts before they escalate. The training also helps staff recognize and address warning signs from people who are at risk of violent behaviour. These include non-verbal cues like pacing, and verbal cues like changes in tone of voice.

A key de-escalation technique taught to staff is rational detachment.

“This helps staff control how they react to others’ aggressive behaviour and stay calm,” says Halima Arush, health & safety specialist at Runnymede. Key to the practice of rational detachment is understanding that hostility from others should not be taken personally.

According to Arush, “this keeps staff members’ response to an aggressive person measured, and helps them focus on resolving the situation in a rational way.”

Staff are also trained to raise their awareness to what are known as precipitating factors, stressors in a person’s life that can trigger violent behavior. Recognizing these factors and being empathetic are key to improve communication with a patient or vis-

itor before they become aggressive.

“It helps the person feel understood and that their concerns are validated, so they’ll be more likely to cooperate with staff in a productive way,” Arush says.

Runnymede’s training consisted of an online learning module followed by an in-person workshop. Facilitated by a violence de-escalation expert, the in-person workshops provided staff with an opportunity to role-play their responses to potentially violent scenarios. This includes using a collaborative, team-based approach to resolving tense situations.

According to Raj Sewda, Runnymede’s VP, Clinical Operations & Quality, Chief Nursing Executive & Chief Privacy Officer, there are many benefits to rolling out violence de-escalation training. “It ensures our hospital continues to provide safe, high-quality care by proactively reducing the risk of harm to patients, family members or our staff,” he says.

“The training also refines our staff’s ability to be empathetic to their needs – another example of how Runnymede puts patients and families at the centre H of their care experience.” ■

Michael Oreskovich is a communications specialist at Runnymede Healthcare Centre. www.hospitalnews.com

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Translational simulation connects learnings to patient outcomes

By Emily Dawson uch like the aviation industry uses flight simulators to train pilots, health care professionals introduced simulation techniques to learn first-hand how to care for patients and respond to critical situations in a controlled, safe environment.

Health care simulation has significantly evolved over the last decade. In addition to the essential role it plays in teaching and learning, there’s an equally important role in research, quality improvement and patient safety initiatives, and space and policy design – and every simulation is designed to positively impact patient care in some way.

Dr. Andrew Petrosoniak is an emergency physician and trauma team

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leader at St. Michael’s Hospital as well as the clinical integration and translational simulation lead for Unity Health Toronto. We caught up with Dr. Petrosoniak and Kristen Daly, a simulation educator, to discuss the opportunities to transform how we think about and leverage health care simulation.

There have been rapid advancements in the role of health care simulation. Can you explain how this shift is changing how we approach simulation design?

AP: Traditionally, simulation was about making teams and people better, more confident, and more adept in their practice. We now realize that health care is more than simply having a good team; it’s about working in an incredibly complex environment.

Kristen Daly is a simulation educator at Unity Health.

In-situ simulation enables us to recreate events in the actual space where people work. It’s become a testing ground for latent safety threats, things that lie beneath the surface that might not manifest themselves on a daily basis but that, under certain circumstances, impact how we deliver care.

More recently, we’ve seen a shift to focus on translational simulation, which is a relatively new field. It’s less about the space where you’re doing the simulation, and more about the direct links between simulation and patient outcomes or system priorities. It’s essentially about translating learnings from the sim environment to actual patient care.

Can you give us an example of translational sim in practice?

AP: We supported a usability testing simulation for a new institutional Heparin protocol with our hematology department. Heparin is a blood thinner used to treat clotting, and while it’s commonly used, it’s finicky and requires constant patient monitoring, which was identified as a quality improvement opportunity at St. Michael’s.

Part of the issue is that it’s a computer-based protocol and algorithm within our electronic medical records.

The team had designed a new proto-

20 HOSPITAL NEWS JANUARY 2020

col to overcome some identified issues so we ran some usability testing simulations with medical residents and nurses – the actual “end-users.” This is critical, since sometimes the changes we make during a committee meeting don’t work for the users in the clinical space.

In this case, we used computer workstations in a boardroom to run the teams through different case scenarios.

We used techniques like “think aloud” where users tell us what they’re doing, where they’re looking on the screens and when they can’t find items they need. We directly observe how they use the protocol and quickly determine if any deficiencies exist. Most importantly, these sessions informed further changes to the protocol before any patient care began. So here, we applied simulation as a technique to ensure the best possible protocol.

It’s all about how to make systems and care better, no matter where the simulation happens.

How does translational sim lead to better patient outcomes?

KD: Where Dr. Petrosoniak really shines is in how he captures and evaluates the data and learnings that arise from simulations. Back to the Heparin protocol, Dr. Petrosoniak followed up with their committee several times to check on how the feedback we gathered was translating into protocol changes. Our goal is to demonstrate, with data and evidence, how the simulation contributed to a successful implementation of the protocol.

AP: Our simulation educators work closely with the team to design the simulation exercises, ensure objectives line up and build case scenarios. My role is to provide ideas for measuring outcomes, how we’ll initiate the feedback loop, how we can think about change management strategies and how we can link the simulation directly to patient outcomes.

What’s important for clinicians interested in simulation to know? www.hospitalnews.com

AP: People think of simulation as “the answer” but we like to think about it as a tool or a strategy. Sim is one tool to help you meet the stated objectives. And what type of simulation you might use will vary depending on the objectives.

KD: I also want to point out how valuable it is for the simulation educators to have the physician lens that Dr. Petrosoniak brings.

We worked on another simulation that looked at how issues are escalated in clinical settings from front-line nurses to physicians on-call. One of the biggest successes was the opportunity to have stakeholders from Quality as well as staff physicians, residents, and nurses in the same room discussing the challenges they face on a daily basis.

We created a psychologically safe environment in this sim where frontline staff were able to openly share feedback and it was incredibly powerful. The simulation had nothing to with individual staff performances in the exercises, but everything to do

Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital as well as the clinical integration and translational simulation lead for Unity Health Toronto. with answering the question of “does this new protocol give you the tools and empowerment you need to care for patients?”

Do you have any final thoughts to share?

AP: More and more, we’re using simulation when designing new spaces.

We watch how people work and then use it to test design prototypes before going live. Every day, we design new facilities and eventually, one patient

– someone’s family member – is the first person in that space. No patient should ever be the first “test case” for a new space, just like we would never drive a car that hasn’t been crash H tested. ■

Emily Dawson is a Senior Communications Advisor at Unity Health Toronto.

www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 21

Inspiring future nurses

By Victoria Alarcon

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ical instructors ensure they can apply what they’ve learned.

INSPIRATION IN AN ACADEMIC SETTING For palliative care RN Mahoganie Hines, advocacy has always been a passion. During her 20s, she was a caregiver and personal support worker for a father who was dying and needed an advocate to encourage his family to support and care for him near the end of his life. She also helped a mother who lived alone, struggled with vascular dementia, and needed help on a daily basis. Seeing these vulnerable clients made Hines want to speak out: “The reality is that many of them are so…exhausted. I think it is our responsibility…to advocate for people in a meaningful and purposeful way.”

her first-year nursing professor Elizabeth Edwards in 2012.

Edwards began teaching as a clinical nurse educator in the 1980s. She moved to Loyalist College in Belleville in 2001, when a full-time teaching position opened up in its new nursing collaborative degree program. “In the midst of giving the best care you can, nurses tend to lose the idealism of what brought them into nursing in the first place,” she says. By teaching undergrad students, I thought “… maybe I can communicate that idealism to them in a way that will make them hold onto it when the work gets very tough.”

As an academic instructor, Edwards works hard to teach students to be curious and enjoy learning. She also makes them aware of their responsibility to speak out for nursing and speak

IN THE MIDST OF GIVING THE BEST CARE YOU CAN, NURSES TEND TO LOSE THE IDEALISM OF WHAT BROUGHT THEM INTO NURSING IN THE FIRST PLACE Hines always knew she wanted to work in palliative care. She also wanted to become a political advocate. She just didn’t know how to combine them. That is, until she met

out for the health of their patients, and all citizens of the province. “That’s part of what a nurse does,” she says.

It’s a lesson she learned from one of her nursing professors.

Continued on page 24 www.hospitalnews.com

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Inspiring future nurses Continued from page 22 And it was part of the reason she joined RNAO when she graduated in 1975. Years later, Edwards became a member of RNAO’s Provincial Nurse Educators Interest Group (PNEIG). In fact, she co-chaired the group between 2011 and 2016, and became the chair again this year.

When Edwards met Hines in 2012, she could see a student with an outgoing personality who wanted to learn and understand what it took to be an advocate. “The word ‘no’ or ‘you can’t do that’ was not in her vocabulary or her world view,” says Edwards.

Thanks to Edwards, Hines learned how nurses can be change agents by staying informed about government policies and getting involved in events outside of school. Edwards says she always introduces RNAO to her students, and tells them about opportunities to advocate for healthy public policy.

As an active nursing student associate, Hines attended chapter and polit-

ical events. Her favourite was Queen’s Park Day, where she joined fellow members to sit down and speak with MPPs in her region. “It helped me understand policy development and how to interact with politicians in a professional manner,” she says.

Hines graduated in 2016 with her bachelor’s degree in nursing. She now works as a palliative pain and symptom management consultant at Hospice Niagara, and is the policy and political action executive network officer for RNAO’s Niagara Chapter and its Palliative Care Nurses Interest Group.

She looks back with a lot of gratitude to Edwards for being her mentor and introducing her to RNAO: “There are no…words for the influence and impact she’s had to my nursing practice.”

INSPIRATION IN A CLINICAL SETTING As a first-year nursing student at Western University in 2017, Alanna Peplinski learned everything from

human anatomy to health promotion.

She completed her first-year exams and did well in all her classes, but still had a lot of doubt and fear about working with patients. “I was afraid to make mistakes,” she admits. Hoping to overcome her fears, Peplinski reached out to certified diabetes educator (CDE) Andrea Zides, a CDE for nine years and a nurse educator for 14.

Zides didn’t begin her career as a teacher. She started in the emergency department at a Buffalo hospital in 1996, commuting from Niagara until she left for an extended maternity leave in 1997. Three years later, Zides went in search of opportunities that would give her time with her kids during the day. She became a night school teacher for Niagara College in 2000. The job opened her eyes to how gratifying teaching could be, and the students she could help.

“They were enriched with…drive and passion, and they were trying to better themselves,” she says of her

students. Zides returned to frontline emergency nursing in 2003, and didn’t go back to teaching until 2007, when she started as a diabetes nurse educator for the Niagara Diabetes Centre.

She taught patients about food, nutrition and exercise, and also did oneon-one counseling. Two years later, she opened her own diabetes education centre in Welland. She became certified in 2010, and began mentoring nursing students. “Some teachers along my path made an enormous difference in my life, and I knew that I wanted to give back,” she says.

When Peplinski reached out and asked to shadow her over the summer, Zides was excited. Peplinski remembers one of the first lessons: you don’t need to know everything right away, and making mistakes is part of the learning process. “(She was) really encouraging,” Peplinski says.

The pair was together throughout Zides’ daily routine, and, from time

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Trauma training program for The Canadian Forces

By Carrie Stefanson to time, Zides would give Peplinski opportunities to interview patients on her own, and take vitals. During a lunch break one day, Peplinski admitted she had never given an injection to a patient. Zides took a plum from the fridge, grabbed a needle with saline, and demonstrated different techniques. “(I was feeling) a little bit nervous, but overall, I was excited,” Peplinski recalls.

Throughout the mentorship, Zides encouraged Peplinski to join RNAO to take advantage of a community that would always be willing to help her.

Peplinski took her advice. “She really enforced the impact RNAO has on nurses and being part of a community,” H she says. ■ Victoria Alarcon is communications specialist/co-ordinator for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published on RNJ.RNAO.ca.

anada doesn’t have military hospitals, so it’s important for military doctors to see injuries typical of the battlefield. The Canadian Forces Trauma training program began about 20 years ago, and is instrumental in keeping Canada’s military medical personnel trained in advanced trauma care so they can deploy when needed.

Dr. Philip Dawe heads up Canadian Forces Trauma Training Centre West in Vancouver. He’s a trauma and acute care surgeon at Vancouver General Hospital, who comes from a long military family. His father and three brothers served in the Canadian Forces and his youngest brother Matthew, died in a roadside bombing in 2007. “If I could save one military persons’ life overseas, then my career will be worthwhile,” says Dr. Dawe. “Preventable deaths occur in deployment and if I could prevent one of those it would be a good day.”

C

Dr. Philip Dawe Dr. Dawe is the third military surgeon to head up Canadian Forces Trauma Training Centre West. The centre’s mandate is to facilitate trauma training for Canadian Forces physicians, physician assistants, and nursing officers. Many of Canada’s military medical personnel have trained at centres in Vancouver and Montreal prior to their deployments.

“As care for the wounded continues to gain more importance in both public opinion and policy, the mutual benefits of a robust civilian-military relationship have become increasingly evident,” says Dr. Dawe. “On one hand, lessons learned from our overseas experiences are being delivered to our colleagues at home to enhance patient outcomes. On the other, our colleagues at home have helped us to get ready for those deployments by affording us cross-training and refresher opportunities to ensure we’re providing best-possible care to our troops in our limited-resource deployed environments.”

Dr. Ross Brown, trauma physician at Lions Gate Hospital in North Vancouver, was the first embedded military trauma surgeon in Canada and is credited with establishing the program in Vancouver. “It’s a win-win for the health authority to have this additional expertise, as well as the health care professionals who are continuously H learning new skills.” ■

Carrie Stefanson works in communications at Vancouver Coastal Health.

Are You Meeting Accreditation Canada Requirements For Physician Training And Education Related To Blood And Blood Products?

Introducing Bloody Easy Lite developed by the Ontario Regional Blood Coordinating Network (ORBCoN) An eLearning program providing practical information for physicians and healthcare professionals who prescribe blood and blood products. The program offers an assessment and an optional learner tracking mechanism to assist healthcare facilities in providing transfusion medicine education for healthcare professionals involved in transfusion medicine.

Also available in SCORM compliant files for hospitals with Learning Management Systems (LMS).

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JANUARY 2020 HOSPITAL NEWS 25

PROFESSIONAL DEVELOPMENT AND EDUCATION

A unique model for training and care

By Sarah Quadri aylor McMonagle has hope – and happiness – for the future. As a young, single mother to twin boys, almost four years old, she’s found a home in health and a true passion, caring for other people.

But her journey to happiness hasn’t always been easy.

“I found out I was pregnant one month before I was supposed to leave for a post-secondary program in respiratory therapy; I was 19 years old,” says the former competitive soccer player from London, Ontario, who’s juggling a full schedule between home, school and work. “Soccer was my first love

T

AS PART OF SE HEALTH’S COMMITMENT TO CARE AND HEALTH LEADERSHIP, THE ORGANIZATION HAS A REGISTERED AND PROVINCIALLY REGULATED CAREER COLLEGE. and I had to make sacrifices; I had to pay rent for the school semester and I wasn’t even there. I gave birth two weeks after my 20th birthday. It was a really difficult time. I am so grateful I found SE Health.”

SE Health, an award-winning, notfor-profit social enterprise and one of the largest health care providers in

The Importance of Hospital Medical Laser Safety Officers (MLSO) & Training As the use of medical laser technology continues to increase, so do the risks and safety concerns associated with surgical lasers. So much so that it continues to draw attention from the highest federal & provincial regulatory bodies. Establishing a dedicated MLSO is critical for your OR. To be compliant with the American National Standards Institute (ANSI) Z136.3 Standard for “Safe Use of Lasers in Health Care,” every facility that uses a medical laser must establish a formal Laser Safety Program that is documented and managed by an appointed Laser Safety Officer (LSO).

Designating an MLSO requires that person to obtain the appropriate education and training to be able to effectively administer the laser safety program.

This training is critical as laser systems are rapidly changing and becoming increasingly more complex, making it very difficult for hospital staff to stay up to date. As a result, the Canadian Laser Safety MLSO training provides much-needed foundation for establishing a safe and effective laser safety program with credibility, expertise, and knowledge – assets necessary to ensure safety for facilities, staff, and patients.

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Medical Laser Safety Officer course March 7 & 8, 2020 in Toronto, Ontario REGISTER ONLINE TODAY

www.canadianlasersafety.com 26 HOSPITAL NEWS JANUARY 2020

Canada has been delivering exceptional health care in people’s homes and communities, pioneering health practices and sharing cutting-edge knowledge for over a century. The organization is proud to help McMonagle to realize her love for health care and practice her passion in a new and innovative way.

“I’m doing what I’ve always wanted to do and it feels so good,” says McMonagle, described by her family and friends as ambitious, hardworking and passionate. “I was working at Tim Horton’s because I didn’t have a lot of options and I needed to support my boys; but then one day I was looking online and I came across the SE Health HSW-PSW Program and it was screaming my name, I needed to do that!”

livery Centres (SDCs) across Ontario.

In the 29-week, integrated program, students begin with a fourweek paid HSW training program.

Then, as HSWs, they complete the PSW program while working as an HSW at the same time. The flexible, five-hour schedule, each day – classes begin at 11:00a.m. – allows students to work before and after classes.

There are no tuition costs and they earn a pay cheque for their work as an HSW. As part of the program, students sign a Return of Service agreement which helps to meet the care needs of SE Health’s SDCs across Ontario. Upon completion of the program, graduates are eligible for employment in many different health care settings, including community and long-term care.

The program is also helping to highlight the importance of the HSW role in the scope of home care services. As an SE Health HSW, these employees are an essential part of the overall health care team. Together with their Personal Support Supervisor, they work with a variety of clients

THE COLLEGE CREATED A ONE-OF-A-KIND HOME SUPPORT WORKER (HSW) AND PERSONAL SUPPORT WORKER (PSW) PROGRAM – THAT RUN-IN SEQUENCE – TO MEET THE NEEDS FOR PSWS IN ITS SERVICE DELIVERY CENTRES (SDCS) ACROSS ONTARIO. As part of SE Health’s commitment to care and health leadership, the organization has a registered and provincially regulated career college. In 2018, the college created a one-of-a-kind Home Support Worker (HSW) and Personal Support Worker (PSW) program – that run-in sequence – to meet the needs for PSWs in its Service De-

and other health care professionals to promote client independence and provide excellence in client-centered care. By integrating the HSW into the care team SE Health is maximizing the use of its health care resources and providing a complete care experience for the client.

Continued on page 28 www.hospitalnews.com

MEDICAL LASER SAFETY OFFICER TRAINING Our Medical Laser Safety Officer (MLSO) training program is designed for registered nurses, physicians, surgeons, surgical technicians and all operating room personnel Covers specific laser safety protocols as they relate to medical and health care environments in Canada.

Developed in accordance with the NEWEST version ANSI Z136.3 – 2018 Standards, Safe Use of Lasers in Health Care, as well as the Canadian Safety Standards Z386-14 & Z305.13-13 – Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings.

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It is essential to develop, implement and maintain a laser safety program to prevent laser-related accidents. Our goal at CLS is to give Laser Safety Officers the knowledge and background needed to run a safe and successful program and one that meets and exceeds all government requirements.

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PROFESSIONAL DEVELOPMENT AND EDUCATION Taylor McManagle with her boys.

Training and care Continued from page 26 “This is a wonderful program and we are ecstatic to offer this opportunity in communities across Ontario,” says Nancy Lefebre, SVP and Chief Clinical Executive at SE Health. “As the only health care organization in Ontario with a Ministry approved PSW program,” SE Health has the unique opportunity to deliver this as a mobile program and set up courses in cities where we have the greatest need for this type of learning and training.

We’ve had incredible results and we are truly excited to be bringing care training opportunities ‘closer to home’ for everyone.”

“SE Health has given me the opportunity to attend a full-time, recognized program while still earning an

The Benefits of Revolutionizing Health Care Delivery It might come as no surprise that Health Information Management and Health Informatics are in-demand career paths.

Health information systems use technology to gather, analyze, and manage volumes of health information by transitioning records from paper to digital formats. This process alone has revolutionized health care delivery. From increased access and accuracy of patient care and administrative data to reduce personnel costs and optimized inventory levels, the overall results equate to improved quality of patient care.

An educational investment in health information technology allows health professionals to not only increase efficiency but improve the experiences of staff, patients, and families. This will not only lead to higher success for your health centre, but it will also ensure you stand out from your peers and will give you a competitive edge.

With the rise of health information systems, more health professionals are seeking courses like the ones offered at McMaster Continuing Education. Programs such as Health Information Management, and Health Informatics will help you gain the skills and education you need to advance in your health career and become a leader in revolutionizing health care delivery.

income,” adds McMonagle. “It can be extremely difficult to attend classes full time and keep a part time job while juggling the rest of life. But since I am working for the same organization that I am learning from; working for two to three hours before and after class is great; it’s the ideal situation for me and my boys.”

of a mobile HSW-PSW integrated program benefits everyone.”

McMonagle adds that the support in the program has exceeded her expectations and the concurrent learning and working opportunity is ideal for understanding and applying health care protocols and policies and providing client care.

“WE RECOGNIZE THAT POTENTIAL PSWS DO NOT ALWAYS HAVE ACCESS TO A COLLEGE, OR THE ABILITY TO PAY THE REQUIRED TUITION; NOR ARE THEY IN A POSITION TO BE OUT OF WORK FOR THE TIME REQUIRED TO TAKE THE PROGRAM,” “We recognize that potential PSWs do not always have access to a college, or the ability to pay the required tuition; nor are they in a position to be out of work for the time required to take the program,” says Kim Miller-Utley, Senior Lead of SE Health Learning and an instructor in the program. “We also recognize the immediate need of our SDCs to have support workers on the ground working. Our solution

This innovative HSW-PSW learning opportunity is one of several programs offered by the SE Career College – a not-for-profit, regulated school, operated by SE Health. The Career College and PSW program is registered and approved by the Ministry of Advanced Education and Skills Development. Widely acclaimed for innovative practices, SE Career College of Health is at the forefront of delivering excelH lence in health care education. ■

Sarah Quadri is Head of Communications at SE Health.

28 HOSPITAL NEWS JANUARY 2020

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Timely two day medical course helps ensure trauma room success

By Tracey Richardson t was early evening in May this year – a weeknight – at the tiny Lion’s Head Hospital on the Bruce Peninsula. The day had been warm, 20 degrees, with a heat wave right around the corner, but still too early in the season for the waves of tourists gliding up and down Highway 6, heading to the national park or Tobermory and the Chi-cheemaun ferry.

There was nothing to suggest it would be an atypical shift in the emergency department for the one nurse and the RPN on duty, while the doctor, Dr. Jonathan Thomas, slipped home to eat dinner with his family.

Nothing except for the unending sirens suddenly piercing the air.

RN Dana Fries wondered if something was up, but it wasn’t until an

I

THE CARE COURSE (COMPREHENSIVE APPROACHES TO RURAL EMERGENCIES) IS DESIGNED FOR SMALL RURAL HOSPITALS WHERE GENERALISTS (FAMILY PHYSICIANS), NURSES AND PARAMEDICS TEND TO MEDICAL EMERGENCIES WITHOUT THE SUPPORT OF A LARGE, SPECIALLY TRAINED TEAM. ambulance roared up to the back doors that she sprang into action. And quickly realized that what she had on her hands was no broken ankle or chest pain complaint.

On the stretcher was an adult male patient in critical condition after an ATV crash. Fries knew immediately she’d need all the resources at her disposal – her RPN, Margaret Thompson, the doctor, and the on-call X-Ray technician. ORNGE too, and whatev-

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er help she could get from the paramedics and even the police. All would be pressed into action.

Without the ability to intubate, without a CT scan or MRI, with no other doctors to call upon and the regional hospital – Grey Bruce Health Services Owen Sound Hospital – more than 65 kilometres away, Fries and Thomas were limited. What wasn’t limited was their determination that night to save a life.

With the patient hemorrhaging blood and his breathing compromised, Thomas and Fries got to work on the basics – circulation, airway, breathing.

A laryngeal mask airway, two separate chest tubes, blood transfusions. Even then, the patient was barely hanging on as ORNGE rushed to the scene and police officers tag teamed to Grey Bruce Health Services Wiarton Hospital to retrieve blood for the patient.

“A lot of mistakes happen when you try to do more than that early on,” Thomas says of their treatment plan that night. “You’ve really got to stick to the fundamentals.”

Following that standardized approach helped them to “stay organized, to compartmentalize,” he says, “especially when we don’t have a giant team or different parts of the team attending to different parts of the case.”

And if they’d had a large team at their disposal? Thomas insists the same protocols would have been followed for stabilizing the patient. “If this had been at a Level 1 Trauma Centre like Sunnybrook, the treatment would have been no different. Again, you stick to the basics.”

They knew the patient had catastrophic injuries, even though at the

time it wasn’t known how bad. “Basically, any one of his injuries could have and should have killed him,” says Thomas. The patient, who is still recovering, had suffered a ruptured spleen, a ruptured diaphragm, lacerated liver, lacerated aorta, a perforated bowel, and his stomach was in his chest wall.

When Thomas and his team later discovered the extent of the man’s injuries, and better yet, his positive prognosis, “to be honest, it was pride at that point.”

For Fries, a nurse for 18 years, “it’s one of those things where all your education paid off, the training and everything. Makes you proud of your career choice. And proud of our little facility, proud of our physicians, our team.”

Thomas likes to call it “frontier medicine. We’re just used to not having the same resources as elsewhere, so we just take care of it. It may not be a perfect solution, but we’ll come up with a solution that’s workable.”

Both health care professionals credit teamwork as the key to success in such a small emergency department.

The Lion’s Head Hospital is a fourbed facility with a 24-hour ED, one of the six hospitals under the Grey Bruce Health Services umbrella, and one of the smallest in Ontario.

“In a situation like (the one in May), we need the team,” Thomas says. “If I was on the hook as the sole leader who’s making (all) the choices, that (patient) would have died, for sure.”

It’s the isolation of the hospital that promotes that much needed teamwork, Thomas says, because “it promotes self-reliance, and that drives the necessary teamwork.”

A timely two-day rural emergency medicine course on the Bruce Peninsula just two months before May’s incident also played a critical role in the successful outcome, Fries and Thomas says. The CARE Course (Comprehensive Approaches To Rural Emergencies) is designed for small rural hospitals where generalists (family physicians), nurses and paramedics tend to medical emergencies without www.hospitalnews.com

the support of a large, specially trained team. “It was excellent and it certainly did help us in this scenario,” Fries says.

The course originated in British Columbia and offers healthcare providers working in isolated areas opportunities to hone their emergency response skills in simulated emergency situations. It was the first time the course had been offered in Ontario, and dozens of nurses, doctors, and EMS on the Bruce Peninsula participated. The course is being piloted as part of a rural medicine initiative of the Ontario College of Family Physicians’ Collaborative Mentoring Networks.

Thomas called May’s incident “a once-in-10-years case for us.” But it’s one he and the team were better prepared for than at any other time, he says. “I feel to a certain extent that we’ve been preparing for that case for years. We’ve been slowly, slowly learning little bits and pieces here. …We’re more prepared now than we were five H years ago.” ■

RN Dana Fries and Dr. Jon Thomas in the Lion’s Head Hospital ER.

Tracey Richardson works in communications at Lion’s Head Hospital.

Earn your degree close to home in Buffalo, then launch your career anywhere.

DYC.EDU www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 31

PROFESSIONAL DEVELOPMENT AND EDUCATION

Educational modules available for hospitals and the public to support

new mandatory reporting requirements be used ffective Decemberr 16, use as entire modules, individual slides or 2019, reporting of adverse dverse o selected content for individuDocumenting al learning, or incorporated into predrug reactions (ADRs) DRs) lear the Serious sentations for information-sharing. and medical device ice sen ADR or MDI Sharing the The incidents (MDIs) within 30 cal-T modules include: Learning Module 1 – Overview of endar days of first documentaVanessa’s Law and Reporttion became mandatory for all ing Requirements: explains Canadian hospitals. The Prothe purpose of Vanessa’s law, tecting Canadians from Undescribes the regulations for safe Drugs Act, also known mandatory reporting of seas Vanessa’s Law, is intended rious ADRs and MDIs by to increase drug and medical hospitals, and outlines the redevice safety in Canada by quired data elements for manstrengthening Health Candatory reporting. ada’s ability to collect inford Reporting Module 2 – Reporting Promation and to take quick and d to Health Communicating Canada cesses to Health Canada: deappropriate action when a serious ous cess Findings scribes the expectations for mandahealth risk is identified. tory reporting, provides samples of Four educational modules have re the for reporting and how to been developed to support and d rraise i th fforms r Reviewing and Assessing Reports and Other Data Sources submit reports to Health Canada, and awareness of mandatory reporting reMedication Practices Canada (ISMP includes a number of case studies as quirements. Available in PowerPoint Canada), Health Standards Organizaexamples. The module also includes a and PDF formats, these presentation (HSO), and the Canadian Patient Guidance document for reporting and tions were developed collaboratively Safety Institute. The materials can options for voluntary reporting.

by Health Canada, Institute for Safe Module 3 – Strategies to Promote and Support Mandatory Reporting: identifies potential barriers to serious ADR and MDI reporting, how to facilitate documentation and reporting, and outlines strategies to support implementation. Examples of various reporting systems in place are also included.

Module 4 – Health Canada’s Review and Communication of Safety CELEBRATING 135 YEARS of educational history and more than 70,000 Findings: summarizes the importance graduates, Westervelt Colleges' four locations in southwestern Ontario of health product vigilance, the pro(London, Kitchener, Brantford and Windsor) offer top notch training in the cess that will be used to share informaareas of healthcare, business, law and IT. At Westervelt College, our mission is to not only provide you with quality tion on ADR and MDI reporting, and instruction but also give you a lot of hands on training to master your new how data will be secured and shared. skills. No need to worry about day one of your new career as you will be All four modules can be accessed on trained, ready and confident. the Canadian Patient Safety Institute Whether you are just starting your career or looking for a new career, the programs at Westervelt College will ensure you are well prepared! website at: https://www.patientsafetyFocused comprehensive career training has you job ready faster by attendinstitute.ca/en/toolsResources/Vanesing classes 20-25 hours per week with a consistent predictable schedule that sas-Law/Pages/default.aspx allows you to plan life around college. Program Advisory Committees and dedicated faculty ensure students receive skills training for today’s employPatients for Patient Safety Canament world. da have also created a presentation Westervelt College is one of the oldest colleges in Canada - having first to help patients and the public unopened our doors in 1885 in London, Ontario. Through the years, a lot has changed and evolved, but our dedication to our students and our communities derstand and promote the reporting remains the same. At Westervelt College, we offer assistance every step of of serious adverse drug reactions and your educational journey. From career counseling to developing a financial medical device incidents. package, from personalized instruction to one-on-one graduate employment For the purposes of mandatory reservices, our staff and instructors are committed to your success.

As we like to state, “Be a Westervelt Graduate, so you do not compete with porting, a serious adverse drug reacone!” tion is defined as a noxious and unin-

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32 HOSPITAL NEWS JANUARY 2020

tended response to a drug that occurs at any dose and that: • requires in-patient hospitalization or prolongation of existing hospitalization, • causes congenial malformation, • results in persistent or significant disability or incapacity, • is life threatening, or • results in death.

The mandatory reporting requirements for hospitals apply to therapeutic products, including: • Pharmaceuticals (prescription and non-prescription drugs), • Biologic drugs (biotechnology products, fractionated blood products, plasma proteins and vaccines (excluding vaccines administered under a routine immunization program of a province or territory), • Radiopharmaceutical drugs, • Disinfectants, • Medical devices, and • Drugs for an urgent public health need.

Mandatory reporting does not apply to natural health products, however reporting is encouraged.

A medical device incident is an incident related to a failure of a medical device or a deterioration in its effectiveness, or any inadequacy in its labelling or its directions for use that has led to the death or a serious deterioration in the state of health or a patient, user, or other person, or could do so were it to recur.

All classes of medical devices are included in mandatory reporting by hospitals, including those classified as Class I (lowest risk) to Class IV (highest risk). Examples are: • Class I – Hospital beds, wheelchairs, leg prostheses, • Class II – infusion sets, syringes, tracheostomy tubes, urethral catheters, • Class III – infusion pumps anesthesia gas machines, intrauterine devices, and • Class IV – pacemakers, defibrillators, breast implants, bone grafts.

More information on mandatory reporting is available on the Health H Canada website. ■

This article was contributed by the Canadian Patient Safety Institute. www.hospitalnews.com

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Using augmented reality (AR) to train health-care providers from virtually anywhere

By Monica Matys irtual reality systems are increasingly finding their place in health care. They allow patients to “see� and experience stressful medical procedures in a safe space before their actual treatment. Research has shown that by knowing what is involved in the process, this can help ease a patient’s concerns and anxiety.

New systems in development are now hoping to train future health care workers from literally anywhere.

Sunnybrook’s Collaborative Human Immersive Interaction Laboratory has been advancing virtual reality for years, and three of the experts involved provide an update on their exciting work. • Dr. Fahad Alam, Co-Founder, Collaborative Human Immersive Interaction Laboratory (CHISIL)

V

• Dr. Julian Wiegelmann, Anesthesiologist, AR Development Lead • Dr. Bill Kapralos, Associate Professor, Ontario Tech University How is VR is currently being used at Sunnybrook?

Fahad: We’ve been using VR for various applications. For example, some patients who are anxious about having surgery, or certain medical procedures, can first go through the steps virtually. In our studies, we’ve found this approach decreases the anxiety that patients feel, and actually improves their outcomes.

So what’s the latest system you are working on?

Fahad: There are a lot of medical emergencies that can happen, so we’re creating an AR system called HoloSIM that will literally immerse the learner inside one of their choosing; things

like cardiac arrest or anaphylactic shock. A special headset is worn that interacts with sensors in the room, so learners can walk around and control the simulated environment with their hands and movements. If a mistake is made, they can see the patient’s vital signs will react. That feedback can all be reviewed afterwards as part of the learning experience.

Julian: Right now, HoloSIM is in the prototype stage. The idea is that any room a medical student is in can be used for training by overlaying interactive holographic resources onto it. We’re currently working on creating a platform in this system where different variables can be changed, like medical props and types of patients, and their physiology can be adjusted to any parameter to simulate almost any situation in health care.

Bill: What’s great about this is you’re not stuck to one static scene.

Educators can come in and develop new scenarios or modify existing ones.

Are there limitations?

Julian: Right now, the HoloSIM system responds to some hand gestures and head movements, but there are still many interesting problems that need solving.

For example, how do you convey a sensation like pulse when it’s something the learner can’t actually touch?

Bill: The plan is to develop a pair of gloves that deliver haptic feedback, or touch sensation. But we’re not there yet. Right now, we’re also unable to realistically convey smells that are authentic to various environments.

So how realistic is the experience a person is getting?

Fahad: It’s quite realistic, I’d say at least 80 per cent for AR.

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34 HOSPITAL NEWS JANUARY 2020

www.hospitalnews.com

Bill: Yes, and with VR you definitely feel immersed in it. While there’s still work to be done on the haptic side of VR, the cognitive decision-making side is very realistic.

Sunnybrook has a Simulation Centre that uses mannequins to train students. How do VR and AR fit in?

Fahad: The SIM Centre definitely plays an important role, and in the future, maybe these two worlds can connect. For example, bringing students into the SIM Centre, and using AR to overlay different scenarios.

Bill: VR and AR technologies allow us to develop additional training tools. Since the haptic side of training still isn’t totally realistic yet, currently these tools can, for example, be used to prep students before their experience in the SIM Centre.

Fahad: And there are benefits for remote students with AR and VR, as you can literally do the training anywhere. As the technology advances and gets more affordable, hopefully we’ll see more and more people at

home with these special goggles and headsets.

Do you wish VR and AR existed during your own medical training Julian: Absolutely! I recently completed my anesthesia training, and that’s why I’m creating the HoloSIM technology. You realize that you’ll

never encounter all of these different crisis scenarios in real life during your training, so this software would have helped put me in the hot seat to practice in a safe environment. While HoloSIM is still in the testing phase, the hope is to roll it out to our anesthesiology residents by early 2020.

Fahad: As long as this is developed properly, it’s can be such a great training tool. Imagine as a student, during 15 minutes of downtime, popping on a headset and doing a run through of any procedure.

Bill: Plus, this is a really engaging, H immersive and fun way of learning. â–

Monica Matys is a communications advisor at Sunnybrook Health Sciences Centre.

Student Testimonial Not only does McMaster University is a research-intensive institution, but it also provides a supportive environment to help students to pursue career goals as a clinician scientist. The dual MSc. (Occupational Therapy)/ PhD (Rehabilitation Science) allows me to conduct my research in cancer rehabilitation and learn about how occupational therapy addresses the needs of cancer survivors during my professional OT program concurrently.

With the great support from Dr. Jackie Bosch (My Supervisor), Dr. Julie Richardson (Assistant Dean of School of Rehabilitation Science) and my committee, I have the opportunities to join the world-renowned multidisciplinary teams in an international multi-center study; and attend national conferences to develop professional networks. They are dedicated to address my learning needs as a direct Ph.D. student and help me succeed.

Their continued support has allowed me to leverage my leadership skills and collaborate with clinicians and investigators at the Princess Margaret Cancer Centre to advance my research potential. This program will be an ideal fit for me to develop the knowledge, skills, and attitudes of a competent and compassionate clinician scientist.

Name: Vanessa Fan (Dual OT/PhD Candidate, HBSc.) Supervisor: Dr. Jackie Bosch www.hospitalnews.com

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JANUARY 2020 HOSPITAL NEWS 35

Guided meditation and relaxation

help offset the technofilled world of health care

By Michaela Schreiter ew guided meditation and relaxation recordings are available to all staff at The Ottawa Hospital. They were developed by in-house wellness experts to help staff maintain balance in the busy and technology-focused world of health care.

“We need to take care of our employees and physicians,” says Dr. Amanda Pontefract, Psychology Profession Leader at The Ottawa Hospital. “Change and stress require additional care.”

N

It’s getting harder to control how much time we spend using technology as our world becomes more and more digital.

“Many of us spend long hours tied to a computer, with little natural light or exercise,” says Dr. Kerri Ritchie, Professional Practice Coordinator in Psychology at The Ottawa Hospital.

“This is hard on our bodies and our minds. The more time we spend on technology, the more revved up we become (through dopamine) and the

Workplace Violence Prevention Tools for Healthcare Organizations The Violence, Aggression and Responsive Behaviour (VARB) Toolkits are evidence-informed resources developed by Public Services Health & Safety Association (PSHSA) to help address workplace violence in hospitals, long-term care and community care organizations.

Free toolkits on Workplace Violence Risk Assessment, Individual Client Risk Assessment, Risk Communication, Security and Personal Safety Response Systems are available now.

An additional four toolkits are under development. The new toolkits will focus on Incident Reporting and Investigation (root cause analysis), Patient Transit (both inside the facility and to another facility), Code White, and Work Refusals. These toolkits are being developed with the input and guidance of a broad range of stakeholders across healthcare to ensure they meet the needs of those working in the sector. The resources are also being informed by research and best practices identified in other jurisdictions.

Each toolkit includes step-by-step prevention strategies, customizable elements and a variety of support materials to enable robust workplace violence program planning and implementation.

The toolkits can be used together as a complete resource or accessed as stand-alone resources to address an immediate priority.

Organizations with existing workplace violence prevention program can also use these tools to evaluate or enhance program components.

The new toolkits are expected to be released in early 2020. For more information and to stay up-to-date on this project, visit www.workplace-violence.ca.

New guided meditation and relaxation recordings by wellness experts at The Ottawa Hospital help staff like Linda Miller find balance in health care. more disconnected we can become from ourselves.”

Staff can access these guided meditations and relaxation recordings whenever they need them.

Dr. Caroline Gerin Lajoie, Medical Director of Physician Health and Wellness at The Ottawa Hospital, knows that wellness initiatives like this one can have a positive effect on staff, and help them perform at their best.

“Sometimes we get so caught up in our work that it’s easy to lose perspective,” she says. “Taking small breaks, using visualization, or distraction can help us feel refreshed so that we can carry on our day.”

Many people who work in a hospital spend a lot of time thinking, planning and adjusting activities to meet shifting demands. Some of us can get so wrapped up in our thoughts that we experience cognitive overload. These guided meditations and relaxations are one way to help staff re-establish their sense of balance.

“Spending a few minutes to intentionally focus on incoming information via the five senses helps to re-anchor our brains in the here-and-now,” explains Dr. Bryce Mulligan, Clinical, Rehabilitation, and Neuropsychologist. “It can reduce cognitive overload by shifting to an emphasis on experiencing information gathered by our sensory systems rather than on judging, classifying, responding to, or planning with that information.”

The recordings can also be used to complement gentle physical activity.

Dr. Rose Robbins, Clinical, Health, and Rehabilitation Psychologist from the Chronic Pain Program highlights the negative impact that staying immobile for long periods can have on pain.

“The nervous system becomes more sensitive and pain sensitivity is increased,” says Dr. Robbins. “Along with gentle movements like stretches and going on a short walk, relaxation techniques can help ease pain by releasing tension, calming the mind, and H soothing the nervous system.” ■

Michaela Schreiter is the Media Relations Officer for The Ottawa Hospital.

36 HOSPITAL NEWS JANUARY 2020

www.hospitalnews.com

Safe health care workers mean better care.

Together we are reducing violence in health care.

Our free Workplace Violence Prevention resources for Hospitals, Community Care & Long Term Care are making a signiďŹ cant impact.

Findings from a recent evidence-based evaluation indicate that health care organizations are using the tools to improve processes for assessing and managing workplace violence.

Access the tools & evaluation report at

workplace-violence.ca

www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 37

PROFESSIONAL DEVELOPMENT AND EDUCATION

Bluewater Health welcomes community members to

“Mini Med School”

By Dr. Michel Haddad to access the latest evidence on a wide range of health topics: a monthly series called “Mini Med School”.

The inaugural presentation in October 2019 was a discussion on screening for breast, lung and colon cancers, led by a Dr. Youssef Almalki, Chief of Radiology. The November presentation was on prostate health, led by Dr. Paul Martin, Urologist. Based on the success of the first two sessions, others will be scheduled that focus on other areas of medicine that affect large numbers of people, such as Diabetes, Vaccinations and Advanced Care Planning. At this time, we anticipate offering four to six interactive talks each year.

Each 90-minute class is held in the hospital auditorium and includes a

embers of the public have an appetite for investigating information about their own health. “Dr. Google” is a now a common phrase, referring to individuals attempting to diagnose themselves or loved ones before visiting their own physicians.

But the information available online is notoriously unreliable, and can include wild opinions with no factual basis. As a result, those undertaking internet research may worry unnecessarily or may make decisions based on inaccurate information.

At Bluewater Health, an innovative community hospital with locations in Sarnia and Petrolia, we have a new approach to assist members of our public

M

BIOMED PRESENTS...

Probiotics, The Immune System, & Mental Health Special Seminar To Be Held Can health be improved by microbes found in our bodies? Clinical evidence shows that internal microbes can help treat obesity, diabetes, depression, periodontal disease, and bipolar disorder.

The scientifically-based six-hour course, “Probiotics, the Immune System, and Mental Health” is designed to provide health professionals with information on how internal microbes affect health. The seminar will cover such diverse subjects as binge eating, brain substances, sugar substitutes, and popular diet plans.

The seminar will be presented four times in Alberta Province: Thu., Apr. 23, 2020, the Royal Hotel Trademark, 2828 - 23rd Street NE, Calgary, Alberta; Fri., Apr. 24, 2020, the Radisson and Convention Center, 4520 - 76th Ave., NW, Edmonton, Alberta; Wed. May 6, 2020, Edmonton Inn, 11834 Kingsway Avenue, Edmonton, Alberta; Thu., May 7, 2020, Royal Hotel Trademark, 2828 - 23rd Street, NE, Calgary, Alberta; and Fri., May 8, 2020, Royal Hotel Trademark, 2828 - 23rd Street, NE, Calgary, Alberta.

The seminar times will be 8:30 A.M. to 3:40 P.M. The instructor will be Dr. Laura Pawlak (Ph.D., RD emerita), one of North America’s leading experts on biochemistry, immunology, and nutrition.

The course will examine serotonin (a neurotransmitter), autistic microbes, and the secrets of people who live to be 100. It will also cover factors – found in food, water, and furniture – that disrupt the endocrine system.

38 HOSPITAL NEWS JANUARY 2020

Dr. Michel Haddad presentation from a physician followed by an opportunity for participants to have their questions answered.

Mini Med Schools are currently offered by some university medical schools. But we are not aware of any others based in community hospitals.

Bluewater Health certainly has many physicians with the teaching experience needed to provide insightful and informative sessions: at least half of the hospital’s physicians are also on faculty at Western University’s Schulich School of Medicine.

Bluewater Health already has a strong relationship with its community – Mini Medical School will build on it, providing benefits to both the public and the hospital. While

individuals will learn the latest evidence-based information about health, diagnosis and treatment, the hospital will benefit from future patients who understand the health system better and be fully engaged and informed partners in their care. With increased education, individuals may even be able to take preventive steps for improved health.

Bluewater Health is fully committed to offering patient-centred care.

Care can only improve when patients are knowledgeable partners who understand their own health and are equipped to make informed decisions on healthcare, treatments, and preventive actions to ensure their own H optimal health. ■

Dr. Michel Haddad is Chief of Staff, Bluewater Health. www.hospitalnews.com

BIOMED PRESENTS...

PROBIOTICS, THE IMMUNE SYSTEM, & MENTAL HEALTH A Seminar for Health Professionals TUITION $109.00 (CANADIAN) Instructor: Laura Pawlak, Ph.D., M.S., R.D. (emerita) Conference registration is from 7:45 AM to 8:30 AM. The conference will begin at 8:30 AM. A lunch break (on your own) will take place from approximately 11:30 AM to 12:20 PM. The course will adjourn at 30 DW ZKLFK WLPH FRXUVH FRPSOHWLRQ FHUWLÂżFDWHV DUH GLVWULEXWHG

7:45 AM to 8:30 AM – Registration 8:30 AM to 10:00 AM – Morning Session • The Western Lifestyle: Toxic Environments and Immune Dysfunctions. ‡ %HQH¿FLDO %HQLJQ RU 3DWKRJHQLF" Types of Microbes Found in Our Body. • Anatomy and Biology of Human Microbiota: Are We Just 10% Human? • Diagnosis of Diseases and Syndromes Caused by Bacterial Imbalance. • Clinically Proven Probiotic Treatments: Obesity, Diabetes, Depression, Bipolar Disorder, 3HULRGRQWDO 'LVHDVH ,QÀDPPDWRU\ %RZHO 'LVHDVH &ROLWLV DQG 9DJLQRVLV • Pathological Appetite, Binge Eating, Sugar Metabolism, and Gut Microbes. • The 2017 Breast-Feeding Guidelines: The Role of Probiotics. Innate Immunity.

10:00 AM to 10:10 AM – Break 10:10 AM to 11:30 AM – Mid-Morning Session ‡ :KDW $UH 3UHELRWLFV DQG +RZ ,PSRUWDQW $UH 7KH\" Common and Exotic Sources of Prebiotics. ‡ 5HJXODWLRQ RI WKH ,QĂ€DPPDWRU\ &DVFDGH Deadly Antibiotic Resistance. • “Leaky Gutâ€?: A New-Age Invention or a Serious Condition? • Immune Processes in the Uterus. Microbiome and Infertility: Is There Hope? • Lantibiotics and Hidden Food Additives. • Serotonin, Fluoxetine (ProzacÂŽ), Levodopa (SinemetÂŽ) and Gut Probiotics: Depression, the Vagus Nerve, and Parkinson's Disease. • Gluten and the Body: Separating Fact from Fiction. Mental Health Manifestations of Non-Celiac Gluten Sensitivity.

11:30 AM to 12:20 PM – Lunch 12:20 PM to 2:00 PM – Afternoon Session ‡ 3UR ,QÀDPPDWRU\ DQG $QWL ,QÀDPPDWRU\ )RRGV 0HGLFDO ,QGLFDWLRQV (I¿FDF\ DQG $YDLODELOLW\ • Omega-3, Omega-6, Omega-9, and Now Omega-7 Fatty Acids. • Toxicity of Excessive Omega-6: Are GMO Corn and GMO Soybeans Dangerous? ‡ ,V %XWWHU %DFN" Surprising Findings from Clinical Studies. ‡ 'RHV )LVK 2LO &DXVH 5HSURGXFWLYH &DQFHUV" The Mercury Connection. • Choosing a Safe Supplement: Interactions of Herbal Remedies with Prescription and Over-theCounter Medications. • Sugar Substitutes and Amino Acids: Weight Loss, Depression, ADHD, Diabetes, Bipolar Disorder, and Autoimmunity.

2:00 PM to 2:10 PM – Break 2:10 PM to 3:40 PM – Mid-Afternoon Session • Endocrine Disrupters in Food, Water, and Furniture: Medication Interactions. • Oral Health and Vaccination Against Caries. Periodontal Disease. ‡ &DQ DQ ,PPXQH 0RGXODWRU 0HGLFDWLRQ +HOS 5H *URZ /RVW 7HHWK" A Breathrough. • Mediterranean, MIND, Neanderthal, or Low Glycemic: Popular Diet Plans. ‡ $XWLVWLF 0LFUREHV" Developmental and Mental Health Consequences of Dysbiosis. ‡ 'LHWDU\ 'HWR[L¿FDWLRQ Can Detox Prevent Cancer and Dementia? • Secrets of People Who Live to Be 100: Exercise, Sleep, Diet, Supplements,and Toxin Eradication.

Evaluation, Questions, and Answers

Biomed’s Website: www.biomedglobal.com

MEETING TIMES & LOCATIONS CALGARY, AB

EDMONTON, AB

Thu., April 23, 2020 8:30 AM to 3:40 PM 5R\DO +RWHO 7UDGHPDUN 2828 23rd Street NE Calgary, AB T2E 8T4

EDMONTON, AB

Fri., April 24, 2020 8:30 AM to 3:40 PM 5DGLVVRQ &RQYHQWLRQ &HQWHU 4520 76th Avenue NW Edmonton, AB T6B 0A5

Wed., May 6, 2020 8:30 AM to 3:40 PM (GPRQWRQ ,QQ 11834 Kingsway Avenue Edmonton, AB T5G 0X5

INSTRUCTOR

Dr. Laura Pawlak [Ph.D., M.S., R.D. (emerita)] is a full-time biochemist-lecturer for INR. Dr. Pawlak undertook her graduate studies in biochemistry at the University of Illinois, where she received KHU PDVWHUV DQG GRFWRUDO GHJUHHV $XWKRU RI VFLHQWLÂżF SXEOLFDWLRQV DQG PDQ\ DFDGHPLF ERRNV she conducted her postdoctoral research in biochemistry at the University of California San Francisco Medical Center.

On such subjects as brain biochemistry, geriatric care, pharmacology, women’s health issues, and nutrition, Dr. Pawlak frequently speaks to audiences of health professionals.

Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.

FEE: CHEQUES: $109.00 (CANADIAN) per person with pre-registration or $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.

ACCREDITATION INFORMATION NURSES (RNs, RPNs, & LPNs)

7KLV SURJUDP LV GHVLJQHG WR SURYLGH QXUVHV ZLWK WKH ODWHVW VFLHQWLÂżF DQG FOLQLFDO LQIRUPDWLRQ DQG WR upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Institute for Natural Resources (INR) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

CALGARY, AB

Thu., May 7, 2020 8:30 AM to 3:40 PM 5R\DO +RWHO 7UDGHPDUN 2828 23rd Street NE Calgary, AB T2E 8T4

CALGARY, AB

Fri., May 8, 2020 8:30 AM to 3:40 PM 5R\DO +RWHO 7UDGHPDUN 2828 23rd Street NE Calgary, AB T2E 8T4

ACCREDITATION INFORMATION (cont'd) PHARMACISTS

$OEHUWD OLFHQVHG SKDUPDFLVWV VXFFHVVIXOO\ ÂżQLVKLQJ WKLV FRXUVH ZLOO UHFHLYH VWDWHPHQWV of credit. Biomed is an accredited provider through the Accreditation Council for Pharmacy Education. The ACPE universal activity number (UAN) is 0212-9999-20-001-L04-P. This is a knowledge-based CPE activity.

DIETITIANS

Biomed, under Provider Number BI001, is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RD’s) and dietetic technicians, registered (DTR’s) will receive 6 hours worth of continuing professional education units (CPEU’s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics. This course has Activity Number 131385 and Performance Indicators: 8.1.1, 8.1.2, 8.1.3, and 8.1.4. CPE Level: II.

SOCIAL WORKERS The Institute for Natural Resources, Provider #1356, is approved as a provider for social work education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. The Institute for Natural Resources maintains responsibility for the program. ASWB Approval Period: 02/28/2019 – 02/28/2022. Social workers should contact their regulatory board to determine course approval. Social workers participating in this course will receive 6 clinical continuing education hours.

REGISTRATION FORM

Please check course date:

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Thu., April 23, 2020 (Calgary, AB)

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Fri., May 8, 2020 (Calgary, AB)

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REGISTRATION INFORMATION

Please print: Name: Profession: Home Address: Professional License #: City: State: Zip: Lic. Exp. Date: Home Phone: ( ) Work Phone: ( ) Employer: E-Mail: QHHGHG IRU FRQÂżUPDWLRQ UHFHLSW

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JANUARY 2020 HOSPITAL NEWS 39

DOCTORS WITHOUT BORDERS

Baghdad Medical Rehabilitation Center “I was afraid when I started the sessions but not anymore. There are good people here, so I feel better”. Four years ago, he was a victim of a big blast in Baghdad.

The young boy lost his father and was severely wounded. “I lost part of the bone in one of my legs. Now I have piece of metal instead because the bone isn’t long enough”.

Now nine years old, he benefits of physiotherapy sessions as well as psychological support at the BMRC. “I hope I’ll never need another surgery in my life.

I just want to get my old life back, go back to school, be with my friends.”

My experience working with Doctors Without Borders/Médecins Sans Frontières (MSF)

By Evelyn Cote Grenier hysiotherapy is a passionate, giving profession that enables me to support people and often reach communities that do not have great access to care. In recent years, my path has led me to humanitarian work and I have made it to… Baghdad.

After several months of waiting, in November 2018, I received an offer to work for six months as a Physiotherapy Activity Manager (PAM) in a Doctors Without Borders / Médecins Sans Frontières (MSF) rehabilitation centre in Baghdad! Departing in January!

Wow! A sudden mix of excitement and anxiety briefly took hold of me… but I made my decision quickly – I would leave in January for Iraq.

What do you know about Iraq?

What images do you have in your mind? You might be surprised… Certain regions of Iraq are much more modern than I had thought.

How do you prepare for such an experience?

Read and breathe.

How do you get through such an experience?

P

Breathe a lot.

Under the blazing sun, I am likely going through one of the most demanding experiences in terms of acclimating to an environment that sometimes lacks softness, and adapting to my new professional duties, my multicultural team and the pace that always takes us further. I regularly question myself.

Am I useful? Are we useful? The answer is yes. I am convinced of the positive impact that our presence has on each person and family that comes to the rehabilitation centre, but also on the national health care system.

The centre was put into place by MSF after years of violence. Without it, many Iraqis unfortunately would not have access to sufficient and essential rehabilitation services, and the nation would be deprived of the contribution of hundreds of people. Without it, many patients would not be able to fulfil their roles in their family or return to school or to work. A great deal of them would be stuck in bed.

The centre also looks after the mental health of its patients, many of whom still carry the scars of various wars.

Concretely, the centre’s capacity at that time was 20 hospitalized patients and around 120 outpatients. All the patients have suffered fractures, which are often nasty, and/or amputation, with a low rate of nerve damage, and would receive support at various stages of their rehabilitation.

I see resilience every day. One such story involves a patient I met one Thursday morning during our weekly medical rounds. This young man had been in a terrible accident on the family farm when he was just a child, leaving him with only one arm and one leg.

For more than 10 years, he mainly got around by dragging himself along the ground, and thereby developed incredible physical and mental strength. This young man came out of his rehabilitation with MSF upright and proud, walking toward a brighter future. Despite years of violence and a persistently tense climate, the people look or try to look forward. Nothing comes easy in the cradle of humankind.

The MSF project also supports the national health care system, primarily through knowledge sharing. Unfortu-

nately, the health care and education systems have been particularly hard hit by war, which has taken a toll on the quality of physiotherapy in Iraq.

Today’s system is still marked by the past and by rampant corruption – it struggles to recover and regain its former prestige. The project has given us the chance to improve physiotherapy training so that more people can receive rehabilitative care. As a PAM, my overall role is to support better physiotherapy practices and to work in cooperation with Iraqis to develop services specifically for people who have suffered orthopaedic trauma.

Although Baghdad is fairly modern and freer than its neighbours, tight security checks have become a regular part of day-to-day life. Religion is also very present and serves as an anchor to soothe discouragement or passing frustrations.

Living in Baghdad means living with a heavy past and under the shadow of radicalism… It also means hope. Hope that Iraq’s culture, which is rich, celebratory, generous and ancient, will be recognized and make people forget H about violence. ■

Evelyn Cote Grenier is a physiotherapist from Saskatchewan.

40 HOSPITAL NEWS JANUARY 2020

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NEWS

An innovative approach to understanding

emotional intelligence

By Samantha Pender wo integral pillars of West Park’s mission are to deliver exemplary care to every patient, and to ensure that West Park is a great place to be. Yet with staff burnout in health care on the rise across the sector, West Park Healthcare Centre is making it a priority to better understand and strengthen its organizational culture.

Partnering with the Yale Center for Emotional Intelligence (YCEI), West Park – a leading rehabilitation and complex continuing care hospital in West Toronto with 950-employees and physicians – is conducting a survey administered by Yale in an effort to better support employees and physicians, and ultimately to continue to provide the best care and services possible to patients.

The YCEI is undertaking this important research with five Ontario hospitals, of which West Park is one.

This innovative initiative was brought to our attention by The Ontario Hospital Association (OHA). The OHA continues to see challenges in hospitals across the province pertaining to organizational wellness, employee well-being, employee engagement, burnout, stress, fear of reprisal or failure, and dignity of individuals, yet a deeper understanding has remained elusive.

Without a sufficiently granular understanding of what is going on within hospital cultures province-wide, it becomes challenging to take meaningful or precise action to improve the situation. The aim is to continuously improve and to ensure an emotionally and psychologically healthy workplace.

In 2019, West Park replaced its bi-annual staff engagement survey with the Yale research survey. It is a more comprehensive survey which is necessary to truly get a read on aspects of our culture. The survey is confidential and results go directly to Yale as a leading independent academic and teaching institution. The Yale team

T

“I THINK BEING ABLE TO UNDERSTAND EXACTLY WHAT CHALLENGES OUR EMPLOYEES FACE IS CRUCIAL TO OUR ORGANIZATIONAL WELLNESS” will mine the aggregated data and share de-identified findings that will enable West Park leadership to potentially introduce new policies, programming and plans to improve organizational wellness going forward.

Lee Verweel, Manager, Research & Innovation at West Park, describes the research as an innovative approach to emotional intelligence.

“For our part, we facilitated the research by reviewing the proposed questions with our ethics board and measured the appropriateness of the survey,” he says. “We wanted to evolve the way we survey employees, and looked externally for innovative ways to assess what our employees need for their well-being.”

West Park’s human resources department and CEO are all-too aware

of how critical an understanding of emotional intelligence is to creating a healthy workplace and a positive workplace culture.

West Park President and CEO Anne-Marie Malek met with Dr. Zorana Ivcevic Pringle, the lead research scientist, and facilitated a presentation about the research opportunity with senior leadership at the hospital.

There was unanimous support for the survey and we look forward to learning about areas we can improve upon, as well as validate areas where we are doing well.

“When I became aware of the YCEI survey, I knew how beneficial it would be to West Park,” Malek says. “As we continuously strive to deliver exemplary care and create a safe and healthy workplace for staff, I knew focusing on

emotional intelligence would help us keep moving in the right direction” The hospital’s leaders are integral to a positive workplace culture. Liliana Catapano, Chief Human Resources Officer at West Park, feels positive this approach will build a stronger foundation of healthy people and practices to support staff wellbeing, organizational health, and positive clinical outcomes.

“What we’re able to do with this survey is look at the relevance of emotional intelligence in a healthcare environment, and build leadership capabilities to support an emotionally intelligent workforce” Catapano explains. “We’re working to get ahead of the curve and prevent worker burnout, while continuing to maintain and constantly enhance the positive workplace culture.”

With employees being encouraged to participate in the survey by Malek herself, it’s clear how eager the hospital is to achieve a representative sample from every level, clinical to administrative.

“I think being able to understand exactly what challenges our employees face is crucial to our organizational wellness,” says Jan Walker, Vice President – Strategy, Innovation, and CIO. “What we’ll be able to do with the research will have a great impact and help us develop new policies, practices and ways to work together. We will cultivate an even better workplace and ultimately have an impact on patient care.”

The YCEI’s research started with on-site visits to participating hospitals for observation and project scoping, then moved on to research study design, where they had their questions vetted by hospital ethics boards. Data collection and analysis are currently ongoing, with a debrief of findings to be rolled out in the spring.

Once Yale has completed the research analysis, West Park will have the opportunity work on implementing changes that will be meaningful to H both staff and patients. ■

Samantha Pender xxx www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 41

EVIDENCE MATTERS

Tech to support aging in place:

Help on the horizon?

By Barbara Greenwood Dufour ore than 90 per cent of Canadians aged 65 and older are currently living in private residences. And most, if not all, of them want to remain there as long as possible. To support this desire to “age in place,” there are many new health technologies being developed that aim to help older adults remain healthier, more productive, and living in their own communities.

In a recent issue of Health Technology Update, CADTH looked at a few emerging technologies that could potentially help support aging in place.

CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures to find out what the evidence says. Its Health Technology Update newsletter describes new and emerging health technologies that are likely to have a significant impact on health care in Canada. The technologies described in this recent issue aren’t yet available in Canada, with the exception of the virtual-reality bike, described next.

M

VIRTUAL REALITYINSPIRED EXERCISE BIKE A bike ride through places that hold fond memories could be the ticket to improved physical, memory-related, and cognitive abilities. But how can this be made possible? BikeAround combines a stationary bike with Google Street View to create a virtual bike riding experience. It has been developed for use by older adults experiencing physical disabilities, memory problems, or cognitive disabilities such as dementia or Alzheimer disease.

The technology allows users to tour their childhood communities, favourite vacation spots, or any other place they wish to revisit simply by typing the desired address into Google on the BikeAround laptop. This activity is intended to improve memory skills

as well as provide social engagement for participants, who are encouraged to discuss their ride with an attendant or volunteer assisting with the session.

Even users with mobility limitations can experience the cognitive and reminiscent therapy by having a trained assistant navigate the streets for them.

BikeAround bikes are typically set up at locations within communities and have been commercially available and distributed in Canada since 2018.

SMART HOME TECHNOLOGY FOR HOME-BASED HEALTH MONITORING Older adults experiencing physical and mental decline may eventually need someone to keep an eye on them, either through an in-home care arrangement or by moving to an assisted living or nursing home facility. But smart home technology could someday offer health monitoring that could allow older adults to live independently at home for longer. The concept of wireless smart home monitoring technology isn’t new, but a system that claims to take the concept further is in the works. Called Emerald, it uses radiofrequency signals to track, and differentiate between, multiple individuals; measure breathing, heart rate, and sleep; and learn about patterns of human activity in a house. This could allow the system to detect falls and measure cognitive decline, mental health, and chronic conditions remotely and unobtrusively, allowing older adults to live independently and alleviating the need for trips to the hospital.

DEVICE THAT MONITORS AGE-RELATED MACULAR DEGENERATION AT HOME Age-related macular degeneration (AMD) is common in older adults.

For those with the more advanced, wet AMD – which accounts for 10

per cent of the population – regular visits to the eye doctor are considered critical to ensure that any retinal fluid changes are noticed right away, allowing treatment to be given in time to slow the progression of the condition.

A new, at-home device could reduce not only the number of doctor visits but also the worry that retinal changes won’t be caught in time to prevent serious vision impairment. The device, currently under development by Notal Vision, will allow patients to take images of their eyes in the comfort of their own home. The device will analyze the images and, if a change in retinal fluid is detected, notify the manufacturer’s diagnostic testing staff to contact the patient’s eye doctor and set up a follow-up appointment. The device is expected to come to market in the US in 2020.

WRIST-WORN DEVICE FOR MANAGING ESSENTIAL TREMOR Essential tremor can make daily activities such as eating, brushing teeth, and showering a challenge. But a new device that looks like a smartwatch could provide relief. Essential tremor is a neurological disorder that causes uncontrollable shaking and, while the disorder can affect almost every part of the body, it most often affects the hands.

People can develop the condition at

any age, but most of those affected are 65 years of age and older. Drug treatment (propanol and primidone) provides adequate relief in only about 25 per cent to 55 per cent of patients, and other treatment options (deep brain stimulation and lesional surgery) involve a surgical procedure on the brain.

The Cala ONE device offers a non-invasive option for managing essential tremor. It delivers peripheral nerve stimulation – which has been shown to decrease hand tremor – through the skin whenever the wearer needs it.

As is typically the case with new and emerging technologies, there’s currently only limited evidence on their effectiveness or how they compare with existing treatments. But early awareness of interventions that might come into broad use can help us plan for their possible introduction into the Canadian health care system.

For more information about the technologies covered here, read the related Health Technology Update newsletter: https://www.cadth.ca/ health-technology-update-issue-24.

If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your region: cadth.ca/Liaison-Officers. To suggest a new or emerging health technology for CADTH to review, email us H at HorizonScanning@cadth.ca. ■

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. 42 HOSPITAL NEWS JANUARY 2020

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FROM THE CEO’S DESK

Modernization brings opportunities for patient transportation

By Dr. Homer Tien started my career as a medical officer with the Canadian Armed Forces.

On any given day during the Canadian mission in Afghanistan, land, rotor wing and fixed wing ambulances responded to a variety of traumatic and medical incidents. Our prehospital response was widely regarded as excellent: Canadian military prehospital providers were trained and equipped to a set standard, were supported with linked information and communication systems, and each response was well coordinated and appropriately prioritized by a central dispatching authority. The net result was that all Canadian soldiers in Afghanistan, including those working at remote Forward Operating Bases, had timely access to routine and emergency health care. As well, our small hospital in Kandahar was always able to treat the influx of casualties, because patients were being efficiently decanted back to their front-line units or to Canada.

As the new CEO for Ornge, I’m excited about the prospect of Emergency Health Services (EHS) Modernization, as announced by Ontario Health Minister Christine Elliot in November 2019. Improving the integration of emergency health services and reducing hallway medicine will benefit pa-

I

Dr. Homer Tien tients, and I’m confident that Ornge can play a key role.

While Ornge’s primary responsibility is to provide timely and safe air ambulance transport of critically ill and injured Ontarians, our capabilities could be applied to greater advantage.

We have the expertise and information infrastructure to help ensure that medically stable patients also receive well-coordinated, safe and timely transportation, and we are uniquely positioned to contribute to improved health equity for remote Northern Indigenous communities.

Ornge’s footprint is province-wide with helicopter, fixed wing and land ambulance bases in communities such as Thunder Bay, Kenora, Sioux Lookout, Sudbury, Timmins, Moosonee, Ottawa, Toronto, Mississauga, Peterborough and London. Adult and paediatric emergency and critical care physicians are immediately available for consultation 24/7. We employ support personnel who perform aviation safety audits, inspect medical equipment and provide medical education and oversight, including for our contracted fixed wing service providers that transport low acuity, medically stable patients across the province.

Transportation of medically stable patients is a key area of focus for EHS Modernization. There would be value in standardizing and managing the performance of the mainly privately owned non-emergent stretcher transport services. Ornge is experienced in this regard through its current work with aero-medical transport providers.

We are also well positioned to work with health system partners to develop a centralized dispatch model for non-emergent transports and to improve accountability.

While EHS Modernization discussions take place, Ornge is not standing still. We’re developing a portal for electronic booking of medically stable

transfers using the Provincial Transfer Authorization Centre (PTAC) platform, and are already using PTAC as a way of updating facilities on their patient’s Estimated Time of Arrival.

Ornge is also working with partners to improve health equity in remote Indigenous communities.

Many of the health equity issues in northern Indigenous communities are related to geography, availability of key medical expertise, and timely supply of key medical consumables. With community, regional and provincial partners we have worked to provide 24/7 emergency telemedicine services to remote Nursing Stations, and supply point-of-care laboratory testing capabilities. In the course of a two year period, multiple enhancements to provision of care within the patient’s own community were achieved and unnecessary transports were potentially prevented for nearly 500 patients. Other innovative solutions are also being discussed including remote tele-mentored diagnostic ultrasound, advanced resuscitation training for practitioners, and just-in-time drone delivery capability for critical medical supplies.

It’s serendipitous that lessons learned on the front line of military care are being so readily applied within the changing dynamics of health care H modernization in Ontario. ■

Dr. Homer Tien is the President & CEO of Ornge www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 43

ETHICS

Ethical decision-making and mass casualty incidents

By Daniel Buchman arthquakes. Floods. Mass shootings. Highly pathogenic strains of influenza.

What do these disasters have in common? They all have the potential to cause massive levels of morbidity and mortality. Some of these situations happen quickly with immediate impact, like mass shootings. Others happen slowly with large numbers of casualties growing over time, such as pandemic influenza. In all situations, there are huge losses of life, unbearable suffering, and they can overwhelm hospitals, health systems, and communities. Hospitals refer to these mass casualty incidents as a Code Orange.

In Canada, and in many parts of the world, researchers, healthcare professionals, and members of the public have attempted to describe the relevant ethical values that underpin decision-making in planning for and during a mass casualty, particularly in the wake of experiences such as SARS and Hurricane Katrina. Some of these values include: • Individual liberty: Governments and hospitals may be required to place restrictions on individual liberty (e.g. quarantine) to protect the public from harm.

• Fairness and equity: Plans in response to a mass casualty incident must be perceived as fair by affected parties. This includes a fair process for decision-making. A fair plan must also reflect the needs of structurally vulnerable populations.

Furthermore, hospitals will have to make hard decisions about which services (e.g. some surgeries) will be cancelled or limited in favour of other healthcare services that addresses a prioritized need in response to the mass casualty.

• Proportionality: Restrictions on individual liberty should be propor-

E

DECISION-MAKERS NEED A FAIR PROCESS TO JUSTIFY RESOURCE ALLOCATION DECISIONS, AS WELL AS CRITERIA THAT REFLECTS WHAT MOST PEOPLE CAN ACCEPT AS FAIR.

tionate to the scope and severity of the mass casualty, and more restrictive means on liberty should be reserved only when less restrictive methods have failed.

• Public engagement: Plans to address a mass casualty incident must reflect an inclusive public engagement process where stakeholder voices and communities’ values are reflected, and the voices of the most structurally vulnerable members of society are amplified.

• Reciprocity: Society has an obligation to protect and care for those individuals who take on additional burdens in protecting the public during a mass casualty. For example, healthcare professionals may bear a disproportionate burden by taking

on higher than normal levels of risk to themselves and their families. For healthcare professionals, reciprocity may include providing support over the long-term for those who face risks to their physical and mental health.

• Solidarity: Solidarity acknowledges our shared vulnerability, our interdependence, and that ‘we are all in this together’. This includes solidarity within and across healthcare institutions and systems.

In a mass casualty incident, the demand for scarce healthcare resources will likely exceed the supply—even more than usual. Healthcare professionals may find themselves in situations where there are several patients who require access to the same scarce

resource. For example, who should get a ventilator when there aren’t enough to go around? How should hospitals ration blood products? Such difficult, gut-wrenching decisions cannot be made by looking to the medical literature alone. Decision-makers need a fair process to justify resource allocation decisions, as well as criteria that reflects what most people can accept as fair. In their book, Setting Limits Fairly: Can we Learn to Share Medical Resources?, Norman Daniels and James Sabin describe the conditions that should guide an open and transparent priority setting decision-making process in a framework called Accountability for Reasonableness: • Relevance: Decisions should be transparent and based on reasons that fair-minded people can agree are relevant to priority setting in the mass casualty context.

• Publicity: Decisions and their rationales should be transparent and made publicly accessible.

• Appeals: There should be opportunities to revisit and revise decisions and their rationales in light of new evidence. There also should be a mechanism to resolve disputes.

• Enforcement: Assurance that the other four conditions are met, either voluntarily or regulatory.

A mass casualty creates a situation where governments, healthcare professionals, communities, and leaders need to make decisions that nobody should ever have to make. Planning for a mass casualty is a critical undertaking that health systems must make nowadays.

Indeed, many hospitals in Canada and around the world have emergency preparedness plans well underway. Having a strong plan, grounded in ethical values to guide decision-making, can help promote the interests we have in common with one another: our safety, H survival, and security. ■

Daniel Buchman is a Bioethicist at the University Health Network (UHN), a Clinician Investigator in the Krembil Research Institute, an Assistant Professor in the Dalla Lana School of Public Health, and a Member of the University of Toronto Joint Centre for Bioethics. He is also a member of the UHN Code Orange Steering Committee. @DanielZBuchman 44 HOSPITAL NEWS JANUARY 2020

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LONG-TERM CARE NEWS

How virtual reality is shaping the future of dementia care

By Arielle Townsend t only takes a moment for Alan Scott to see the positive impact a virtual reality (VR) experience has on his wife Beverly. The experience, courtesy of the albert project™ – a VR application designed for people living with dementia – helps Beverly, and by extension her husband, feel at ease.

The goal of the project is simple: to improve the quality of life for people living with dementia, their family members, and caregivers through VR technology. And it’s working, says Alan, who agreed to trial the technology at Henley Place, a Primacare Living Solutions long-term care residence, last year.

“Before the project started, Beverly would have these really rapid highs and lows…she would almost be in a panic,” notes Alan. “Those highs and lows aren’t there anymore, which is really nice to see.”

Depression, agitation, and even aggression are common behaviours in people living with moderate to severe dementia. Watching loved ones go through these experiences can leave family members feeling helpless. The project aims to mitigate these behaviours and offer alternative solutions to dementia care that focus on reducing the use of pharmaceuticals.

The Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, matched media content company, Crosswater Digital Media, and Primacare Living Solutions together to test and validate the VR technology in a real-world setting.

Through CABHI’s Industry Innovation Partnership Program (I2P2), the project has received funding to carry out evaluations in three long-term care facilities across Ontario with up to 325 participants.

Participants are given the opportunity to enter the VR experience

I

The albert project is an immersive reality experience helping to improve the quality of life for people living with dementia.

THE PROJECT’S CUSTOMIZABLE EXPERIENCE NOT ONLY BENEFITS PARTICIPANTS, BUT THEIR FAMILY MEMBERS AND THOSE INVOLVED IN THEIR CARE AS WELL.

through a machine called the Broomx.

When activated, the Broomx projects an immersive image on to the walls and ceiling, transforming an empty room into a lush green park or the heart of a bustling city.

The benefits of VR are promising, explains Jill Knowlton, one of the project leaders and Chief Operating Officer at Primacare Living Solutions.

“We saw a reduction in the use of medication, agitation, and depression,” she says. “Residents who would pace as the nurses tried to give them a sandwich now sit and are much more settled.”

The experience has helped Kay Punter, another participant in the study, relive some of her most valuable memories.

“From day one we could see her interaction with the pictures on the

wall, especially when they would show pictures of London, England,” explains her daughter Monica. “She saw things and would say, ‘I remember that!’”

Part of what makes the experience so unique is its musical component, says Armin St. George, project lead at Crosswater Digital Media. “Music plays such an important role in our lives and it stimulates us in ways that we don’t even understand,” he adds.

The project’s customizable experience not only benefits participants, but their family members and those involved in their care as well. It also has positive implications for the broader healthcare system. Alternative solutions to dementia care, like VR technology, mean less reliance on medication and costly one-to-one staffing programs.

Primacare Living Solutions has already noticed a 30 percent reduction in the use of psychotropic medications to treat responsive behaviours in their residents.

Another unique aspect of the project is the merging of long-term care practices and technology, something Knowlton would like to see continue. “In long-term care, you don’t always get the opportunity to explore different approaches,” she explains.

“CABHI really acted as an incubator for these ideas to develop.”

When she thinks about the future of the project, Knowlton is hopeful it will add a fresh approach to dementia care.

“We’ll be working with CABHI to commercialize this, so we don’t create local pockets of innovation,” she says.

St. George is also looking forward to the way VR will support the broader health and homecare industries, adding that with CABHI’s support, he hopes to make the VR experience more accessible and affordable for everyday use.

Learn more about how CABHI is fueling innovations in the brain health H and aging sector at www.cabhi.com ■

Arielle Townsend is the| Marketing & Communications Content Specialist at the Center for Aging + Brain Health Innovation (CABHI).

46 HOSPITAL NEWS JANUARY 2020

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LONG-TERM CARE NEWS

First unplanned hospital admission associated with 5-fold increased risk of death in older adults nexpected admission to hospital could be an early warning indicator of death within 5 years for seniors.

New research in CMAJ (Canadian Medical Association Journal) found that a first unplanned admission to hospital for any reason was associated with a 5-fold increased risk of death in adults over the age of 65.

The study of more than 900,000 community-dwelling adults aged 65 and older looked at the relationship between first unplanned admission to hospital and risk of death over a 10year study period (2007 to 2017) in Ontario, Canada’s largest province.

Researchers included only people who had not been admitted to hospital or visited an emergency department within 5 years. After their first unplanned hospital admission, nearly 40 per cent of people died within 5 years (59,234 people). This was a substantial difference compared to about 10 per cent of people who died within

U

5 years of their first planned hospital admission (10,775 people) or in those who visited an emergency department and were sent home (35,663 people).

Among those who were neither admitted to hospital nor visited the emergency department, only 3 per cent died within 5 years (11,268 people).

“This study addresses existing knowledge gaps by estimating the risk of death after a first acute care encounter in a population of previously healthy older adults cared for in Ontario, Canada,” writes Dr. Chaim Bell, physician-in-chief at Sinai Health System, and professor at the University of Toronto, Toronto, Ontario, with coauthors.

Cancer and heart disease were the most common causes of death in all age groups, and more than 50 per cent of all deaths in the study were among those with their first unplanned hospital admission.

“In a population of healthier people without previous use of acute care,

study builds on these prior studies by estimating the long-term risk of death for all conditions among older adults without prior hospital admission or emergency department visits.

These findings may be useful in the following ways: • To allow patients, families and their doctors to make informed decisions and advanced planning for health care by estimating risk of death; • To help physicians estimate an individual patient’s risk by use of population-level risk; • To help health services researchers in adjusting risk in future studies; • To help health care system planning for health care delivery.

“Our hope is that this simple information can inform complex health care decisions,” concludes Dr. Quinn, with coauthors.

“The risk of death within 5 years of first hospital admission in older adults” H was published December 16, 2019. ■

unexpected hospital admission should be recognized as a sentinel event that likely signifies an increased risk of death in the long term,” writes lead author Dr. Kieran Quinn, a general internist and palliative care physician and health services researcher at Sinai Health System, with coauthors.

“Recognition of this risk may trigger important discussions among patients, caregivers and health care providers about health preferences for future care.”

The risk of death increased with age, with a 15–20 per cent increase per decade of life. In people aged 66– 70 years, the death rate was about 20 per cent, compared with more than 60 per cent in people aged 86–90 years and 90 per cent in people aged 96–100 years.

Other studies have looked at short-term outcomes following hospital admission as well as 5-year death rates for specific conditions, such as heart failure and lung cancer. This

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LONG-TERM CARE NEWS

Meet your dietitian and nutrition manager

By Maria Biasutti and Karen Thomas t is small wonder that residents and families in long term care (LTC) often find it difficult to understand the difference between the role of the Dietitian and the Nutrition Manager (Food Service Supervisor).

These two individuals work closely together to provide quality nutrition and hydration care, ensuring that food and beverages are planned so residents enjoy healthy, appetizing meals. The Dietitian and Nutrition Manager make sure that residents are provided with choices and any support needed to eat, drink and enjoy dining. Perhaps the

I

most important thing to know is that if a resident or family member has a concern, comment or question related to meals, beverages, diet, etc. they are welcome to ask either person and he/ she will be most willing to assist. This is the residents’ home and the team wants all residents to enjoy a pleasurable and healthy dining experience.

The Food and Nutrition/Dietary Department is unique in Long Term Care Homes because it has a dual role, providing both a service (administrative) and clinical component to care.

The service role includes the planning, preparation and provision of appetizing, nutritious food and beverages (meals and snacks) to promote resident well-being. The clinical role takes this planning a step further by looking at the unique needs of all the residents in a LTC home, both as a group and as individuals. Together,

the Administrative and Clinical roles combine to provide optimal nutritional care that works for all residents and is tailored to the resident’s individual needs.

Registered Dietitians (RDs) are health care professionals with a university degree as well as post graduate internship training who are uniquely qualified to practice dietetics and are regulated by law under a professional College. They play a distinct and expert role in the provision of high quality care for seniors by promoting health and well-being through food and nutrition. RDs have the expertise and qualifications to assess nutrition status, establish care plans and evaluate outcomes.

Residents/Family members will most often see Dietitians observing in the dining room and working with residents to determine which diet, tex-

ture of food, types of beverages, and feeding assistance, if needed, will support a resident’s health and well-being.

The RD will visit residents when they move into a LTC home to discuss any concerns or questions about meals, diet or special dietary needs and will provide suggestions about the type of care he/she feels would improve or maintain health, comfort, well-being and independence in dining. The Dietitian tries to provide this in a liberalized manner, to allow as much variety and choice as possible to enhance resident enjoyment of the meals in their home. She/he works closely with residents who are at increased nutrition risk and provides ongoing support and education to residents, family and the care team about ways of managing the risks. Behind the scenes, the Dietitian

THE DIETITIAN AND NUTRITION MANAGER MAKE SURE THAT RESIDENTS ARE PROVIDED WITH CHOICES AND ANY SUPPORT NEEDED TO EAT, DRINK AND ENJOY DINING.

48 HOSPITAL NEWS JANUARY 2020

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LONG-TERM CARE NEWS

also works with the Nutrition Manager to determine that the home’s menu provides the therapeutic and texture modifications that meet the unique nutrition and hydration requirements of each resident.

Nutrition Managers (sometimes called Food Service Supervisors or Dietary Managers) are skilled professionals who have completed an accredited program in Food and Nutrition Management with supervisory experience.

Their roles and responsibilities may include: co-ordinating and supervising the operations of the Food and Nutrition/Dietary Department to provide optimal food and nutrition services; maintaining efficient and cost-effective operations; ensuring high standards of food safety in all aspects of food production and food services; and assisting the Registered Dietitian in the provision of residents’ nutrition care.

Residents will see the Nutrition Manager (NM) on a regular basis as he/she monitors the dining room to see that residents are enjoying their dining experience and that the food is prepared according to the quality standards of the department. Residents will meet the NM shortly after arriving at the home when he/she visits to determine what food and beverages the resident enjoys and what type of support and/or assistance would improve their dining experience. She/he will also monitor some residents on a quarterly basis to see that dietary/nutrition needs are being met. If the NM feels more specialized care is needed, the Dietitian will be notified so she/ he can review care and suggest other ways to improve comfort and well-being. Behind the scenes, the Nutrition Manager also plans the menu based on what residents have indicated they

enjoy, providing recipes and production sheets for the cooks and food service team so that quality food is safely produced. He/she is also responsible for ordering the groceries and dining supplies, hiring and training staff and numerous other tasks that make this a very busy role.

The Ministry of Health and Long Term Care requires minimum times for the Registered Dietitian and Nutrition Manager to be in each home.

In a 100 bed home, this works out to having a Dietitian available approximately 11.5 hours per week and the NM for about four days per week.

Some homes have increased the time these valuable team members can be on site, in recognition of their extensive responsibilities and the importance of providing residents with quality meals and nutrition care. Dietitians and Nutrition Mangers work

with the Ministry and advocate for more time to meet residents’ nutrition and hydration needs and to provide a pleasurable dining experience in your home.

Ultimately, the goal of both Dietitians and Nutrition Managers is optimal nutrition care for residents, achieved within a cost effective Nutrition and Food Services operation.

Residents and families are encouraged to let the Dietitian and/or Nutrition Manager know how they are enjoying the dining program in their home and to let them know if there is anything they can do to help make this a more positive experience! They would also like to hear if you or your family have any questions about your meals, beverages or special dietary needs.

Adapted from LTCAG – Long Term Care Action Group, Dietitians H of Canada. ■

Maria Biasutti, BASc, RD and Karen Thompson, BASc, RD are Registered Dietitians with extensive experience in long-term care. They participate on the Ontario Long Term Care Action Group, an advocacy group of the Dietitians of Canada.

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JANUARY 2020 HOSPITAL NEWS 49

LONG-TERM CARE NEWS

Supporting employee mental health at Ornge

Working Mind First Responders program geared to helping the helpers

By Courtney Kraik aramedics, firefighters and police officers are often the first on scene in the event of a traumatic or medical emergency. Emotions and expectations are high as the public looks to these individuals for answers simultaneously expecting them to remain calm, professional and provide assistance in often chaotic situations.

It’s a heavy weight to carry, and left unacknowledged, may result in compassion fatigue, vicarious trauma and potentially, post-traumatic stress disorder (PTSD). Paramedics at Ornge, Ontario’s provider of air ambulance and related services, routinely transport some of the province’s sickest and

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50 HOSPITAL NEWS JANUARY 2020

most severely injured patients, and consequently often find themselves dealing with these challenges.

There has been positive change in how we view these conditions within the context of workplace injuries.

Still, the barrier of the stigma remains.

Signs of deteriorating mental health include anxiety, depression and substance abuse, which can leave first responders feeling helpless, hopeless and sometimes result in the individual being sidelined indefinitely. Training individuals to recognize such warning signs in themselves and in their peers is crucial.

The Working Mind First Responders (TWMFR) is a training and guid-

ance module used to support the mental wellness of front line emergency responders. The course originated within the Canadian Department of Defense and among the first organizations to utilize it were the Calgary Police Service and the British Columbia Wildfire Service.

Each module for paramedics, fire and police looks a little different. The idea is to gather statistical data to measure the mental health and wellness of all first responders and what interventions, if necessary, have the most positive impact and outcome.

At Ornge, the first step to implementing the TWMFR module to support its front line employees is to train

“trainers” within the organization.

Thomas Walker, Ornge’s Human Factors Specialist and Dawn Gilpin, a Disability and Claims Management Officer in the human resources department at Ornge were instructed in the Primary and Leadership level courses – under the The Working Mind First Responder’s umbrella – to help facilitate the creation of a culture of sustainable mental health education.

Together they train managers at the leadership level and a network of front line peer supporters across all of Ornge’s bases. Walker and Gilpin coach these leaders and peer supporters on how to recognize when a member of their team is displaying signs of www.hospitalnews.com

LONG-TERM CARE NEWS

THE WORKING MIND FIRST RESPONDERS (TWMFR) IS A TRAINING AND GUIDANCE MODULE USED TO SUPPORT THE MENTAL WELLNESS OF FRONT LINE EMERGENCY RESPONDERS. unhealthy coping mechanisms and/or mental or emotional disturbances.

“The base managers are the best point of contact with their staff because they are with them all the time,” says Gilpin. “They get to know what a normal day looks like for that individual and when that individual looks like they might be struggling.”

The three central components of the TWMFR course at any level are: • scenario-based practical application/ custom videos; • a set of cognitive behavioural therapy-based techniques coined “The Big 4;” and • a Mental Health Continuum Model.

These components give managers and members of the peer support network an overview of what stress looks like and how it can manifest physically.

Gilpin and Walker recognize that training people to see the signs is important, but that the stigma surrounding “mental illness” still creates a significant obstacle when it comes time for those individuals to seek help. It is common for first responders, who broadly exhibit A-type personalities, to feel concerned that once they seek help, they will be labeled as weak or ineffective at their jobs.

“I often hear ‘I can’t be unhealthy, I’m the one who fixes people’,” says Walker. To exacerbate that problem, there’s also the hesitation of peers who feel uncomfortable prodding into the private lives of their colleagues.

“It’s important for (us) to say exactly what we’re thinking,” says Walker.

“We have to name it. We have to say, ‘I notice you and I notice that you don’t seem like yourself.’ We have to talk.”

Ornge, like many first response organizations, has built-in safety measures to support their staff following a traumatic event. Ornge’s Traumatic

Incident Review Process (TIRP) and Critical Incident Stress Management (CISM) briefings are the most common action plans. Operational pauses are offered to crews following high-stress calls if the crew feels it is required.

However, as the industry moves in a progressive direction with regards to employee mental health and wellness, programs and modules like TWMFR gain serious traction.

Giving front line staff healthy tools that ultimately bolster their capacity for resiliency in the face of a traumatic event take priority. Tools like SMART goal setting, positive self-talk, visualization and tactical breathing are encouraged at the onset of and following stressful and disturbing incidents.

“I think a big idea we need to send home with (people) is to just take each part of what they’re going through in small chunks,” says Wayde Diamond, a Critical Care Paramedic at the Ornge Toronto Island base. “Everything in its due time; there’s no rush.”

Ultimately, the goal of the TWMFR is to create a space where open discussions on the fluid nature of mental health and wellness is tabled in a safe and supportive environment.

“Do I think there’s ever going to be a time when we won’t need to talk about mental health in first responders? No,” says Walker. “But I do think (maybe) there will be a time when we don’t need to teach people how to talk to each other or how to know themselves.”

The emotional and mental strain experienced by front line staff when they put on their uniform can have insidious and long lasting traumatic repercussions. Creating space and opening dialogue to begin the healing process is just as important as setting a bone or H suturing a wound. ■

Courtney Kraik is a Communications Intern at Ornge www.hospitalnews.com

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JANUARY 2020 HOSPITAL NEWS 51

NEWS

Survival tips for

agency nurses

By Jen Halliday-Dinon ospitals have utilized agency nurses for decades now.

Agencies can provide an opportunity for nurses to sample or try out different specialities to see what they might connect with and enjoy. It can provide variety in patient populations and workloads and also provide a flexibility that large unionized organizations simply do not offer. They fill staffing shortfalls and are agile and adept and providing care to patients without orientation or formal integration into the individual workplace.

Over the years, I have been asked how I had survived as an agency nurse.

As a staff nurse, I have worked alongside agency nurses. As a manager, I have had my urgent staffing needs filled with agency nurses.

21 years ago when I had started to dabble with agency nursing while continuing to work as a full-time staff nurse, I naturally transitioned into being an expert at change management, resulting in becoming resilient and adaptable, which has served me well over the last two decades. I’ve worn many hats: staff registered nurse, unit manager, case manager, analyst, director of health and wellness, patient flow expert, team leader, mentor, consultant and business development manager.

I remember seeing the invoice in one of the units for using an agency

H

52 HOSPITAL NEWS JANUARY 2020

nurse and thought holy cow! There is a middle-man here that also needs to be paid and there is a role for this niche. When I started so many years ago, shortly thereafter I had accepted a management position and it was firmly communicated in the hospital world that the use of agency nurses was just a temporary measure to fill urgent staffing needs since it was an expensive alternative. Here we are 20 years later, and while the utilization numbers have declined, there remains a need for this service. The heaviest utilization period for this group of nurses are over the winter holidays and outbreak season, March break period and sum strained-at-the-seams workloads, one staff member out of the mix can easily and quickly transition to unsafe care and the risks can be devastating to patients, staff and organizations.

Imagine being thrown into a hospital or a unit you have never worked in before with people you have never worked with before for a 12h shift. You may not be familiar with the documentation system – is it still on paper or E documentation? Where are basic supplies kept and are they locked with a staff badge in order to access?

In connecting with other agency nurses over the years, even after I have accepted staff positions, there are critical challenges that agency nurses face.

Staff nurses – do you remember the way it feels when you are asked to float

to another unit? The considerations already listed above are not even part of the equation here. So you can imagine the stress level of this registered nurse coming into a completely new situation and taking on a patient assignment so that these patients do not have to be added to the rest of the RN team’s already heavy workload.

HERE ARE SOME TIPS FOR AN AGENCY NURSE’S SURVIVAL: • Come confident – you have the nursing assessment skills and have demonstrated your ability to be adaptable.

• This is an excellent way to sample different units and specialties to find out which one speaks to

you and lights your fire as a professional nurse – sometimes in other nursing positions we hang on to a role because we become comfortable and lose that hungry desire to learn more and try different things or grow in non-linear or unconventional ways to hone our professional development.

• Come early to connect with the team leader to let them know you are from the agency, you are here and willing to get to work – this is an opportunity to get a very short orientation to the unit and any log ins that you will need for access to documentation and medication systems.

• Don’t be afraid to ask questions. Yes everyone is busy, but since you are www.hospitalnews.com

NEWS

THE HEAVIEST UTILIZATION PERIOD FOR THIS GROUP OF NURSES ARE OVER THE WINTER HOLIDAYS AND OUTBREAK SEASON. here, the rest of the team doesn’t need to take on more patients!

Today – you are part of the team.

If you do not receive a professional and helpful response – that’s on them, ask the next person until you find a professional and supportive colleague.

• Give feedback to your agency coordinator. Often they can help pave a

smoother path for you as they have developed some relationships with the managers that utilize agencies.

• Often units have a binder for agency nurses. While its unlikely you will be able to look through it at the start of your shift, make an effort to find out if there is one and see what is in there – usually it is a few relevant policies and temp logins.

• Make your presence known to staff, while you may not know the routines of that particular unit, you are a registered nurse and a team player – yes you can help others with patient care and answer the patient care unit’s phone that never seems to stop ringing.

• An agency nurse often is a non-union position, it does not hold guaranteed hours and can frequently be cancelled somewhat last minute without any compensation. Be as flexible as you can, if you were booked to go to one hospital and have been cancelled, try to be willing to go to

long-term care or another hospital location if there is an existing need.

Having personal transportation will give you an edge for this adaptability. There isn’t a retirement benefit or a health plan, and vacation time is often paid out with each pay period.

So, let’s support one another. Today, we are all on the same team. This brave nurse coming to the unit with staffing gaps needs support and to be part of the team.

And just like any nurse team player, you can be an asset or a liability. We all have our own strengths – show your H team yours. ■

Jen Halliday-Dinon MBA, BScN,RN is a Leader, entrepreneur, disruptor and Registered Nurse. www.hospitalnews.com

JANUARY 2020 HOSPITAL NEWS 53

LONG-TERM CARE NEWS

Putting staff wellness in focus

By Darryl Mathers roviding exemplary care to people living with mental illness is a responsibility everyone at Ontario Shores Centre for Mental Health Sciences (Ontario Shores) takes great pride in.

The compassion and empathy shown by all staff, regardless of role, is part of what makes Ontario Shores a place where those impacted by mental illness want to receive care and treatment.

While its commitment to the communities it serves is undeniable, behind the scenes the specialty mental health hospital is taking action to maintain and even enhance the mental and physical health of its employees.

“People who are paid to look after others need to have attention given to their own strength, resiliency and well-

P

ness in order to do a good job providing care,” says Karim Mamdani, President and CEO of Ontario Shores.

Located in Whitby, Ontario Shores provides staff with supports for their own mental well-being. Its new twoyear psychotherapy pilot program offers free confidential psychotherapy services, either as an internet-based system for employees to seek digital cognitive behavioural therapy, or as extensive psychotherapy through an in-person therapist on-site or at a clinic.

“We’ve talked it up and tried to alert people to it,” Mamdani says. “Often people won’t admit they need help. So the way we’re doing it is not to suggest that any one person needs to get help, but that everyone can benefit from a little TLC. Reaching out is not some-

asking what they like so far and what they’d like to see at the hospital. We want to make sure staff are enjoying what we offer and being heard.”

Ontario Shores also promotes the various aspects of wellness in its design of hospital-specific initiatives.

This year, the hospital turned part of its focus toward nutrition with the launch of its Eat Well, Live Well program. Each day, the hospital’s Nutrition and Food Services team created fresh and affordable healthy options such as salads, snacks, sandwiches, smoothies or entrees. They were labelled as part of Eat Well, Live Well so that people can quickly identify items that are part of the program.

To start it off, senior management gifted each employee with a card for H 10 free meals. ■

thing the organization sees as a problem or weakness. It’s what we expect.”

The hospital has also offered resiliency training and mindfulness sessions in addition to offering a range of wellness benefits such as walking clubs, fitness classes and an on-site gym.

To organize it all for staff, Kaelen O’Rahilly, a recruiter in Human Resources with a background in workplace wellness, helped develop a Wheel of Well-being with nine domains, including physical, social, spiritual and financial health. People can access information on the programs anytime through the hospital’s intranet.

“One of my roles is research on whether people are interested in the initiatives we’re running,” says O’Rahilly. “So I visit the units on a monthly basis and pop in at their team huddles,

Darryl Mathers works in communications at Onatrio Shores Centre for Mental Health Sciences.

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Social Worker • Full Time RESIDENT/FAMILY CENTERED CARE Located in the Oakridge area of Vancouver, B.C., Louis Brier Home and Hospital is an “Exemplary Status” accredited long-term care facility situated next to the Weinberg Residence (Assisted Living Suites and Multi-Level Care, both Private Pay). Our Mission is to provide exemplary resident and family-centered care for seniors through innovation, education, research, partnerships and collaboration through the contributions of staff, volunteers, funding partners and donors with a focus on quality and safety, all guided by Jewish heritage. Our vision is to be a center of excellence for elders providing innovative and outstanding care consistent with Jewish values and traditions. We live by our Values - CHAI (Hebrew word for LIFE): Caring, Health, Safety and Wellness, Accountability, and Integrity. Resident and employee safety is a priority and a responsibility shared by everyone at LBHH/WR, and as such, the requirement to continuously improve quality and safety is inherent in all aspects of this position.

The Social Worker is an integral member of the interdisciplinary team, and provides input and support to problem solving and decision-making concerning resident issues and concerns. Social worker services are delivered to residents (and families) at Louis Brier Home and Hospital and at Weinberg Residence five days per week from 8AM to 7PM and on Sundays from 10AM to 6PM (a two-week rotational schedule). Two Full-Time Social Workers provide services within the framework of an elderly, predominantly-Jewish community with diverse ethnic and cultural experiences.

To apply for this position please forward your covering letter and resume to our Human Resources Department at

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Qualifications Master of Social Work Degree from an accredited university including or supplemented by coursework in Gerontology, registration with the BC College of Social Workers, and two years of social support services experience.

careers@louisbrier.com JANUARY 2020 HOSPITAL NEWS 55

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