SPECIAL FOCUS: HOSPITAL SECURITY Inside: News-in-brief | From the CEO’s Desk | Evidence Matters | Nursing Pulse | Safe Medication
December 2017 Edition
Integrating technology into healthcare Page 14
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Contents Decmeber 2017 Edition
IN THIS ISSUE:
Youngest cochlear implant patient
28 ▲ Cover story: Integrating technology into healthcare
▲ Body worn cameras in healthcare security
COLUMNS Editor’s Note ....................4 In brief ..............................7 SPECIAL FOCUS: Hospital Security ...........17 From the CEO’s desk .....24 Evidence matters ...........25 Safe medication ............29 Nursing pulse ................30
▲ First ventral hernia repair using da Vinci
▲ Planning the hospital of the future
▲ Can security reduce patient falls
Patient reported outcome measures
A patient-centred approach to
hospital discharge H
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By Joshua Tepper ospital discharge is a critically important time when it comes to patient care. Ensuring patients receive proper information when they leave the hospital can help reduce risks, improve patient satisfaction and improve outcomes. A report by Ontario’s Avoidable Hospitalization Expert Panel in 2011 found communication of discharge instructions by hospitals was often poor because patients did not understand medical terms, were not fluent in English or French, were not able to remember instructions or were too stressed at the time of discharge to absorb critical information such as medication changes, upcoming tests or concerning symptoms to watch for. Now thanks to the ARTIC (Adopting Research to Improve Care) program, 27 hospitals in Ontario will be using a new tool that gives patients clear and easy-to-understand information when they are discharged. Research has shown that this type of information leads to greater confidence among patients in their ability to care for themselves, and may also lead to fewer readmissions for patients, better medication adherence and improved health outcomes. Through ARTIC the Patient Oriented Discharge Summary (PODS) has the potential to improve transitions from hospital for approximately 50,000 patients in the province in the first year alone. PODS provides a set of clear and easy-to-understand instructions to help make their transition to home go as smoothly as possible.
610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189
PODS provides patients with five key pieces of information: 1. Medications you need to take 2. How you might feel and what to do 3. Changes to your routine 4. Appointments you have to go to 5. Where to go for more information PODS uses plain language, large type, pictures and images to make the information as easy to understand as possible. It’s available in 15 languages and includes space for patients to take their own notes. Part of the success of PODS is not just in the form but how it is used. The summary is completed with the patient and their family, and the patient is asked to recall the instructions in their own words, to ensure they have been understood. A traditional discharge summary is still sent to the patient’s Primary Care Provider. PODS was designed by patients and caregivers working with healthcare providers and experts at the University Health Network’s OpenLab in Toronto – a group dedicated to finding creative solutions to health care problems. The new tool was piloted in eight Toronto-area hospital departments. In the pilot study, patients’ understanding improved by 9.3 per cent to 19.4 per cent in the key areas covered by the PODS template – medication, danger signals, resumption of activities, who to call with questions, and follow-up appointments. Overall, the hospitals found significant improvements in patient and provider expeContinued on page 7 rience.
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Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON
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Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.
Ventral hernia repair using da Vinci Surgical Robot system By Joe Gorman n a Canadian first, Humber River Hospital surgeons, Dr. Steven MacLellan and Dr. Jensen Tan, performed Ventral Hernia Repair and Abdominal Wall Reconstruction using the da Vinci Surgical Robot System. The operation that would normally require a major incision to reach the organ, can now be done using a minimally invasive approach. As a result, patients experience significantly less pain, less scarring, shorter recovery time as well as a faster return to normal daily activities.
The da Vinci Surgical System is a sophisticated robotic platform designed for complex minimally invasive surgeries. It features an ergonomic console where the surgeon is allowed to view high-definition 3-D video from a camera inside the patient. From the da Vinci console, surgeons control four interactive robotic arms equipped with precision instruments. Powered by state-of-theart robotic technology, the da Vinci System mimics the movements of the surgeonsâ€™ hands while filtering out even the slightest tremors.
THE DA VINCI SURGICAL SYSTEM IS A SOPHISTICATED ROBOTIC PLATFORM DESIGNED FOR COMPLEX MINIMALLY INVASIVE SURGERIES â€œA hernia can drastically impact someoneâ€™s quality of life,â€? Dr. MacLellan says, â€œWe are excited to make an impact and improve outcomes for our patients. Weâ€™re in a good position to do that at Humber, with our existing robotics program and with the support we are receiving from the hospital and from nurses and physicians who have experience using the da Vinci.â€?
Thanks to a transformational donation in 2012, the da Vinci Surgical Robot is the centrepiece of the Murphy and Helen Hull Robotics Centre at Humber River Hospital. Barbara Collins, CEO and President of Humber River Hospital says, â€œOur commitment to perform an ever-increasing variety of surgical procedures using high tech robotics is all about providing the most advance quality of
Drs. Jack Barkin, Steven MacLellan, and Jensen Tan. Dr. Barkin, who uses the da Vinci robot for prostate and kidney surgeries, has been lending his expertise to the new hernia repair program. have both had a lot of practice with the robot, and we made sure to address how the operation would flow H beforehand.â€? â–
care to our patients and ensuring surgeons have access to that equipment.â€? Dr. Tan added, â€œToday went very well. We were fully prepared. We
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Joe Gorman is the Director, Community Relations at Humber River Hospital. www.hospitalnews.com
DECEMBER 2017 HOSPITAL NEWS 5
PhD student makes discovery that could help stop the spread of cancer aitlin Miron is a PhD student in the Department of Chemistry at Queen’s University. In collaboration with the European Institute of Chemistry and Biology in France, and with support from a Mitacs award, Caitlin broke new ground in the biochemistry world with her discovery of a DNA binder that could ‘switch off’ cancer cells and prevent them from spreading. Her finding is expected to be ready for licensing by pharmaceutical comH panies within two to five years. ■
FOR MORE ON HER RESEARCH PICK UP THE JANUARY ISSUE OF HOSPITAL NEWS AND LOOK FOR CAITLIN’S ARTICLE
Top 40 research hospitals C
anada’s leading research hospitals, hospital networks and health authorities spent a total of nearly $2.53 billion on research in Fiscal 2016. The total spending represents a gain of 4.1 per cent over the prior year, on the heels of a –0.3 per cent decline during Fiscal 2015, according to Research Infosource Inc., which released its Canada’s Top 40 Research Hospitals 2017 list. The total number of health researchers rose to 8,511 nationwide. Toronto’s University Health Network topped the list with $332.0 mil-
he Centre for Addiction and Mental Health (CAMH) is home to Canada’s first positron emission tomography (PET) centre dedicated to mental illness research, and has a long-standing track record of pioneering new brain imaging agents. CAMH’s legacy in this field will now be powered through the creation of a new research centre, the Azrieli Centre for Neuro-Radiochemistry. CAMH welcomes Dr. Neil Vasdev as the inaugural Director of the Azrieli Centre for Neuro-Radiochemistry. The Centre will work toward creating new radiolabeled chemicals to pro-
toring, Education, and Clinical Tools for Addiction: Primary Care-Hospital Integration (META:PHI). This program provides integrated care for those with opioid or other substance use issues and trains primary care providers to provide proper care for these individuals. Health Quality Ontario and CAHO are strong supporters of ARTIC because of its primary aim to foster widespread dissemination and implementation of healthcare innovations. With better management of transitions in care being a priority for Health Quality Ontario, PODS is exactly the sort H of resource that merits our support. ■
Dr. Joshua Tepper is President and CEO of Health Quality Ontario. www.hospitalnews.com
tale-Nationale – site IUSMQ (23.5%), Provincial Health Services Authority (20.9%) and Centre for Addiction and Mental Health (19.1%). London Health Sciences Centre/St. Joseph’s Health Care London posted the highest research intensity (spending per researcher) among large institutions ($562,500 per researcher). Sinai Health System ($716,600 per researcher) led the medium institution group, while Institut de Cardiologie de Montréal ($601,600 per researcher) headed the small institution H group. ■
CAMH builds on radioimaging legacy
Hospital discharge Continued from page 4 The evaluation also found the number of phone calls from patients asking about follow-up instructions declined, freeing up hospital staff for other duties. ARTIC is a joint program of the Council of Academic Hospitals of Ontario (CAHO) and Health Quality Ontario dedicated to accelerating the spread of proven healthcare throughout the province. PODS represents the third project that has benefitted from ARTIC sponsorship this year. The program helped expand primary care memory clinics to assist in helping patients with memory disorders in rural and remote communities. It also supported the expansion of the Men-
lion of research spending, followed by Hospital for Sick Children ($201.5 million), McGill University Health Centre ($178.8 million), and Hamilton Health Sciences ($171.5 million). In total, eight organizations reported more than $100 million of research spending in Fiscal 2016. Twenty of the Top 40 hospitals are located in Ontario, attracting 56.4 per cent of the national total, followed by 12 Quebec organizations (24.9 %) and 2 British Columbia groups (12.3%). Research spending growth was strongest at CIUSSS de la Capi-
vide a more accurate and complete understanding of several mental illnesses, as well as to aid in the development of new treatments and improve understanding as to why some drugs work better for certain patients. “Mental health is brain health and, in order to truly understand the brain, we need new imaging techniques. Scientists will now be able to look in the brain and explore non-traditional approaches for drugs and treatments. We are thrilled to enable this exciting work,” says Naomi Azrieli, Chair and CEO, the Azrieli Foundation. Dr. Vasdev most recently served as the Director of Radiochemistry at Massachusetts General Hospital and Associate Professor in the Department of
Radiology at Harvard Medical School. “Imagine being able to understand the origins of mental illness by visualizing the function of brain cells, their connections and chemicals – and monitoring changes with treatments and supports. Thanks to this gift from the Azrieli Foundation, CAMH will advance research that’s making this possible,” says CAMH’s Dr. Catherine Zahn. The Azrieli Centre for Neuro-Radiochemistry, located at 250 College Street, will be housed within CAMH’s Research Imaging Centre. It will initially employ a research staff of 10, in partnership with additional clinical-research staff of approximately 100, all working toward the next set of breakthroughs in H brain science and neuropsychiatry. ■
Find quality addictions care he Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Executive Council on Addictions (CECA) have released Finding Quality Addiction Care in Canada, a national guide developed to help individuals and families make informed decisions when seeking treatment for alcohol and drug use problems. CCSA and CECA developed the guide in partnership with the Government of Alberta to raise awareness among Albertans about treatment options and to offer guidance to individuals seeking to access treatment in the province. The guide has national applicability and is accessible to all Canadians. The content, informed by those with lived
experience, includes an overview of how to determine if treatment is required; information and considerations for various treatment options; important questions individuals should ask when talking to an addiction or other healthcare professional; and a list of resources across the country for individuals seeking treatment. Up until now, Canadians have had difficulty obtaining information on what quality care for addiction and substance use disorders looks like and how to gain access to it. Finding Quality Addiction Care in Canada addresses this gap by providing reliable information on what is already available. It empowers individuals and families with H knowledge about treatment options. ■ DECEMBER 2017 HOSPITAL NEWS 7
From left: Laura Oxenham-Murphy, manager of quality; Sonia Pagura, senior director of quality, safety and performance; Alifa Khan, family leader and vicechair of the Family Leader Accreditation Group (FLAG); Adrienne Zarem, family leader and chair of FLAG; Elena Garisto, quality coordinator.
Families advance patient-centred quality and safety nationwide By Robyn Cox hen Adrienne Zarem and Alifa Khan, family leaders at Holland Bloorview Kids Rehabilitation Hospital, first joined the Family Leader Accred-
itation Group (FLAG) as chair and vice-chair they knew they were joining something different. They were on the leading edge of a movement to advance health quality through shared
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decision-making with patient and families. FLAG posed an opportunity for family leaders to improve quality and safety as a crucial part of Holland Bloorview’s accreditation preparedness strategy. One year later and they are two of the first family surveyors with Accreditation Canada, an organization that reviews health centres across Canada for best practices in quality and safety. They are bringing lived experience and valuable insight to the accreditation process, nationwide. How did Zarem and Khan go from shifting the conversation at one hospital to shifting the conversation across the country in a single year? Before taking leadership roles on FLAG, Zarem and Khan were members of the Family Advisory Committee at Holland Bloorview. They were accustomed to informing and developing initiatives across the hospital. Zarem was also participating in a Canadian Association of Paediatric Health
Centres (CAPHC) committee working on a reporting system for paediatric rehabilitation centres across Canada. In April 2016 the quality, safety and performance team at Holland Bloorview launched an unprecedented engagement strategy to embed family leaders on its accreditation steering committee and on each accreditation working group at the hospital, to prepare for the hospital’s accreditation survey in October 2017. At the same time, they developed the FLAG framework to bring these family leaders together to share experiences and learnings. It was a natural fit for Zarem and Khan to take leadership roles. “Patients and families know best what will improve their care experience most,” says Sonia Pagura, senior director of quality, safety and performance at Holland Bloorview. “Health care organizations must partner equally with patients and families through training and engagement on quality www.hospitalnews.com
NEWS and safety so improvements make sense from a patient and family perspective.” Laying groundwork for meaningful participation through the development of the FLAG framework was the first step. Making sure everyone felt confident taking part in quality improvement conversations was the next. Holland Bloorview provided toolkits and training to staff and family leaders on how to partner effectively. “The quality, safety and performance team invested time and resources to teach Holland Bloorview staff the necessary skills to partner meaningfully,” says Zarem. “They also trained family leaders in the science of patient safety and quality improvement so discussions were fulsome, and partnerships were genuine.” Realizing they could help other organizations partner more effectively with patients and families, Khan and Holland Bloorview’s quality team leads worked with the Canadian Patient Safety Institute and master facilitators to update Patient Safety
Accreditation Canada, also bringing her lived experience and knowledge to health systems throughout the country. Additionally, she recently joined the Primary Health Care technical committee at HSO. While Zarem and Khan are advancing patient and family centred quality and safety across Canada, they continue to strengthen quality and safety practices at Holland Bloorview. Their significant contributions, and the contributions of all FLAG members, in the many months leading to the hospital’s on-site survey in October helped Holland Bloorview meet 100 per cent of the standards, securing Accreditation with Exemplary Standing for the second time in a row. Looking forward, Zarem and Khan are excited to build on this momentum. “I am infinitely confident that Holland Bloorview’s team of family leaders will continue to partner and find innovative ways to drive client centred quality and safety, both within the hospital and beyond,” says H Zarem. ■
FAMILY ADVISORS FROM HOLLAND BLOORVIEW KIDS REHABILITATION HOSPITAL ARE AT FOREFRONT OF MOVEMENT TO DRIVE QUALITY AND SAFETY DECISION MAKING WITH PATIENTS AND FAMILIES Education Program (PSEP-Canada) modules in May 2016. The updated modules reflect the patient and family perspective and support health sector staff, patients and families in advancing patient safety together. “Leveraging the knowledge and lived experiences of health system users is paramount,” says Khan. “Taking our knowledge and experience beyond the walls of single organizations enables providers, patients and policy makers to improve care and makes a meaningful impact on outcomes for everyone.” As Zarem and Khan grew their expertise, more organizations reached out with opportunities to promote health quality across the country.
This summer Accreditation Canada asked Zarem to train as a family surveyor. While Holland Bloorview was having its accreditation survey in October, Zarem was in Halifax doing her first survey at Nova Scotia Health Authority. Zarem was also recently asked to co-chair the Assessment Methodologies technical committee at Health Standards Organization (HSO). HSO is a national body that develops the standards and measures used by Accreditation Canada. Zarem will be using her experience with FLAG and as a patient surveyor to shape decision-making, system wide. This fall Khan completed her training to become a family surveyor with
Robyn Cox is a Communications Coordinator at Holland Bloorview Kids Rehabilitation Hospital.
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Patient reported outcome measures: Canada’s opportunity to be a leader By Neil Fraser & Melicent Lavers-Sailly iven our single payer healthcare system within each province and territory, Canada is uniquely positioned to be a leader in implementing value-based healthcare by addressing both elements of the value equation: measuring outcomes that matter to patients, and integrating funding for the costs associated with those outcomes. Before we become the leader, however, first we have to be in the race. Leading the charge on harmonizing outcomes measurement globally is the International Consortium for Health Outcomes Measurement (ICHOM), which has developed standard sets for almost 50 per cent of the global disease burden. These standard sets not only measure acute complications, survival, and disease control, but also patient reported outcomes. For example, if a patient has prostate surgery, the data set would measure urinary incontinence, sexual dysfunction, and vitality, in addition to complication rates, recurrence, and survival. One of the most striking examples of the impact of measuring patient reported outcomes is their use at the
Martini Klinik in Hamburg, Germany, which has one of the largest prostate cancer treatment programs in the world. By measuring, comparing, and acting upon the results of patient reported outcomes, the program has achieved significantly better results relative to the national average – 6.5 per cent rate of incontinence versus the national average of 43.3 per cent; and 34.7 per cent rate of severe erectile dysfunction versus the national average of 75.5 per cent. The impact of measuring and comparing results is clear. In a fragmented system, with each hospital, regional health authority, and province having its own measurement criteria, it is challenging – but necessary – to make meaningful comparisons. Santeon, a group of six independently run hospitals in the Netherlands, aimed to address this issue by collaborating on a project entitled Collaborating for Value: The Santeon
10 HOSPITAL NEWS DECEMBER 2017
Hospitals in The Netherlands. The report outlines how the six hospitals worked together to standardize reporting of: outcomes – including the addition of patient reported outcome measures – all costs associated with surgery (e.g. diagnostics, treatment days, and outpatient visits), and processes (e.g. cancellation rates). Santeon discovered that by sharing best practices among clinicians, and adopting a centre of excellence approach (also known as an integrated practice unit), they could improve outcomes and reduce costs. For example, by merging the radical prostatectomy
programs of two hospitals, post-operative complications for prostatectomies were cut in half; and the expense of buying a second robot was spared. They also discovered that the simple act of making data transparent had a notable impact. For example, only two hospitals decided to make reducing overnight admission rates for breast cancer care a focus for their improvement teams; nonetheless, all six hospitals reduced the rate of overnight admissions – by an average of 65 per cent – once the data was made transparent.
Canada has some of the best hospitals and physicians in the world. Imagine the opportunity for Canada to improve clinical outcomes if we were able to leverage standard sets and compare outcome measures among our own hospitals, across provinces, and with other countries? In addition to the impact on patients, measuring outcomes would allow governments, healthcare administrators, and care providers to measure the results of adopting new procedures, new payment models, and new technologies â€“ including those provided by companies like Medtronic. At the 2017 ICHOM Conference, Ernst van Koesveld, Deputy Director-General, Ministry of Health, Welfare and Sport, in the Netherlands said the countryâ€™s goals are to measure 50 per cent of outcomes by 2021, and to give 100 per cent of patients digital access to their health records by 2020.
HAVING STANDARDIZED OUTCOME MEASUREMENTS BY CLINICAL CONDITION AND PATIENT SEGMENT IS THE SINGLE MOST POWERFUL DRIVER OF IMPROVEMENT IN HEALTHCARE They are also planning to broadly experiment with health funding models and innovative procurement. If a country of 17 million people has the potential to accomplish this ambitious goal in such a short timeframe, imagine what each province in Canada could accomplish? According to Harvard Professor Michael Porter, who also spoke at the ICHOM conference, having standardized outcome measurements by clinical condition and patient segment is the single most powerful driver of improvement in healthcare.
Not surprisingly then, at an OECD conference in January 2017, Ministers of Health from around the world â€“ including Canada â€“ agreed, â€œWe need to invest in measures that will help us assess whether our health systems deliver what matters most to people.â€? Now that we are in agreement, we have the opportunity to act. The federal government in Canada could play a leadership role in harmonizing outcomes measurement across the country by working with the provinces and aligning with ICHOM data sets. Doing so would address the first element of the value equation.
In order to address the second element of the value equation, and to be able to act on the information gleaned from the outcomes data, we need to be prepared to also address the way we fund healthcare. As with measuring outcomes, there are plenty of international examples of integrated funding models we could leverage. There are even a half dozen Canadian examples of bundled payment pilots in Ontario. We can do better though â€“ by measuring all costs over a complete cycle of care for a specific clinical condition, not just the elements that are reimbursed. Harvardâ€™s Dr. Robert Kaplan has shown that this time-driven, activity based costing method does work in healthcare, not just in factories. Now that we know measuring outcomes and costs works, letâ€™s not only join the race on a national scale, but H aim to be a leader in the field. â–
Neil Fraser is the President of Medtronic Canada, Chair of MEDEC, the industry association representing the medical device industry in Canada, and a Member of the federal Economic Strategic Table, Health & Biosciences. Melicent Lavers-Sailly is Senior Manager, Communications & Corporate Marketing at Medtronic Canada and a Member of the TOHealth! Marketing Working Group.
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How do we plan the
the hospital of the future? By Sarah Hartwick he days of hospitals as institutions set apart from surrounding neighbourhoods are in the past. The Ottawa Hospital is committed to building a 21st-century facility that draws the community in to explore its public spaces, both outdoors and indoors. This might seem a paradigm shift for a hospital but it is an essential one – a great hospital is a cornerstone of a great city. The Ottawa Hospital is in the early stages of planning a brand new healthcare centre in the heart of the nation’s capital. Planned to open in about 10 years, the new centre will replace The Ottawa Hospital’s aging Civic Campus, a building deeply connected to Ottawa’s history. The Civic (formerly the Ottawa Civic Hospital) boasts sections older than the Peace Tower on Parliament Hill and leaves a strong legacy of discovery, research and compassionate care. Like the Civic before it, the new campus will be Eastern Ontario’s regional trauma centre, and will provide acute, specialized and complex care to the region’s 1.3 million residents.
DESIGNING A 21STCENTURY HOSPITAL The hospital of the future is a community space. It’s laced with and surrounded by nature and greenery. It’s a place where cutting-edge science drives learning and discovery. It’s dedicated to health promotion and wellness alongside healthcare and healing. Inside the digitally-connected building, accessible design will be based on scientific evidence, to improve patient flow and access to treatments, and reduce hospital stays, infection spread, stress, staff injuries, and the need for pain medication. Single-patient rooms with private washrooms reduce the spread of infection, and ceiling lifts reduce staff and patient injuries. Nursing sub-stations
ZIM Hospital, Mannheim, Germany – HDR/TMK Architects
The Ottawa Hospital is in the early stages of planning a brand new healthcare centre, one that will draw the community in to explore its public spaces, both outdoors and indoors. allow nurses to take fewer steps and spend more time on patient care. Hallways and elevators separated from public areas move patients more efficiently. “The hospital of the 21st century will be warm and welcoming,” says Dr. Virginia Roth, The Ottawa Hospital’s incoming Chief of Staff. “It will improve safety, privacy, convenience and comfort. It will reach beyond its walls to provide care where it’s best for the patient and improve the wellness of our community. We will be relying on the voices of our patients and community to achieve this vision.” Engaging patients and community members is key to designing a patient-centred hospital, says Dr. Roth. “Having patients and community members involved from the beginning will allow us to provide world-class care that’s centred on the needs of patients rather than the convenience of healthcare providers.”
EMBRACING NATURE The Ottawa Hospital’s new campus will be built in a naturally beautiful
area that is rich in heritage. The site is a unique blend of urban and naturalized landscapes in central Ottawa. It’s nestled next to Dow’s Lake and the Rideau Canal, a UNESCO World Heritage Site where residents and tourists alike gather to skate during Winterlude and stroll through the Tulip Festival displays in the spring. The new campus will honour the Indigenous land it rests on. It will have areas allocated for greenspace, gardens, walking and bicycling paths, and contemplative areas. The hospital has committed to an open and transparent engagement process with the Ottawa community to determine how these naturalized spaces will look at the new campus, among other important issues. Research has found that experiencing nature is directly associated with improved mental health, so wellness areas around the hospital are vitally important for patients, visitors, and staff members. “Getting patients outside for a while can help them feel like they’re not in a hospital any more. It gives them
the break they need,” says Linda Ferro-Chartrand, RN in The Ottawa Hospital’s General Campus Intensive Care Unit. When Stanford University researchers studied participants after they had experienced a walk through nature, they reported lower levels of rumination – repetitive thoughts focused on negative aspects of the self, a known factor for mental illness – and reduced neural activity in the sgPFC, an area of the brain linked to risk for mental illness. Contact with nature contributes to a healthy workplace, and has a proven major effect on staff. A study at the University of Florida found that staff who took breaks outdoors recorded significantly reduced perceived stress and an overall decrease in health complaints. “When patients can see something other than the same four walls of their rooms, it’s good for them,” says Ferro-Chartrand. “Getting some sun and fresh air can really boost their mood H and change up their thoughts.” ■
Sarah Hartwick is Communications Officer at The Ottawa Hospital. 12 HOSPITAL NEWS DECEMBER 2017
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Integrating robotics, artificial intelligence and 3D printing into healthcare systems:
The challenge ahead By Senator Kelvin Kenneth Ogilvie and Senator Art Eggleton, P.C. t isn’t news to anyone in the medical community that Canada is a sprawling country covered by healthcare systems that sit at the core of our national values but are struggling to meet the needs of a growing and aging population.
The system is financially stretched and expensive – $228 billion a year and increasing at a rate of 2.7 per cent annually – and as all hospital employees experience on a daily basis, struggling to meet the needs of the people it’s meant to serve. But here’s some good news.
Senator Chantal Petitclerc greets a robot at a University of Ottawa high-tech laboratory.
14 HOSPITAL NEWS DECEMBER 2017
Artificial intelligence (AI), robotics and 3D printing have progressed by leaps and bounds. While technological innovations are slowly becoming part of some medical treatments, it is also true that the healthcare system has yet to fully adjust to the notion
of ‘automation,’ let alone prepare for it. By ‘automation,’ we mean a myriad of innovations with the potential to cut costs, make treatments and diagnoses quicker, easier and more accurate, and create a system that routinely goes to the patient rather than the other way around. These technologies will help with hospital workflows and management. In home care, wearable devices and sensors will assess and predict patient needs while personal robots will relieve home care helpers from many menial tasks. So how do we ensure that advanced technology and the healthcare system grow together in harmony while keeping Canadians healthy, and successfully treating those who need care in a timely manner? This was the starting point for the Senate Committee on Social Affairs, Science and Technology when we began our study this year on the use of robotics, artificial intelligence and 3D printing in healthcare. Between February 1 and May 15, 2017, we met a dozen times, went on two fact-finding site visits and heard from hospital administrators, surgeons, researchers, research funders, ethicists, entrepreneurs, engineers and healthcare providers. Our final report, released on October 31, is titled Challenge Ahead: Integrating Robotics, Artificial Intelligence and 3D Printing Technologies Into Canada’s Healthcare Systems. Our overarching conclusion? The topic is complicated, but if our 14 recommendations could be boiled down to one sentence, this would be it: With the will and support of the federal government and ongoing producwww.hospitalnews.com
An example of 3-D printing during the launch of the Senate committeeâ€™s report
tive partnerships among stakeholders, we can find a way to make this integration work for the well-being of all Canadians. In healthcare, robotics are already used in laboratory and pharmacy automation, surgery, exoskeletons, rehabilitation needing physical therapy and the daily well-being of the elderly and disabled. Work in artificial intelligence began in the early 1960s, but rapid developments in computer capacity and the advent of the home computer and the internet saw a surge of interest in the 1990s. But as one leading expert told us: â€œArtificial intelligence is only artificial intelligence until some critical mass understands how it works. Then itâ€™s just a computer program. Itâ€™s nothing more.â€?
Uses for artificial intelligence already include speech therapy, diagnostics, and blood tests. 3D printing isnâ€™t printing, as we know it and can more accurately be described as â€˜additive manufacturing.â€™ It uses a range of plastics and metals, cells and other biological materials to build a layered 3D object. In medicine weâ€™re seeing 3D printing used in the building of prototypes for surgical planning, designing implants, producing prosthetics and orthotics and regenerating tissues and organs. The report is the latest in a series of healthcare studies undertaken by our committee. We have examined and reported on obesity and dementia and the increasing needs of an aging population and lifestyle choices as they relate to chronic disease.
The Challenge Ahead, as we will call it, casts us into the future but a future with a strong-enough connection to the here and now to convince us that our hospitals â€“ indeed, all our healthcare components â€“ need to prepare for significant change. We refer to it as a â€™transformative technological revolutionâ€™ and while that sounds dramatic, it is an apt phrase to describe what lies ahead. Our report wonâ€™t give you all the answers because nobody has all the an-
swers. But our research and the witnesses who appeared before our committee left us convinced that, as a country, the better we prepare, the more beneficial these amazing, emerging technologies will be for all Canadians. They will: â€˘ Increase speed and accuracy in diagnosis â€˘ Transform home healthcare and provide surgeons with the tools to operate remotely Continued on page 16
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DECEMBER 2017 HOSPITAL NEWS 15
A University of Ottawa health sciences researcher demonstrates a glove fitted with fingertip sensors. The technology renews feelings of touch for patients suffering severe nerve damage.
The challenge ahead Continued from page14 • Mean less invasive surgical procedures • Offer Canada the opportunity to build a better, more efficient, less costly healthcare system. Robotics, artificial intelligence and 3D printing will eventually take us to a place where the average person will be able to anticipate his or her own heart attack, get immediate notice of insulin deficiency or get body parts artificially renewed and replaced in hours. People will want the same service on their bodies as they get now for their cars. Whatever the ailment, they will want it fixed today – not months or even years from now. Currently, you might have the most brilliant surgeon on the planet, but there is no guarantee you will get to see him or her before it’s too late. With the arrival of artificial intelligence in medicine, people will be even less willing to wait for treatment and it’s going to take planning and a sig-
“THESE TECHNOLOGIES ARE GOING TO REVOLUTIONIZE THE WAY CANADIANS LIVE AND SPECIFICALLY THE WAY HEALTHCARE IS DELIVERED. CANADA CAN CAPITALIZE ON THE FORESIGHT OF ITS INVESTMENT IN THESE RESEARCH AREAS BY MOBILIZING THE TALENT AND SOCIAL STRUCTURES NECESSARY TO RETURN THE BENEFITS TO OUR SOCIETY.” nificant change in institutional culture if our current system is going to cope. During our work for this report, we witnessed the 3D production of a brace for a broken knuckle. It took 15 minutes using a portable machine. It is
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staggering to imagine what the capabilities of 3D production will be 10 or 20 years from now. Canadian researchers have done amazing work in getting us to this stage. We must nurture that energy and innovation and capitalize on it. Our primary recommendation is for the federal government to convene a recurring national conference that would include a broad range of professionals from the healthcare system, government, Indigenous communities and, of course, those who are developing and refining the technologies. That initial conference would create expert working groups representing the various stakeholders and a secretariat to co-ordinate the ongoing work and report progress to the federal government. We chose this route because of the need for Canada to stay on the lead-
ing edge of these technologies and to monitor the ethical and social challenges they will undoubtedly unleash. Patient privacy is an obvious concern for us and so is the need for humans to remain in control. We envision robots as mechanical assistants to healthcare and social workers, relieving them of many routine, menial tasks. Within the healthcare system, there will be job losses, jobs created and tasks within existing jobs that will change. The technological revolution that society in general has experienced during the past two or three decades has shown those types of changes to be inevitable. Robots should not be in charge. They should be our assistants and our servants, but we must learn to trust them, or rather the artificial intelligence that drives their ‘thought’ processes. Physicians need to prepare for, and accept, contrary opinions and patients will need to understand that on occasions, the doctor might be wrong and the robot might be right. Education and training will be fundamental to building this trust. What we heard and saw from a variety of witnesses was enough to convince us that sitting back and waiting for change to happen is not an option. We have to be proactive, and we have H to be prepared. ■
The Hon. Kelvin Kenneth Ogilvie, who retired from the Senate in November, was chair of the Senate Committee on Social Affairs, Science and Technology. Senator Art Eggleton, P.C., is its deputy chair. www.hospitalnews.com
The role of
healthcare security By Sam Asselstine, CHPA communications, Criminal Code applications, first aid and CPR, sharp edge weapon defense, emergency management and has completed a comprehensive on-site training program that includes the hospital’s mission, vision and values as well as the organizational structure of the hospital. The aforementioned is not an inclusive list and different hospitals ask for varying criteria – some expansive and some extremely limited. A growing trend is having healthcare security staff acting as Special Constables with Peace Officer Status. Although not practiced widely across Ontario the concept has picked up steam elsewhere across Canada. These highly trained guards are usually found in supervisory positions and have received next level training at a provincial law enforcement training entity.
efore I found myself fully submerged in the security industry I used to wonder what security staff did all day. What I usually saw were people in uniforms standing around, sometimes in groups who appeared to be waiting for something to happen. Sound familiar? I didn’t wonder what other first responders did all day, I seemed to know or at least thought I knew. Fire, police and paramedics all have highly identifiable roles leaving no question in mind. In healthcare it is no different. For instance, the role of a registered nurse was clear to me. As were the roles of doctors, cleaners, porters, social workers, clerical staff and such – all very important roles dedicated to ensuring the highest possible level of patient centred care. But then, I saw these people in uniforms on the sidelines and I was unsure of what they were there to do.
HOW CAN THEY HELP?
WHO ARE THEY? Healthcare security professionals (HSP) come from a variety of backgrounds and their credentials vary. In some cases the industry is chosen by those embarking on a second career after retiring from law enforcement. Other healthcare security professionals are fresh college graduates from emergency management, police foundations or private security and investigations programs, usually looking for work experience before moving on to their long-term career goals. And then, there are some who have not done either, simply looking for long-term employment, who happen to meet the basic minimum requirements to be licensed. The main question for me was what makes these people healthcare security professionals instead of just – again – people in uniforms who happen to work in a hospital. Some healthcare organiza-
Sam Asselstine (centre) with two of the security guards at The Royal Ottawa Healthcare Group. tions hire just that – security guards to work in their hospitals. The training requirements are weak, and the role of the guard is unclear or at times unnecessary. This is a type of worst case scenario for the person who has been sent to work in a uniform, leading to embarrassing situations usually at the front doors of the facility. This person in uniform is not a healthcare security professional. Although well-intentioned this person is not ready for what’s in store for them in a hospital – where 40 per cent of workers report being assaulted. The best healthcare security programs hire a mix of talent possessing education and experience, with internal annual training
re-certification. The best programs conduct semi-annual reviews of the Standard Operating Procedures and include security staff in the hospital new-hire-orientation process.
WHAT CAN THEY DO? Generally speaking, HSPs have no different power or authority than anyone else. This was another question I always had – “If I get wrapped up with these guys what can they do to me?” As said before, some have no training at all – which is a very dangerous situation for the guard as well as the public they are hired to serve. A well trained HSP is trained in resistance management, crisis management, effective
Well, how they can help will be determined by two things 1. Their level of training, and 2. How their role is defined within the hospital. If their role is supported and defended by the hospital as “ a customer service ambassador” you can be assured that this HSP has the patient in mind. True HSPs are able to assist in Team Huddles as well as Patient Interventions – all the while taking direction and advice from a Clinical Lead. HSPs often have a bridge role within the facility they serve. Assisting various departments in many ways 24/7. Helping environmental services clean up a flood, assisting maintenance with a broken down elevator and walking nursing staff to their vehicles at shift change are all common duties. More and more, HSPs are found in the centre of the circle of care, as patient safety and security is a H paramount focus. ■
Sam Asselstine, CHPA is a Certified Healthcare Protection Administrator and is an Executive Member of the Ontario Chapter for the International Association of Healthcare Security and Safety. www.hospitalnews.com
DECEMBER 2017 HOSPITAL NEWS 17
Body worn cameras
in healthcare security By Mark McCormick n the last few years the topic of Body Worn Cameras, or BWC’s, has become the focus of much public debate. With more law enforcement agencies around the world starting pilot programs or fully deploying BWC’s on their front line officers every day and the general public having ready access to smart phone cameras and You Tube, privacy is becoming an increasing concern. However, as these “new” devices spread throughout our daily lives, most people don’t realize that they have been around for many years. The first time I encountered such a device it was a product called a “Vidmic” and it was 2007. That first article I read, oddly, proudly touted the device as a tool for school bus drivers to record hazardous encounters on the job and only as a secondary option made reference to security and law enforcement applications. During that initial product demonstration, I immediately recognized the potential value in such a device. A short time later I started a conversation with our emergency department leadership team to discuss the potential benefits of recording and reviewing critical incidents within our ED. That conversation turned into quick acceptance of the basic premise and we began a pilot program later that year. Before our initial deployment of the devices we sought and received approval from risk management, legal counsel, our research ethics board, senior leadership team, emergency department leadership and most importantly, our front line nursing staff. After careful deliberation, each group brought forward questions and concerns about the devices and their
usage, each of which was carefully addressed and incorporated into our first policy and procedure documents. Specifically, these centered around encryption, usage, acknowledgment, privacy, access, retention and how/when to share video with the authorities. For data safety, we ensured that our devices are encrypted on the device, the process to download and store the images is password protected and the images themselves are recorded in such a format as to ensure they cannot be modified. Usage of the devices has always been left in the hands of senior security staff, primarily the shift supervisor, to ensure it is controlled by the most senior, well trained individual on duty. When a camera is activated, we routinely advise those present and those who join a conversation, that the camera is on and recording. Access to the data, storage of the video and decisions on when, where and with whom to share footage is always handled as a joint discussion between two or more of the following: security manager, privacy officer, risk manager, corporate legal counsel and human resources, as the situation dictates and are handled in the same respectful manner as all personal health information. Over the ensuing 10 years the legislation, public opinion, our policies and even our equipment have evolved but through it all, the cameras have proven invaluable time and time again. Not only has the announced usage of such a device caused many escalating individuals to self-regulate their behavior, the cameras have provided pertinent and timely first-person perspectives on patient/staff interactions, footage has led to the arrest, trespass and charging of numerous criminals, they have substantiated reports of
abusive behavior against our healthcare workers and community partners and have, without a doubt, resulted in a safer environment. As an investigative tool , body worn cameras have both created and filled a necessary niche in Mount Sinai security’s response to incidents in our environment. Individuals coming forward to report crimes can opt to have us video record their statements from which a transcript can later be accurately created. This has the benefit of vastly increased accuracy as well as eliminating any observer bias in reporting. Photographic evidence of vehicle break ins or injuries sustained during assaults can also be helpful. These cameras have also had a number of unanticipated side benefits: they have helped improve patient care and service delivery and become a powerful training tool. Once we started using the BWC footage to debrief after critical incidents, it was immediately realized that having an impartial, unbiased
recoding of an event could allow us to identify and reward previously unnoticed excellence as well as examine our own faults and then to enact changes to improve both our own responses as well as how we cared for our patients. As privacy concerns about the use of such devices continue to dominate the topic, I am frequently called upon to share our experiences on the subject. Whether at a security conference or with a new front line staff member who has a concern, I regularly maintain that the success of our program can be directly attributed to our transparency and our strict adherence to protocol. Staff have and always will be reminded that these cameras are not a means of covert surveillance but are used as an important tool to protect staff and patients alike. While not everyone may like them, Body Worn Cameras are here to stay and where used properly they are arguably one of the most valuable pieces of H protective equipment at our disposal. ■
Mark McCormick, CHPA is Fire Marshal and Security Manager at Mount Sinai Hospital. 18 HOSPITAL NEWS DECEMBER 2017
The New Security Model:
Enforcement through service By Kevin Schoch he words “Enforcement” and “Customer Service” initially appear as if they could not be any more different from each other. When you picture each term, the visuals depict a very drastic difference. Enforcement persons depict police officers, men and women in tactical vests, belts adorned with handcuffs, radios, and various other items, who show a stern and hard presence whenever they enter a room. Customer service based persons are men and women working in a service environment, striving to help others and solve issues and concerns. While one is viewed as a strict duty to establishing order through rules, law and policies, the other is a compassionate attention to assisting others to achieving a desired goal. For security however, these two terms come hand in hand. This paradigm shift in how security approaches their duties, responsibilities and policies is not a new concept, but it is one that has had a large impact on how the department operates. There was a time when security staff, when called upon, was expected to be purely enforcement, and the “strong hand” of the hospital; restraining patients, conducting arrests, and pushing the boundaries of the use of force model that any security guard is taught to follow. Now, security staff is taught and trained proper use of force techniques, crisis intervention, de-escalation tactics, mental health first aid, positive space awareness, among a variety of other programs, techniques and systems. The aim of this is to improve the standards of professionalism of the security department, better interactions with those in crisis situations, and to help mitigate and minimize violent situations once security is present. To paraphrase Sun Tzu, “The supreme art of conflict is to subdue your enemy without fighting.” The second aspect is to understand that a security department’s role is that of service. It is through servitude to the hospital’s staff, patients, vis-
a mental health patient from harming others, or themselves to helping an elderly visitor traverse the parking lot
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itors, and the facility itself, that they can truly be effective. Serve the staff by responding and assisting in times of need; whether it is from a CODE WHITE, to opening a door when keys are locked inside. Serve the patients by keeping them safe from any further harm or discomfort while they receive treatment; whether that be responding to a patient in crisis, or finding that extra pillow and blanket for a patient laying in a bed in the emergency room. Serve the visitors by ensuring their time at the hospital is as stress free as can be, considering they are at a hospital; whether it be escorting them to their desired destination instead of pointing and giving directions, to a friendly hello and honest smile as they pass. Serve the facility by conducting active patrols and checks to minimize risks and damage; from testing the fire alarm system so should the worst case scenario occur, the system works and security is prepared, to nightly lockups and unlocks to minimize access points in off hours. Commitment to not just service, but selfless service is a new attitude that is changing how security departments approach their role within a hospital. The balance between the two images is one many security departments in a hospital environment continue to perfect. Even in the most high-stress crisis moments, the reminder that security’s presence is to serve, in the best manner possible, all parties involved. That service can come in the form of protecting
in a rain storm, by providing an umbrella and a steady arm to lead them. This commitment to selfless service to others is found in many inspirational speakers, thinkers and social disrupters, such as Robin Sharma, Deepak Chopra, Tony Robbins, Mother Theresa and Princess Diana. This approach now emboldens not only the security department to develop their staff to have an investment in the hospital community, as they are now serving, supporting and protecting the interests of not only the hospital, but its staff, patients and visitors. It positions the security department to be not just an aspect of the hospital, but an integral H piece of the overall community. ■
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Can security reduce
patient falls? By Sam Asselstine, CHPA hen it comes to patient injury in the Canadian healthcare arena, one might consider a variety of causes however, according to the Canadian Patient Safety Institute, patient falls account for $2 billion annually. In fact, one third of the senior population will experience a hospital fall often leading to medical complica-
tions such as chronic pain, disability, loss of independence and even death. Falls are known to be the leading cause of injury among Canadian seniors and account for 85 per cent of all injury related hospitalizations. Today, senior’s over 65 account for 15 per cent of the population, and by the year 2031, only 14 years from now, that number will climb to one quarter of the total population.
Studies in acute care show that fall rates are higher with 8.9 falls per 1000, with even higher fall rates in units that focus on Neurology, Rehabilitation and Geriatric Care. A strange topic to be discussed by Healthcare Security Professionals (HSP) indeed, but a relevant topic being discussed at high levels. The question is, how can today’s HSP work to
prevent patient falls, and how can their employers best prepare them to successfully manage such an interaction. You don’t need to be a clinician to take notice and give a helping hand, although a true HSP will always defer to a clinical colleague. Many security managers/directors will already have a slip and fall protocol, and one should not deviate.
Sam Asselstine, CHPA is a Certified Healthcare Protection Administrator and is an Executive Member of the Ontario Chapter for the International Association of Healthcare Security and Safety. 20 HOSPITAL NEWS DECEMBER 2017
5 ways a healthcare security professional can reduce patient falls DON’T WALK BY POLICY
Healthcare Security Professionals can often get caught up in the busy work environment of a bustling hospital. Remember to offer assistance to those who may need it. Avoid the “it’s not my job” mentality and do the right thing. Your assistance is more appreciated than you think.
HAZARD ANALYSIS Keep an eye out for common hazards that others take for granted. Spills, debris and bodily fluids are all reasons why people fall. Report these hazards right away, and go ahead and take the initiative to clean the mess yourself if it poses a direct risk to patients, visitors and staff.
WEATHER INSPECTION You can’t prevent winter, but you can be aware of the risks associated. Make sure you know where the salt is kept and use it when necessary. Again, don’t get caught up with who is responsible for doing it – if you prevent a fall, you have mitigated risk and that is what you are paid to do.
UNDERSTANDING KINESICS Watch patients and the way they walk. The Non-Verbal cues are there. People walking with limps may be more vulnerable to a fall, or they already could be recovering from one. Slow down – offer assistance and mitigate risk.
SAFETY INVENTORY At the beginning of your shift scan for an inventory of canes, wheelchairs and walkers to be readily available if needed. Hint: Check out your parking lots, common area’s and entrances. If you come across an item in need of repair take it to your maintenance departH ment to be fixed. ■ www.hospitalnews.com
In the face of fire:
Taking care of healthcare facilities By Erin Toews he staff were hired and the training was complete. After months of planning, the Cariboo Memorial Hospital security team was eager to get started. The new service was set to launch on July 10 2017, providing welcome 24/7 security coverage at the Williams Lake hospital for the first time. Who could have predicted that, instead of starting their new jobs, the new security team and other residents of Williams Lake would be ordered to evacuate? It was to be a record fire season in B.C. and the impacts were felt across Interior Health. Over the course of the summer, close to 880 patients and home health clients would be evacuated, to be cared for in other facilities. With communities on evacuation order, and hearing news of looting in some areas, Interior Health’s Protection Services team worked to ensure facilities were protected without having security officers remain on site. Facilities were remotely secured and access cards were temporarily suspended. Anyone requiring access to Cariboo Memorial Hospital or One Hundred Mile Hospital advised Protection Services, who could remotely open doors or reinstate access for individuals on an as-needed basis.
This photo was taken from the CCTV system at Cariboo Memorial Hospital. These two helicopters were aiding in the evacuation of CMH and were the last to leave the site. contracted security provider, throughout the evacuation order period. “As soon as repatriation planning began, they were scheduled to start working at Cariboo Memorial,” says Andrew Pattison, Manager of Protection, Parking and Fleet Services. “The security officers returned home and quickly reported for their first shifts, some without much time to settle back home, working long hours to maintain security coverage in the initial days while the remainder of the team worked to return home.” Although these actions went a long way in keeping the facilities safe, for
SECURITY WAS ONE PART OF A MASSIVE RESPONSE ACROSS INTERIOR HEALTH. IN TOTAL, 19 HOSPITALS, HEALTH CENTRES AND RESIDENTIAL CARE HOMES WERE EVACUATED DUE TO THE WILDFIRES Remote video patrols of the evacuated facilities were also performed regularly from the security office in Kelowna. Meanwhile, the new Cariboo Memorial security officers remained in contact with Paladin management, the
a team that is used to being heavily involved in major incidents, Andrew says it was tough feeling trapped on the sidelines wanting to do more. “I know myself and my security/ protection colleagues all wished we could have done more right out of the
gate,” he says. “But given the remoteness and facilities that were impacted, there wasn’t much we could do. We remained on standby to assist where we could.” “When Logistics requested access to a fleet truck that was not being used in Salmon Arm, my colleague and I drove out from Kelowna on a Sunday afternoon to pick it up and deliver it to Kamloops, so it could be used to move beds, air filters, and other equipment around our facilities as needed. We wanted to help and it felt like the least we could do.” Security was one part of a massive response across Interior Health. In total, 19 hospitals, health centres and residential care homes were evacuated due to the wildfires. “Many people were left devastated by this emergency event and it was essential for their sense of security that we were able to ensure patients, clients, and residents in our care were never at risk,” says Interior Health President & CEO Chris Mazurkewich. “While the wildfires were beyond our control, we were able to make sure patients were evacuated safely and well taken care of even when we had to improvise and make the best of limH ited space and supplies.” ■
Erin Toews is a Communications Consultant at Interior Health. DECEMBER 2017 HOSPITAL NEWS 21
right to search By Sam Asselstine, CHPA et me set the scene. Three police officers arrive at 3:00am with an Emotionally Disturbed Person/ Patient (EDP). The officers are directed to take the patient to a secure room. The patient is formed under the Mental Health Act and now considered “Involuntary”. Police leave the patient in the custody of the hospital and assure clinicians the patient has no weapons. The police have now cleared. Security staff are alerted by the nurse that to ensure the safety of the patient and the rest of the emergency department, they will be required to assist in the search of the patient, including asking the patient to change into a gown, and remove their backpack. The nurse asks the patient for consent to search and the patient becomes argumentative, and refuses claiming that they know their rights. The nurse consults the attending physician, who orders the door to be locked and the patient to be searched. No one wants to do it, the nurse and security all worried about the ramifications… sound familiar? All the security staff can think of is a glaring violation of Section 8 of the
Charter of Rights and Freedoms that says “Everyone has the right to unreasonable Search or Seizure”. To be named in a Charter violation at the beginning of your career can be a potential career ender. All the nurse can think of is “The bill of Patient Rights”, as well as their Nursing License. No clinician wants a battle with any patient advocacy office, armed with lawyers. To put this situation in perspective we must focus on the rationale that has led to the search as well as how the search is conducted
result? Could it be argued that the hospital did not take every reasonable precaution to ensure the safety of the patient? What about employees? Could the same be argued if an unsuspecting staff member were injured/assaulted as a result? Remember, the patient has been placed on a Form 1, under the Mental Health Act by a competent medical authority, which means that the patient has been deemed to be a threat against themselves or others. Having the patient change into a gown reduces the opportunity for the patient
IT IS NOT THE RESPONSIBILITY OF THE SECURITY STAFF TO SEARCH THE PATIENT, HOWEVER THEY SHOULD PLAY A SUPPORTING ROLE IN THE PROCESS SAFETY, SAFETY AND SAFETY! The paramount reason for changing a patient into a gown and searching for weapons is...you guessed it, patient and environment safety. What would be the fall out, should a search not occur and the patient self-harms as a
22 HOSPITAL NEWS DECEMBER 2017
to use their clothing for the purpose of self-harm, and any items that may have been missed by the police (it happens more often than you may think) will now be in the custody of the hospital until time of discharge. Section 3(1) of the Occupiers Liability Act of 1990 states that “An occupier of prem-
ises owes a duty to take such care as in all the circumstances of the case is reasonable to see that persons entering on the premises, and the property brought on the premises by those persons are reasonably safe while on the premises” Ever notice that there are no signs around a hospital that say, all patients assume the risk of being assaulted by another patient? This is because legislation states that the occupier is responsible for reducing this risk.
PATIENT AND CLIENT CENTRED It is not the responsibility of the security staff to search the patient, however they should play a supporting role in the process. Healthcare security staff have become increasingly patient centred and understand that any search must be done “by using least invasive means necessary” so as to not make the search “unreasonable”. Techniques such as using the back of ones hand to search body parts, and “effectively communicating” through this process are just two techniques that should be employed. Instead of conducting the search themselves, security staff should create the conwww.hospitalnews.com
HOSPITAL SECURITY ditions for the search to occur by the clinicians. In addition, gender should always be considered. If the patient happens to be female, and the security team is all male, a security supervisor might want to consider enlisting the support of a female staff member from a neighboring department. In an all fail scenario, consider requesting the assistance of a female police officer. Either way you will want to document that efforts were made to consider the sensitivity to the gender of the patient. Remember, this is a horrible moment for an EDP, and the goal of all staff is to play a role in the healing process, not to damage the patient any further.
PATIENT RESTRAINT MINIMIZATION ACT (2001) The purposes of this Act are to “minimize the use of restraints on patients and to encourage hospitals and facilities to use alternative methods, whenever possible, when it is necessary to prevent serious bodily harm
DO HOSPITALS HAVE THE RIGHT TO SEARCH PATIENTS WHO ARE DEEMED TO BE A THREAT AGAINST THEMSELVES OR OTHERS? THE ANSWER IS YES by a patient to himself or herself or to others.” So placing a patient in a gown, and removing other items such as bags/backpacks instead of chemical and/mechanical restraints actually satisfies the hospitals requirement to comply with this piece of patient centred legislation. When a patient refuses to comply with a search, reasonable grounds have presented themselves that a search must occur, to satisfy the requirement to keep the patient and the hospital safe. Imagine going to a theme park and refusing a search – one would certainly be denied access to the park. The difference between a theme park scenario and a hospital is that the patient cannot leave, and as long as the patient is considered “Involuntary”
the hospital has to take responsibility for the safety and security of the patient as well as the environment.
DOCUMENTATION Should a patient demonstrate active resistance or assaultive behavior during a patient search under the aforementioned circumstances it is important to understand that the duty of security staff would effectively change from assisting with the process to protecting the nurse. The provision of security staff is for the protection of people and property, this function of security is not disputable. At this point the security staff would be required to articulate why they used the level of force that was required, and receive
protection from the Criminal Code of Canada as long as the force is no more than necessary. Do Hospitals have the right to search patients who are deemed to be a threat against themselves or others? The answer is Yes. Should everyone consult and be trained in the relevant legislation instead of taking my word for it? Yes! Will everyone involved in the process at some point be named in a discovery process? Yes! As hospital culture is becoming increasingly violent, and society continues to seek resolve through civil courts, the onus will always be on the care providers to articulate why the search was necessary, how the search was performed as well as the duty of care that was exercised to enhance the patient experience rather than contribute to what might have been the worst day ever in the life of the patient. All these things considered will be considered mitigating factors that will contribute to your innocence after being accused of a Charter violation and/or patient H assault. ■
Sam Asselstine is the Manager of Security, Safety and Parking at The Royal Ottawa Mental Health Centre and is Chapter Chair, International Association of Healthcare Security and Safety – Ottawa/Carleton Chapter
FROM THE CEO’S DESK
Let’s innovate how we innovate By Dr. Andy Smith ince starting my role as the President and CEO of Sunnybrook Health Sciences Centre a few months ago, people have often asked me: ‘what keeps you up at night?’ Well, the truth is, quite a bit. But specifically, my thoughts are often focused on how can we continue to deliver great care in the face of pressing demand (which will only continue to grow) and how can we achieve our vision to invent the future of healthcare and therefore improve care for our patients? I believe the answer to this challenge is found in our ability to innovate, which requires our people and teams to be nimble, and in attracting support – financial and otherwise – to help fuel our engine of discovery. The factors that drive nimbleness and innovation are multiple in number, however, two important elements are collaboration with our research institute and philanthropy. At Sunnybrook, we have made a concerted effort to blur the line between our researchers and clinical care teams. Having basic scientists and engineers working alongside our physicians, nurses, and professional staff has resulted in some dramatic innovations and world firsts for our organization. For example, so called ‘scalpel-free surgery’ that uses high intensity focused ultrasound (HIFU) has been pioneered from bench to bedside in precisely this manner. In a relatively short number of years, our interprofessional teams have brought science-fiction to reality and are now using focused ultrasound to treat patients who have essential tremors, and are exploring use of this technology in the treatment of cancer, Alzheimer’s, obsessive compulsive disorder, and several other conditions. It is increasingly possible to imagine a day where cutting into a patient with a scalpel will be the exception rather than the norm. This innovation materialized as the result of putting great minds together and providing them with government
THE FACTORS THAT DRIVE NIMBLENESS AND INNOVATION ARE MULTIPLE IN NUMBER, HOWEVER, TWO IMPORTANT ELEMENTS ARE COLLABORATION WITH OUR RESEARCH INSTITUTE AND PHILANTHROPY support, and the generosity and vision of our donor community to help accelerate the development from idea to innovation to system implementation. Our goal through these initiatives is to meet increasing demand for care while creating efficiencies in the use of resources. Essentially, innovation and investment helps stretch our finite healthcare dollars to achieve the greatest societal impact. Another great example is our Cancer Ablation Therapy program. This involves sophisticated imaging (such
as MRI) combined with refined radiation to deliver treatment with unprecedented precision, but also provide a better experience for patients. For example, brachytherapy treatment of gynecological cancer that once required up to eight hours and multiple visits are now accomplished in two hours while the patient is asleep. Not only is this great for the patient but it is also good for the healthcare system. It reduces the need for stay in hospital and therefore decreases costs. This is the aim in all we do: increasing quality,
improving the patient experience and decreasing the cost of care. Philanthropists in Canada have long provided Sunnybrook and other hospitals with crucial resources necessary to not only provide exceptional care but also fund research and innovation. For that we are truly grateful. How do we take this a step further? Recently at Sunnybrook, I’ve seen some amazing and original approaches to fundraising that are getting people excited about healthcare innovation. The “Sunnybrook Next Generation Hawk’s Nest” for example is a group of young business professionals who are hearing pitches from medtech start-ups and awarding a prize to the company with the most promising project. Funds raised at the event will be donated to the Sunnybrook Research Institute. I recognize however, that not all science should be tied to a business plan. In fact, discovery research often does not yield an immediately obvious marketable product but rather, it provides the seed for further work. When we do have a marketable success, our role is to be ready to implement it with a view to improving care across the system and generating economic opportunities to fund further research. I am also aware of the need to have a critical eye on how we measure the impact of innovation. We are well aware that new is not always better. If a new technology is so expensive that we are unable to adopt it for widespread use, our efforts may be in vain. Our challenge then is to get better at reimagining ways to make it work or try another track all together. We have seen improvements in the many ways we diagnose and treat illness to keep patients as well as possible and avoid unnecessary hospital visits. But to improve our healthcare system, we need to improve the way we innovate. Creating an environment where great minds are provided with time and investment to achieve great things is the way forward. My role is to ensure this happens, and it’s a challenge I’m H willing to lose sleep over. ■
Dr. Andy Smith is the President and CEO of Sunnybrook Health Sciences Centre. 24 HOSPITAL NEWS DECEMBER 2017
Getting a sense of biosimilars By Barbara Greenwood Dufour reatments called biosimilars have been gradually entering the Canadian pharmaceutical market, adding treatment options for patients with chronic, difficult-to-treat diseases. But what are they and who should use them?
UNLIKE TRADITIONAL DRUGS Biosimilars, formerly called subsequent entry biologics, are highly similar versions of biologics, or biologic drugs. Biologics are a class of drugs that are used to treat chronic diseases such as diabetes, anemia, inflammatory bowel disease, psoriasis, rheumatoid arthritis, hormone deficiency, and some forms of cancer. They are designed to control specific immune system responses – for example, to block an inflammatory response in the treatment of Crohn’s disease or, to treat certain cancers, stimulate an inflammatory response to attack cancer cells. Some examples of biologics include insulin analogues, erythropoietin, interferons, and monoclonal antibodies such as infliximab or adalimumab. What distinguishes them from traditional drugs is that they are manufactured using human or animal tissue or micro-organisms instead of chemical reactions. In Canada, biosimilars can be brought to market after the patent for the original product – the “reference biologic drug” – has expired. More and more biosimilar treatments, therefore, can be expected to become available as the patents on biologics expire.
NOT AN EXACT COPY, BUT SIMILAR Like generic drugs, biosimilars are post-patent copies of original, brand name products. But, unlike generic
drugs, which contain exactly the same active ingredients as the brand name versions, biosimilars are not exact copies. Whereas generic drugs and their brand name versions are small molecules that can be precisely replicated, biologics are large molecules that are produced using complex and proprietary manufacturing procedures. This makes it difficult to exactly duplicate all of their characteristics. In fact, because biologics are derived through the metabolism of living organisms, there could also be variations between batches of the same biologic drug.
BIOLOGICS ARE A CLASS OF DRUGS THAT ARE USED TO TREAT CHRONIC DISEASES SUCH AS DIABETES, ANEMIA, INFLAMMATORY BOWEL DISEASE, PSORIASIS, RHEUMATOID ARTHRITIS, HORMONE DEFICIENCY, AND SOME FORMS OF CANCER ARE BIOSIMILARS EFFECTIVE? Not identical doesn’t mean not as effective. There is a process in place to make sure that every biosimilar marketed in Canada is a good and safe therapeutic alternative. Prior to being authorized for sale, the drug manufacturer must prove to Health Canada
that the product is highly similar to the reference biologic drug according to a detailed set of criteria – including, for example, its biochemical structure and its pharmacodynamic (how the drug affects the patient) and pharmacokinetic (how the patient’s body processes the drug) characteristics – as well as in terms of its effectiveness and safety profile. This ensures that there are no clinically meaningful differences in safety, quality, and efficacy between the biosimilar and the original biologic.
WHEN TO SUBSTITUTE A BIOSIMILAR Because, unlike generic drugs, biosimilars aren’t exact copies of the reference biologic products, pharmacists can’t automatically substitute a biosimilar for a biologic. Instead, whether to initiate treatment on or switch to a biosimilar is a decision that rests with healthcare providers and their patients with consideration to each patient’s unique situation and based on the available clinical evidence.
WHAT’S THE BENEFIT OF BIOSIMILARS? Biosimilars typically cost less than biologics. When biosimilars become available, the resulting market competition tends to lead to lower prices. Given that biologics are some of the most costly treatments available – because their complexity makes them
expensive to develop and manufacture – the cost savings could be significant. As a result, biosimilars have the potential to expand and improve access to treatment for patients and to save money that can be redirected elsewhere within the healthcare system. To help healthcare decision-makers better understand biosimilars and their use in clinical practice, CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – has produced useful, evidence-based tools for healthcare providers and their patients. These tools, which briefly describe what biosimilars are and explain the differences between interchangeability and switching, can be found at www. cadth.ca/biosimilars. Tools developed to explain generic drugs and bioequivalence are available at www.cadth.ca/ generics. For the evidence on specific biosimilars or biologics, you can search the CADTH website at www.cadth. ca/reports. If you would like to learn more about CADTH and the evidence we have to offer to help guide healthcare decisions in Canada, visit www.cadth. ca, follow us on Twitter @CADTH_ ACMTS, or contact a CADTH LiaiH son Officer in your region. ■
Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com
DECEMBER 2017 HOSPITAL NEWS 25
NEWS The MRI machine at the recently-expanded Milton District Hospital.
2017 – A healthy year for hospital infrastructure renewal By Michaela MacPherson his past year was significant for Infrastructure Ontario and the healthcare sector. We brought our hundredth project to market, and more than half of those are hospitals. Here’s a look at some of the projects that reached significant milestones this past year:
CASEY HOUSE (TORONTO) In March, construction wrapped up on a new facility for Casey House, a specialty hospital for people living with HIV/AIDS. The new 58,000 square foot space has enabled an enriched model of care, increasing Casey House’s capacity to accommodate a new day health program.
PROVIDENCE CARE HOSPITAL (KINGSTON) In Kingston, the new Providence Care Hospital opened its doors in April. The 622,000-square-foot hospital is Kingston’s largest infrastructure
project to date, and includes 270 private inpatient rooms, as well as modern therapy and clinic spaces for inpatients and outpatients. The facility is also among the first hospitals in North America to fully integrate long-term mental healthcare with complex care and rehabilitation.
BROCKVILLE GENERAL HOSPITAL In May, an RFP was issued for a company to build and finance the Brockville General Hospital redevelopment project, which will account for the largest public investment in the Leeds-Grenville region. The redevelopment involves the construction of a new four-storey tower and renovations to the existing Charles Street facility. Once complete, programs and services currently offered at the Garden and Charles Street sites will be consolidated to the Charles Street site, offering more accessible care for those who need it.
26 HOSPITAL NEWS DECEMBER 2017
Joseph Brant Hospital’s new Patient Tower in Burlington was completed in summer 2017. Renovations to Joseph Brant’s existing tower are ongoing, and expected to be complete by the end of 2018.
JOSEPH BRANT HOSPITAL (BURLINGTON) In August, Joseph Brant Hospital opened the doors to its new patient tower, complete with a new emergency department, operating rooms, a new intensive care unit, and room for 172 beds. All acute care patient rooms in the new tower have a view of Lake Ontario, Hamilton Harbour and/or the Niagara Escarpment. The renovation to the existing hospital is ongoing,
and expected to be complete by the end of 2018. All told, this project is bringing state-of-the-art healthcare and medical facilities and services to a community that has not seen their hospital redeveloped in 50 years.
WEST PARK HEALTHCARE CENTRE (TORONTO) West Park provides specialized rehabilitation, complex continuing care, long-term care and community health www.hospitalnews.com
NEWS services to help individuals get their lives back. In July, an RFP for a team to design, build, finance and maintain the 730,000 square foot replacement facility was released. The new hospital development will have capacity for 314 beds, 80 per cent single-patient rooms, and significantly increased outpatient care and services. As part of West Park’s vision to provide exemplary care inspired by innovation and exceptional performance, the project will also transform the 27-acre site into an integrated campus of care that truly models the way of the future for patient care delivery, education and research.
GROVES MEMORIAL COMMUNITY HOSPITAL (CENTRE WELLINGTON) In August, the community of Centre Wellington celebrated the start of construction on the new Groves Memorial Community Hospital. Patients and families will soon have better access to healthcare with the construction of a new, modern, rural hospital in
ity for critical care, maternal-newborn care and diagnostic imaging, including a new MRI machine. The project also added as many as 66 new inpatient beds, with more private rooms to protect patients from infection and provide privacy.
CENTRE FOR ADDICTION AND MENTAL HEALTH (CAMH) (TORONTO) Officials celebrate the start of construction on CAMH 1C Redevelopment Project (October 2017). Aboyne. The new hospital will replace the existing facility in Fergus, and will accommodate the healthcare needs of the growing region by late 2019, providing more space for emergency, ambulatory, diagnostic and inpatient services as well as more private, single-patient rooms.
MILTON DISTRICT HOSPITAL Hospital officials and patients celebrated a ribbon cutting in Milton
this past September, the second hospital project Infrastructure Ontario has delivered for Halton Healthcare (Oakville Trafalgar Memorial Hospital, 2015). Adding 330,000 square feet to the existing hospital, the expanded facility was built to meet the increasing care needs of one of Canada’s fastest growing communities. The new centre will offer a full range of clinical services for this rapidly growing community, including new emergency, surgery and inpatient beds, as well as more capac-
Michaela MacPherson works is a communications advisor at Infrastructure Ontario.
This October, shovels hit the ground once again on CAMH’s campus. Phase 1C of the redevelopment project is the largest and boldest to date. It involves the construction of two hospital buildings that will support the immediate care and recovery of patients with acute and complex mental illnesses, while advancing education and research. Once complete, all inpatient and clinical programs will be consolidated onto the Queen Street site and integrated with green space and the surrounding neighbourhood, allowing for seamless, flexible, H patient-centred care. ■
Carter with his parents Stephanie and Adam. Carter is believed to be the youngest person in Canada to undergo the cochlear implant procedure.
Youngest cochlear implant patient By Ana Fernandes ‘magical life-changing moment’ is how parents Stephanie Visser and Adam Holland describe the day their son Carter’s cochlear implants were ‘turned on’ for the first time. Carter Holland, now six months old, received bilateral cochlear implants when he was just three months of age, and is believed to be the youngest person in Canada to undergo this procedure to restore hearing in both of his ears. Twelve days after Carter was born he was rushed to the emergency department at The Hospital for Sick Children (SickKids) with a high fever, which was later diagnosed as meningitis. As part of the provincial Infant Hearing Program, all babies in SickKids’ neonatal intensive care unit (NICU) undergo hearing screening. In the case of meningitis, hearing loss is a known side effect, so early detection is critical, notes Vicky Papaioannou,
Audiologist and Associate Director of the Cochlear Implant Program at SickKids. Meningitis can cause the hearing organ, the cochlea, to turn to bone (ossify) meaning Carter would not be a candidate for cochlear implants. “Carter is a great success story and an example of how our hearing loss intervention program is working,” says Papaioannou. Due to the high risk of hearing loss associated with meningitis, in 1997, Papaioannou and the Otolaryngology team developed a protocol to quickly assess the hearing of children with bacterial meningitis at SickKids. This streamlined the process from hearing loss identification to cochlear implant surgery in just six weeks, avoiding the risk of cochlear ossification which prevents implantation of the electrode. Before meningitis vaccination in the early 2000s, SickKids performed around five cochlear implant surgeries a year due to meningitis complica-
tions, now we see less than one to two cases a year, says Papaioannou. “Carter had spent weeks in the NICU, so our main concern was naturally the meningitis and that he would live. When we were first told that he had lost his hearing, we were shocked but it didn’t really sink in. It wasn’t until we were discharged home and trying to play and interact with him did we realize that he seemed very absent and didn’t look at us very much. It hit us then that he couldn’t hear us or the world around him,” says Stephanie. With his other health issues stabilized, Carter was discharged from SickKids’ NICU in late May. He went into surgery to receive his cochlear implants on July 31, 2017 and had them activated or ‘turned on’ a month later on Aug. 28, 2017. “In a matter of minutes he went from staring blankly, not focusing on anything around him to giggling and responding to our voices.
It was amazing, absolutely life-changing. As soon as we got him back home, we noticed him actively engaged, looking at us, reaching for things. It was a complete, night-and-day change.” At six months old, Carter is doing well and regularly comes to SickKids for physiotherapy and other appointments to ensure he’s meeting all his developmental milestones. He was recently fitted for a special helmet to address a mild case of plagiocephaly (flat head syndrome), that will also accommodate the external speech processor of the cochlear implants. SickKids Cochlear Implant Program performs about 100 cochlear implantations per year in children of all ages. For most cases of severe to profound hearing loss, either congenital or acquired, it is ideal to do the surgery before speech has developed at around eight months. Due to Carter’s unique case, the team responded more H quickly. ■
Ana Fernandes is an Intern, Communications and Public Affairs at The Hospital for Sick Children. 28 HOSPITAL NEWS DECEMBER 2017
The next generation tool in medication safety:
The Knowledge Mobilization Tool By Edmond Chiu and Certina Ho edication safety in Canada is an area that many stakeholders can relate to. From pharmacists to physicians, from nurses to patients, each of these groups considers medication safety a core value in healthcare. Throughout this decade, the Canadian Medication Incident Reporting and Prevention System (CMIRPS) has brought together the Institute for Safe Medication Practices Canada (ISMP Canada), Canadian Institute for Health Information (CIHI), Canadian Patient Safety Initiative (CPSI) and Health Canada, to collect, analyze, and share medication incidents reported by Canadians and healthcare professionals alike. The learnings from this initiative are vast and its power continues to grow with new incidents and themes being generated from ongoing incident analyses. With the increasing volume of shared learning, there is a need for a new resource to help manage and support information search and retrieval. The Knowledge Mobilization Tool (KMT) is a novel approach to address this need. The KMT serves as the next generation tool in medication safety.
WHAT IS THIS TOOL? The KMT is an educational tool providing healthcare practitioners with relevant, context-specific information at the point of conducting medication incident analyses or performing quality improvement initiatives. Users can search for medication incident analyses and learnings, using variables, such as, drug name, type of error, stage in the medication-use process, and more. The search conducted by the KMT will retrieve from the ISMP Canada database of medication incident analyses and generate a report containing relevant results in three categories: (1) Published Incidents; (2) Contributing Factors; and (3) Published Recommendations.
HOW CAN IT BE USED? Consider a pharmacy has identified a medication error involving www.hospitalnews.com
mix-ups between bisoprolol (a cardiovascular medication) and bisacodyl (a laxative). When performing quality improvement for the pharmacy, the team would like to know if this type of mix-up or similar incident has been reported by other healthcare professionals and whether previous analyses have been conducted regarding the mix-up between these two medications. The pharmacy team can use the KMT to learn more from incident analyses generated by ISMP Canada.
MEDICATION QUERY The search using the KMT reveals information on Published Incidents and Contributing Factors of medication incidents. The pharmacy team recognizes that it is not the first time a mix-up like this has occurred and reported in other healthcare settings. The team also explores and discusses the contributing factors to help them identify system-level solutions for the pharmacy. In this case, the results generated by the KMT highlight that look-alike/soundalike drug names, lack of drug or patient information (at the order-entry stage), proximity of drug names in the selection menu of the dispensing software, and proximity of the storage location of the two medications with look-alike/sound-alike names are potential contributing factors of the incident.
WHAT DOES THE KMT MEAN FOR YOU? The KMT enables you to find previous incident analyses and recommendations that ISMP Canada has identified from medication incident reporting by Canadians and healthcare professionals. The context-specific search algorithm makes it easy to find what is available in the wealth of medication incident analyses and recommendations that ISMP Canada has published and disseminated. The KMT facilitates shared learning from previous medication incidents in a novel approach by providing information at the point of quality improvement to help drive decision-making and advance safe medication use in the healthcare setting.
THE FUTURE OF KMT Currently, the KMT is a knowledge translation/retrieval tool. In the future, the KMT can be integrated into medication incident reporting programs. For example, consider a medication incident is being reported by a healthcare provider (i.e. the
reporter). Since the variables being required for incident reporting are the same as the search criteria that need to be inputted to the KMT, the reporting program can respond to the reporter of the medication incident with the output generated by the KMT, which includes relevant information pertaining to previously (1) Published Incidents; (2) Contributing Factors; and corresponding (3) Published Recommendations. The reporter will not only share a new medication incident, but also simultaneously learn from previous incidents and analyses. The quantity of relevant information will grow as medication incidents continue to be reported and analyzed; the KMT will help make the shared learning from medication incidents searchable and accessible. Medication safety will continue to be a priority in healthcare settings and the KMT is a key resource to facilitate and support healthcare practitioners to become proactive about it. The Knowledge Mobilization Tool (KMT) is accessible at https://secure.ismp-canada.org/ H KMT/ â–
Edmond Chiu is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; and a Medication Safety Analyst at the Institute for Safe Medication Practices Canada (ISMP Canada); Certina Ho is a Project Lead at ISMP Canada.
RELEVANT INFORMATION At the same time, the KMT provides a link to relevant ISMP Canada Safety Bulletin(s) where pharmacy staff can find additional details behind the contributing factors, as well as recommendations at each stage of the medication-use process regarding how to prevent future mix-up between bisoprolol and bisacodyl. The team can then decide to have a quality improvement meeting to follow-up and agree on which recommendation(s) to undertake at the pharmacy. DECEMBER 2017 HOSPITAL NEWS 29
Living me By Daniel Punch
wenty-year-old Nolan Blodgett walked into a Peterborough health centre hoping to make his body look the way he felt inside. It was September 2014, and he had come out as transgender the previous November. The 10 months since were the most difficult of his life. Since coming out, he had taken small steps toward living life as a man. He bound his chest to hide the breasts he felt shouldn’t be there, and changed his name to Nolan. But that did little to ease his debilitating anxiety and depression. Finding little understanding from family and friends, he attempted suicide in February 2014. “I just hated (my body) so much I couldn’t focus on anything else,” Blodgett recalls. He knew he had to explore medical transition if he was ever going to be happy with how the world saw him. For a transgender man, that meant taking regular doses of testosterone to make his physical appearance more in line with his gender identity. To do that safely, he needed a healthcare provider.
providers. About 19 per cent were denied healthcare because of their gender identity. Blodgett remembers visiting a physician for an ear infection, only to be peppered with questions about his genitals. Another physician scolded him for wearing his chest binder, which got in the way of a stethoscope. And during a four-week stay in hospital after his suicide attempt, nurses often refused to use his preferred male pronouns, corrected others who referred to him as a man, and blamed all his mental health problems on his gender identity. He carried the weight of all those experiences as he sat in a Peterborough waiting room that September day in 2014. But he quickly found out this experience would be different. Howard greeted him and they spent the first part of the appointment just chatting about life. She didn’t assume anything about his history or his goals for his body. She just listened. “(She) didn’t treat me any differently than everyone else,” Blodgett recalls. “That was probably the first time I experienced that.”
DESPITE SIGNIFICANT BARRIERS TO HEALTHCARE, NURSES ARE HELPING TRANSGENDER ONTARIANS TO EXPRESS THEIR TRUE GENDER IDENTITIES That’s how he ended up in registered nurse Sheena Howard and physician Vanita Lokanathan’s Peterborough office. Covered in rainbow flags and trans-positive posters, it looked like a safe space. But he had every right to be skeptical. Transgender people face significant barriers to healthcare. Nursing and medical school curricula barely cover trans issues, if at all. A 2010 U.S. survey by the National Center for Transgender Equality found half of trans people who received healthcare had to educate their care
Howard and Lokanathan worked with their first openly transgender patient five years earlier, when the local medical officer of health recommended them as “friendly” care providers. They quickly earned a reputation among the local trans community. Before they knew it, they were getting referrals from as far away as Toronto, London, Kingston and North Bay. Today, Howard works directly with about 75 of Peterborough Family Health Team’s 220 trans patients. She says her approach is no different than with any other health issue – check for contra-
30 HOSPITAL NEWS DECEMBER 2017
Photo by Jeff Kirk
Nolan Blodgett (right) found “safe” healthcare with Peterborough RN Sheena Howard (left) in 2014.
indications, watch for side effects, monitor blood work, and adjust dosage as necessary. Above all, treat patients with respect and dignity. “Healthcare providers are supposed to meet everyone with an open mind, an open heart, and a willingness to help,” she says. She admits she’s shocked by the barriers trans people encounter accessing care. Patients tell her about being flat-out refused care by health professionals who say they don’t understand. The barriers are also systemic. Healthcare professions have long viewed transgender people as having mental health issues. Gender dysphoria – the feeling one’s gender is different from what was assigned physically at birth – is still classified as a mental illness on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. For a long time, the only option for transgender people seeking medical transition was to undergo extensive evaluation by a psychiatrist, who ultimately decided if they qualified. It often took years before a trans person could access hormones, if at all. Today, health organizations like Howard’s follow the informed con-
sent model, as outlined in the guidelines from the World Professional Association for Transgender Health (WPATH) and Toronto’s Sherbourne Health Centre. Under this model, patients are taught about the benefits and risks of hormone therapy, and make the decision for themselves. The process takes weeks or months, instead of years. Howard says this can make a huge difference for patients during a very difficult time. “From the moment you acknowledge to yourself you’re transgender to the moment you get the help you need, that’s your highest risk of suicide,” she says. That was the toughest time for Blodgett, and he says struggling to find a supportive healthcare provider was a trigger for his suicide attempt. Transgender Ontarians are at least 10 times more likely than the rest of the province to attempt suicide, according to a 2010 survey by the Ontario-based Trans PULSE research project. Blodgett thinks poor access to healthcare is a factor. “When people aren’t able to get (healthcare)… it’s kind of the last straw.” Blodgett was eventually transitioned out of Howard’s clinic and is continuing hormone therapy with support from his primary care physician. He recently completed a psychology degree at Trent University, where he wrote his undergraduate thesis on trans people’s experiences in healthcare. When he and Howard ran into each other at a Peterborough Pride celebration last year, she didn’t even recognize the bearded man in front of her. He identified himself, and she was flooded with memories of his first visits to her office when he was on the brink of suicide. He thanked her, gave her a big hug, and told her she saved his life. Howard’s voice wavers when she thinks back to that day. “That’s such a gift. (It) is precisely why I got into nursing,” she says. “Who wouldn’t want to have someone say that to H you?” ■ www.hospitalnews.com
St. Michael’s Hospital says it plans to build the world’s leading treatment and research centre for multiple sclerosis, to be known as the BARLO MS Centre after the two families who each donated $10 million to the centre, John and Jocelyn Barford (left) and Jon and Nancy Love (right). The donors are shown walking across the bridge from the hospital to its research building after touring the site of the new centre.
World leading treatment centre for multiple sclerosis By Leslie Shepherd t. Michael’s Hospital has announced plans to build the world’s leading treatment and research centre for multiple sclerosis (MS). The centre will occupy the entire top two floors – about 25,000 square feet–of the hospital’s new 17-story Peter Gilgan Patient Care Tower under construction in the heart of downtown Toronto. St. Michael’s already has the largest MS clinic in North America, with about 7,000 patients, and is home to some of the world’s leading MS clinicians and researchers. MS is known as “Canada’s disease” because the country has the highest prevalence of the neurological disease in the world. One in every 340 Canadians lives with MS. It affects three times as many women as men and strikes people in the prime of their lives, as the average age of onset is 31. “Our ultimate goal in creating the world’s premier multiple sclerosis centre is to find the cause of this disease and then a cure,” says Dr. Xavier Montalban, the world-renowned Spanish clinician and researcher who was recruited to St. Michael’s this summer to lead the centre. “While we are working on that, we will give our patients the best possible
care from the moment they are diagnosed in our new world-best centre of excellence. Every day, three more Canadians are diagnosed with MS. Early diagnosis means we can start people on promising new treatments and give them hope they can live fulfilling and productive lives.” The clinic, which will be custom-designed for the care and needs of MS patients, is expected to open in 2020. Dr. Montalban says the clinic will offer “one-stop care” for patients who will be diagnosed, treated and offered the opportunity to participate in research, all in the same location. They will see not only their neurologists and nursing team in the same place, but also a broad interprofessional support team of social workers, physiotherapists, occupational therapists, speech therapists and other medical professionals. He says that because of the growing awareness of the impact MS has on a patient’s mental health, cognition and relationships, the clinic is already recruiting a neuropsychologist – a psychologist that deals with how the brain and the rest of the nervous system influence a person’s cognition and behavior. (80 per cent of MS patients may find themselves unemployed)
St. Michael’s is also conducting an international search for a basic scientist to study the disease at a cellular and molecular level in the hopes of finding out what causes MS and then how to stop or delay the onset of symptoms. Growing evidence suggests that Vitamin D levels play a part, which would explain the high prevalence of the disease in Canada. Smoking, exposure to certain viruses, obesity and genetics may also contribute. The clinic will also have: • an “independent living laboratory,” an apartment/living space where people with mobility and/or cognitive difficulties can learn how to adapt their movements to their surroundings • A dedicated infusion centre, where MS patients can receive drugs intravenously when they need them and with their expert health-care team nearby. • Expanded use of telemedicine so patients don’t have to always come to Toronto Dr. Tom Parker, the physician-in-chief of St. Michael’s, described Dr. Montalban’s arrival from the renowned MS Centre of Catalonia in Barcelona, Spain, as a “game-chang-
er” for multiple sclerosis treatment and research in Canada. “World-class physicians attract other researchers and graduate students who wish to collaborate on new and groundbreaking work, which leads to better research, greater collaboration and life-changing results,” Dr. Parker says. “That’s another reason why these new facilities are essential.” Dr. Parker noted that St. Michael’s already has one of the most promising young MS researchers on staff, Dr. Jiwon Oh, a neurologist and MS expert who joined the hospital in May 2014 after completing her PhD in clinical investigations at Johns Hopkins School of Medicine. Dr. Oh is one of the only researchers in the world using multiple advanced imaging techniques to look at the impact of MS on spinal cord tissue in the hopes of finding biomarkers that will help clinicians monitor and more accurately predict how MS will progress in individual patients. Today’s announcement kicks off the St. Michael’s Hospital Foundation campaign to raise $30 million to build the new clinic, to be known as the BARLO clinic after the two families who each donated $10 million: John and Jocelyn Barford and Jon and H Nancy Love. ■
Leslie Shepherd works in communications at St. Michael’s Hospital. www.hospitalnews.com
DECEMBER 2017 HOSPITAL NEWS 31
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Published on Nov 29, 2017