HSCN Healthcare Supply Chain Conference Inside: F From tthe h C CEO’s EO’ D Desk k|E Evidence id M Matters tt | D Data t P Pulse l |N Nursing i P Pulse
March 2018 Edition
wound care Page 17
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Contents March 2018 Edition
IN THIS ISSUE:
New supportive housing for seniors
12 ▲ Special focus: Wound care
▲ Senior-friendly strategies for an accessible hospital
8 ▲ Gaining the patient perspective through age related training
Editor’s Note ....................4 In brief .............................6 From the CEO’s desk .....16 Evidence matters ...........24 Data pulse ....................35 Nursing pulse ................46
▲ HSCN Healthcare Supply Chain Conference
Cardiacc n rehabilitation
▲ CANVent noninvasive ventilators
Taking your idea for Canadian
healthcare innovation beyond the pilot phase t all started when the two of us sat down over a cup of coffee. As a family physician and endocrinologist, we stand on opposite sides of a large chasm called patient wait times, and we both started seeing more and more of our patients getting swallowed up by this abyss. In her role as a family doctor, Clare noticed how long some of her patients had to wait for an appointment with a specialist. In Erin’s case, patients were waiting months for their appointments with her as an endocrinologist, often for problems their family doctors could have addressed with just a little guidance. Surely, we thought, there was a better way, a quicker path that could save patients the meandering monthslong waits they were too often facing? From this conversation, we came up with an innovative solution: what if, instead of a family doctor making a referral every time they faced a question about a patient’s care, they could instead reach out to a knowledgeable specialist directly? Perhaps, in some cases, the specialist could guide the family doctor, saving the patient a long wait for an in-person appointment. And this could save the beleaguered public health system important resources in the process. With public grant funding and the support of regional partners – including the Champlain Local Health Integration Network and the Winchester District Memorial Hospital – we created the Champlain BASE eConsult service: a secure online platform that allows primary care providers to ask specialists questions about a patient’s care. Specialists respond within a week – two days on
average – with advice on the patient’s care, recommendations for referral or requests for more information. Eight years since its founding, the eConsult service has completed over 30,000 cases, enrolled more than 1,300 primary care providers and allowed thousands of patients to receive high quality care without needing a face-toface specialist visit. Other innovators in several provinces have partnered with us to bring the BASE eConsult model of care to their jurisdictions, and the Government of Ontario has recently committed to expanding the service across the province. The eConsult service made the leap from pilot into practice – no easy feat in the often intractable and rigid Canadian health system. Over the years, we’ve learned a number of important lessons about creating and implementing healthcare innovations, which too often fail to sustain themselves beyond an initial pilot phase.
1) STRADDLE THE DIVIDE BETWEEN RESEARCH AND PRACTICE Successful innovations are built on a foundation of sound evidence and that evidence comes from solid research. But research alone can’t launch a service and many promising innovations have remained cloistered in academic journals – valuable platforms, but ones that rarely resonate outside of their immediate circles. In order to get something implemented, you need to reach the people who do the actual implementing: clinicians, policymakers, and especially patients, whose voices must be heard. Continued on page 8
Dr. Clare Liddy is a practicing family physician and an expert advisor with EvidenceNetwork.ca. Dr. Erin Keely is an endocrinologist with The Ottawa Hospital.
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Monthly Focus: Health Care Transformation/eHealth/Mobile Health/Medical Imaging: Programs and initiatives that are transforming care and contributing to an effective, accountable and sustainable system. Innovations in electronic/digital process in healthcare, including mHealth.
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$3 million in funding available to support industry innovations in the field of aging and brain health he Centre for Aging + Brain Health Innovation (CABHI), led by Baycrest Health Sciences, announced recently the third round of funding available through its Industry Innovation Partnership Program (I2P2). “Our Government is proud to support advancements in innovation for aging and brain health in older adults as we work towards a national dementia strategy,” said the Honourable Ginette Petitpas Taylor, Minister of Health. “Innovative projects and partnerships will help us achieve our goal to improve the quality of life of those living with dementia, both in Canada and abroad.”
CABHI maintains a strong commitment to the cognitive and mental well-being of older adults, and the health and social care needs of persons with dementia, and those who care for them, by supporting innovations that are aimed at finding solutions to the following care priorities: • Aging in place: solutions that enable older adults with dementia to maximize their choices, independence and quality of life to enable aging in the most appropriate setting • Caregiver support: solutions that support caregivers (formal and informal) in providing care to older adults with dementia • Care coordination and navigation: solutions that help older adults, care-
givers and healthcare providers coordinate care and transitions for older adults with dementia • Cognitive health: solutions that focus on health promotion, prevention, early diagnostics, and slow the progression of cognitive impairment for aging adults Applicants must have a mature product or service that they would like to test with older adults at an eligible North American trial partner site. CABHI will provide 50 per cent of the project costs to a maximum of $500,000 CAD to the trial partner site to work with the company, and to test and validate the company’s product or service. Successful applicants will be required to co-invest 50 per cent of the
project costs through cash and in-kind support. “Through the Industry Innovation Partnership Program, we are increasingly excited about some of the early benefits to innovators in the seniors’ care sector,” says Dr. William Reichman, President and Chief Executive Officer of Baycrest Health Sciences. “Through this initiative, CABHI is helping to build networks of collaborators to increase capacity in the seniors’ care sector for testing innovations.” All projects must be completed within a 12 to 15-month period. Eligible applicants must submit their online application by 5 p.m. on March 12, 2018. Full details and selection criteria H are available on the CABHI website. ■
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Alcohol use biggest risk factor for dementia lcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia. This according to a nationwide observational study, published in The Lancet Public Health journal, of over one million adults diagnosed with dementia in France.
This study looked specifically at the effect of alcohol use disorders, and included people who had been diagnosed with mental and behavioural disorders or chronic diseases that were attributable to chronic harmful use of alcohol. Of the 57,000 cases of early-onset dementia (before the age of 65), the majority (57%) were related to
Childhood cancer survivors at higher risk of mental health events hildhood cancer survivors are at a significantly higher risk of a severe mental health event requiring an emergency department (ED) visit or hospitalization, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (SickKids).
CHILDHOOD CANCER SURVIVORS WHO WERE DIAGNOSED BEFORE THE AGE OF FIVE ARE AT THE HIGHEST RISK FOR A SEVERE MENTAL HEALTH EVENT In the study published in Cancer, researchers examined data representing 4,117 childhood cancer survivors and 20,269 controls, and observed that rates of mental healthcare visits to family physicians and psychiatrists as well as the risk for a severe mental health event were significantly increased in survivors. â€œWhile previous research has shown that childhood cancer survi-
vors have an elevated risk of physical health issues later in life, our study shows that these same survivors are also at risk for mental health challenges,â€? says Dr. Sumit Gupta, co-author of the study, adjunct scientist at ICES and staff oncologist and clinician investigator at SickKids. â€œIn particular, survivors of adolescent cancer have a higher rate of mental health visits and survivors of cancer diagnosed prior to age five have a markedly elevated risk of severe mental health events.â€? The researchers found that childhood cancer survivors who were diagnosed before the age of five are at the highest risk for a severe mental health event: by age 28, 16 per cent of these adults will have had an ED visit or hospitalization for mental health reasons. The researchers found childhood cancer survivors had a 34 per cent higher rate of medical visits for a mental health complaint compared to the general population and most visits were to family physicians and psychiatrists. ED visits and hospitalizations were less common but survivors still had a 13 per cent increase in their risk for a severe mental health event. Risk was driven by sociodemographic factors such as female gender and lower income, not cancer type or H treatment. â–
chronic heavy drinking. The World Health Organization (WHO) defines chronic heavy drinking as consuming more than 60 grams pure alcohol on average per day for men (4-5 Canadian standard drinks) and 40 grams (about 3 standard drinks) per day for women.
ALCOHOL USE DISORDERS SHORTEN LIFE EXPECTANCY BY MORE THAN 20 YEARS As a result of the strong association found in this study, the authors suggest that screening, brief interventions for heavy drinking, and treatment for alcohol use disorders should be implemented to reduce the alcohol-attributable burden of dementia.
â€œThe findings indicate that heavy drinking and alcohol use disorders are the most important risk factors for dementia, and especially important for those types of dementia which start before age 65, and which lead to premature deaths,â€? says study co-author and Director of the CAMH Institute for Mental Health Policy Research Dr. JĂźrgen Rehm. Dr. Rehm points out that on average, alcohol use disorders shorten life expectancy by more than 20 years, and dementia is one of the leading causes of death for these people. Alcohol use disorders were also associated with all other independent risk factors for dementia onset, such as tobacco smoking, high blood pressure, diabetes, lower education, depression, and hearing loss, among modifiable risk factors. It suggests that alcohol use disorders may contribute in H many ways to the risk of dementia. â–
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MARCH 2018 HOSPITAL NEWS 7
Canadian innovation Continued from page 4
2) TECHNOLOGY SHOULD BE THE VEHICLE, NOT THE DRIVER We created eConsult first and foremost to solve a problem: poor access to specialist care. Our solution to this problem embraced technology, but when choosing this path, we remained set on our destination, which was always improving access for patients. By remaining agnostic to the particular technology we used, we ensured that the platform we ultimately chose was the best one for the job and avoided being hemmed in by the limitations of a particular program or vendor.
3) STAY FLEXIBLE, BUT STAY FOCUSED West Park helping older individuals improve their functional ability and reclaim their lives with senior-friendly strategies.
Senior-friendly strategies for an accessible hospital By Mariela Castro
SENIORS TODAY ARE MORE ACTIVE AND LIVING LONGER. Senior patients represent a sizeable patient population at West Park Healthcare Centre – approximately 60 per cent of its rehabilitation patients, and about 80 per cent of its complex continuing care patients, are over the age of 65. Demand for West Park’s services is expected to grow by 50 per cent over the next two decades. As such, in 2014, West Park established a Geriatric Service Review that engaged seniors, staff, healthcare providers and partners on how to better service seniors in the future. Fueled by a need to deliver specialized rehabilitative and complex care to an aging, more active population, and to service community members living longer
DEMAND FOR WEST PARK’S SERVICES IS EXPECTED TO GROW BY 50 PER CENT OVER THE NEXT TWO DECADES
but with chronic disease and conditions, the Centre set out to address this particular challenge. Its strategic priorities, patient profile, and the changing demographics of an aging population informed the solution – to build an integrated campus of care that truly models the way of the future for patient care delivery, education and research.
The innovative healthcare “hub” will offer a continuum of service for those, such as seniors and people with disabilities, who face challenges to their independence. It will extend the continuum of care into the community to support health and the self-management of chronic diseases and other medical conditions.
BUILDING AN INTEGRATED CAMPUS OF CARE TO MEET THE NEEDS OF SENIORS Shelley Ditty, VP of West Park’s Campus Development, explains, “Our goal is to incorporate the best practices for senior-friendly design, which promote safety, independence and functional well-being throughout all areas of the campus. Continued on page 33
Mariela Castro works in Communications, Campus Development at West Park Healthcare Centre. 8 HOSPITAL NEWS MARCH 2018
Implementation is an ongoing process and adapting to new facts or changing needs is vital. For instance, in the early days of eConsult, we considered building the service around an email client. However, Ontario’s privacy legislation doesn’t allow transmission of patient data through email because it’s too insecure, so we switched to a platform with more robust security measures. While such adjustments are inevitable and must be taken in stride, the overall goal of the innovation should remain at the forefront of its implementation. Many programs suffer from a gradual broadening of their scope, which can dilute their impact on the objective they originally meant to achieve.
4) TAKE RISKS In research, failure is often preferable to inaction, because failure brings with it lessons on how to improve, while inaction teaches us nothing. Mistakes are inevitable, and the best way to learn from them is to seek continuous feedback from the providers and patients who use or benefit from the service. We’ve seen firsthand the positive impact eConsult can have on patient care, and hope that one day every Canadian can avoid the pitfalls of excessive wait times – which range from inconvenience to serious deterioration of health – and benefit from improved H access to specialist care. ■ www.hospitalnews.com
Early planning and teamwork key to supporting patients and families through discharge By Steph Parrott project spearheaded by an interdisciplinary team of staff on Mount Sinai Hospital’s Acute Care for Elders (ACE) Unit has led to a decrease in the number of alternate level of care (ALC) patients on the unit while providing patients and families with a more collaborative experience around planning for discharge and contributing to greater staff satisfaction. The ACE unit at Mount Sinai, part of Toronto’s Sinai Health System, specializes in caring for elderly patients – often with multiple co-morbidities – who require hospitalization for an acute condition. The unit’s interprofessional approach to meeting the unique needs of seniors has been held up as an example of a leading practice by Accreditation Canada. One of the challenges for the care team is in helping patients who no longer need the specialized acute care to successfully transition back into the community or into assisted living or long-term care. “This is a significant challenge for hospitals across the healthcare system as we adapt to an aging population of patients with increasingly complex care needs,” says Rebecca Ramsden, Nursing Unit Administrator on the ACE unit. “For this population of patients, a complex combination of social, functional and cognitive challenges put them at risk of having a prolonged hospital stay, beyond what is needed for their acute medical issue. Patients may also be at risk of poor outcomes post-discharge, leading to an emergency department visit or readmission to the hospital.” In the spring of 2016, the number of ALC patients at Mount Sinai’s ACE unit climbed to over half of the patients on the 28-bed unit. An interdisciplinary team took up the task of developing a strategy to help. “We recognized that in order to better serve our patients, both on
At a recent education event, Sabrina Gaon, Manager, Interprofessional Allied Health for Social Work and Clinical Nutrition (right) shares with colleagues about an initiative that decreased the number of ALC days on Mount Sinai Hospital’s Acute Care for Elders (ACE) unit.
ONE OF THE CHALLENGES FOR THE CARE TEAM IS IN HELPING PATIENTS WHO NO LONGER NEED THE SPECIALIZED ACUTE CARE TO SUCCESSFULLY TRANSITION BACK INTO THE COMMUNITY OR INTO ASSISTED LIVING OR LONG-TERM CARE the unit and those waiting for beds in the emergency department, we needed to re-consider how we plan support and engage with our most complex patients and their loved ones,” says Rebecca. The team conducted literature reviews, tested screening tools and ultimately developed the Transition Planning Risk Assessment Screen (T-PRAS) along with a robust transition planning process. Whenever the screening tool identified a patient as at-risk, the new transition planning process would be initiated. This process included social work notification of risk, a healthcare team meeting followed by a patient care meeting within five days of admission. Essen-
tial to a successful patient care meeting, the pre-meeting with members of the healthcare team ensures clarity and cohesiveness in the information to be provided to patients and their loved ones. “Bringing together staff members from all disciplines to contribute their expertise to address the individual needs of each patient was an important component of the process we developed,” says Sabrina Gaon, Manager, Interprofessional Allied Health for Social Work and Clinical Nutrition. “These meetings, held early on in the patient’s stay, have helped us work together collaboratively to find solutions for successful discharge with our patients and their families.”
Lydia Chan, a social worker on the unit, says this cohesive team approach helps everything run more smoothly and efficiently. “This has become a shared experience, with staff from all disciplines working together and understanding that we each have different perspectives and a different role to play. It also ensures we’re all on the same page in communicating with the family about the transition plan.” Patients and families have responded positively to the process and reported feeling engaged and supported. Sabrina attributes this to giving patients, families and the care team the opportunity to meet and talk about discharge soon after admission. “The patient and family meeting is a crucial part of the process that helps patients and families during what can be a difficult and stressful time. When patients and families see the whole care team is here for them they know that the lines of communication are open and the team is working together to meet their needs,” she says. “We can then have this important conversation where we help patients and families to understand the factors and options to consider as they are making decisions about discharge.” Since implementation in 2016, the unit has seen an increase in discharges, and fewer ALC days. The new transition planning approach has also had the benefit of improving staff satisfaction on the unit. “We conducted pre and post surveys of staff that showed a boost in morale with the implementation of this project. Staff are more satisfied knowing early on that there is a plan and process in place to support transition planning for the most complex patients,” says Rebecca. Positive outcomes of the pilot and months following supported the spread of the project to another medical unit. In the future the team expects the practice to be disseminated even further to other units across H Sinai Health System. ■
Steph Parrott is a Communications Specialist at Sinai Health System. www.hospitalnews.com
MARCH 2018 HOSPITAL NEWS 9
Rehabilitation technology helping patients By Shelly Willsey hen Hussain Alhussainy puts on a high-tech exoskeleton during therapy, he feels like Iron Man. Earlier this year, the 16-year old became one of Glenrose Rehabilitation Hospital’s first pediatric patients to use the Ekso GT exoskeleton as part of his therapy for cerebral palsy. The Glenrose is finding new ways to use this wearable robot that lets a person with lower extremity weakness stand up and walk. The Ekso was first introduced to Glenrose adult patients in 2015, but new features have since led to new therapies for adult patients as well as the opportunity to help pediatric patients.
With the help of Glenrose Rehabilitation Hospital physical therapist Georgia Diduck and therapy assistant Kristin Tarnowski, patient Hussain Alhussainy uses a wearable robot during his rehabilitation therapy. Photo credit: Sharman Hnatiuk
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WE CAN USE IT TO STRENGTHEN PATIENTS’ LEGS, IMPROVE BALANCE AND INCREASE ENDURANCE “Not only does it allow me to walk, but it helps with my posture and guides me on how to walk,” says the Edmonton teen. “It makes you put in the work for your therapy, and if you can’t, it assists you. It makes me feel powerful.” The Ekso measures the wearer’s shifts in balance, weight and posture, and motors in the suit’s knees and hips auto-adjust to deliver the right amount of power that’s needed to walk.
The technology even offers new features that now allow therapists to isolate a specific leg, lessen the amount of assistance the suit provides or increase the resistance. “As our Glenrose team becomes further trained with the Ekso and the programming advances, we’re able to expand the kinds of patients we’re helping,” says Vickie Buttar, the hospital’s Rehabilitation Technology Leader, Physical Therapy. “We use it with patients who are relearning to walk and, with new features, we have broader applications. We can use it to strengthen patients’ legs, improve balance and increase endurance.” When the Ekso was introduced to the hospital three years ago, it was used in early mobilization for adult patients with stroke, and spinal or brain injuries. To date, more than 80 patients at the Glenrose have used the Ekso during their rehabilitation. Ryan Nicoll, 31, was using the Ekso as part of his rehabilitation from a spinal cord injury when the new features were introduced. Therapists were able to extend his Ekso therapy and increase his strength and endurance. “I feel like my therapy is further along thanks to the Ekso,” says the resident of Mannville, 170 km east of Edmonton. “When I started therapy, I was walking a little bit but I’m walking almost full-time now. The Ekso is a great tool H that has helped me tremendously.” ■
Shelly Willsey is a Senior Communications Advisor at Alberta Health Services.
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Digital health could improve care for Canadian seniors By Shelagh Maloney n February 2018, the Canadian Institute for Health Information (CIHI) released a report that shows the care Canadian seniors receive falls short of the international average. The report, How Canada Compares: Results From The Commonwealth Fund 2017 International Health Policy Survey of Seniors, reveals that Canada continues to be below the global average for access to primary care and specialists. It also shows that care coordination among physicians (i.e., sharing of health information between care settings), has improved, but Canada still remains below the international average in that area as well.
RESULTS FROM THE COMMONWEALTH FUND 2017 INTERNATIONAL HEALTH POLICY SURVEY OF SENIORS, REVEALS THAT CANADA CONTINUES TO BE BELOW THE GLOBAL AVERAGE FOR ACCESS TO PRIMARY CARE AND SPECIALISTS “We learn so much from examining how Canadian seniors interact with their health system and by comparing their experiences with those of seniors from other comparable countries,” says Tracy Johnson, CIHI’s Director, System Analysis, Emerging Issues. “We do see some encouraging signs, particularly in the realm of end-of-life plan-
ning and home care, where Canadian seniors largely report that their needs are being met.” Michael Green, President and CEO of Canada Health Infoway (Infoway), also sees encouraging signs for seniors, who are benefitting from digital health. “Infoway’s original focus on electronic health records created the foun-
dation that is enabling digital health innovations such as patient portals, virtual visits and telehomecare, that are improving coordination of care and access to care for seniors,” he says. Infoway recently released its 20182019 Summary Corporate Plan, Driving Access to Care, which outlines its strategic goals and performance expectations for the upcoming fiscal year. The organization will continue to focus on digital health advances to help keep seniors at home longer, improve outcomes and increase access to care. Initiatives already underway demonstrate that these innovations could improve care for Canadian seniors. Continued on page 12
Shelagh Maloney is Vice President, Communications at Canada Health Infoway.
Are you new to Canada? / Nouveau au Canada? ŽǇŽƵǁĂŶƚƚŽŝŵƉƌŽǀĞǇŽƵƌǁŽƌŬƉůĂĐĞĐŽŵŵƵŶŝĐĂƟŽŶƐŬŝůůƐ͍ WĂƌƟĐŝƉĂƚĞŝŶĨƌĞĞKĐĐƵƉĂƟŽŶͲƐƉĞĐŝĮĐ>ĂŶŐƵĂŐĞdƌĂŝŶŝŶŐĐŽƵƌƐĞƐ tŽƌŬƉůĂĐĞŽŵŵƵŶŝĐĂƟŽŶ^ŬŝůůƐ for Health Care ͻĚĞŶƚĂůŚǇŐŝĞŶŝƐƚ ͻŶƵƌƐĞ ͻŵĞĚŝĐĂůůĂďŽƌĂƚŽƌǇƚĞĐŚŶŽůŽŐŝƐƚ ͻƉĞƌƐŽŶĂůƐƵƉƉŽƌƚǁŽƌŬĞƌ ͻŵĞĚŝĐĂůƌĂĚŝĂƟŽŶƚĞĐŚŶŽůŽŐŝƐƚ ͻƐůĞĞƉƚĞĐŚŶŽůŽŐŝƐƚ
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Digital health Continued from page 11
Left, The McCain Building at 30 White Squirrel Way (Queen Street site), now home to LOFT transitional housing. Right, David (blue coat, front) and Eric (black shirt, front) are the first two residents of LOFT’s transitional housing at 30 WSW.
New supportive housing for seniors By Mike Hajmasy new agreement between CAMH and LOFT Community Services is offering transitional support and housing for older adults living with mental health and behavioural challenges. The first two floors of 30 White Squirrel Way at CAMH’s Queen Street site now feature 12 apartment-style rooms for Alternate Level of Care (ALC) clients who no longer require inpatient beds, but need supportive housing as they transition out of hospital. “These individuals often remain in hospital too long because of insufficient high-support housing in the community or due to long wait times for placement in long-term care facilities,” explains Ann Pottinger, Clinical Director with CAMH’s Complex Care and Recovery Program. “LOFT promotes recovery and independence for people with these complex challenges, and its Specialized Assisted Living Program helps seniors attain housing and remain independent in a home of their own for as long as possible.” With community partner-run transitional housing right on site, it’s ex-
pected that hospital beds will be more readily available for those who need them most.
and behavioural consultation.
LIVING WITH DIGNITY
HOME FOR THE HOLIDAYS
Modelled after the John Gibson House Stepping Stone Project, the new CAMH-LOFT initiative provides residents with temporary housing for three to six months before finding them a permanent home in the community. “LOFT is thrilled to launch this new initiative at CAMH,” says Debra Walko, Director of Seniors Services at LOFT. “This builds on our current collaborative work to develop and implement a person-centered model of transitional support for ALC clients, with the ultimate goal of supporting them in living with dignity out in the community.” Personal Support Workers, Case Managers and Life Enrichment Workers from LOFT are on site and available 24/7 to provide specialized and enhanced assisted living, serve meals and facilitate a host of social activities for residents. In addition to providing the physical space, CAMH offers weekly check-ins as well as psychiatric
The timing couldn’t have been better for Eric and David, the first two residents of the LOFT space at CAMH who moved into their new home on December 21st, just in time for the holidays. Eric and David received a warm welcome from the LOFT team, including Program Directors Lindor Uygur and Breanne Ciacco, who gave the new residents a chance to explore the space, complete with individual bedrooms and ensuite washrooms, a shared rec room and kitchen. “It’s nice to have a feeling of personal freedom and my own space here,” says Eric, who had been on the GAU since September 2017. “It encourages me to keep going; I feel a greater sense of responsibility to look after myself.” Feeling motivated, Eric says he looks forward to eventually getting back into the community and rekindling a relationship with his three adult children. “I feel I have the wherewithal to do H that now.” ■
Mike Hajmasy works in public affairs at The Centre for Addiction and Mental Health. 12 HOSPITAL NEWS MARCH 2018
Nancy Huyck of Dorchester, Ontario, lives with Chronic Obstructive Pulmonary Disease. She is enrolled in an Infoway initiative that works with paramedic services to place digital health tools in the homes of patients, enabling them to measure their vitals including blood pressure, weight and oxygen levels. Paramedics monitor the information and intervene when they note a change in an individual’s health status. The goal is to keep patients like Nancy as well as possible so they can remain in their homes, and out of the hospital. It is also an innovative way to provide real value to caregivers and loved ones. When Nancy enrolled in the program, a paramedic came to her home to teach her how to use the tools, and ever since, she has been measuring and transmitting her blood pressure, weight and oxygen levels every day. Readings that require follow-up are flagged, and a secure portal provides Nancy’s family and the rest of her care team with upto-date results. One day, Nancy received a call from the paramedic when her blood pressure was higher than usual. He came to her home, then worked with her doctor to resolve the issue. “Avoiding a trip to the doctor was an obvious benefit,” says Nancy. “But getting to know my own results has taught me to make changes early on in order to avoid complications down the road, and that has been an added bonus.” Michael Green believes digital tools ranging from e-consultations to inhome monitoring to patient portals have the potential to greatly improve the care seniors receive in Canada. “CIHI’s report reinforces the need to accelerate digital health advancement and improve access to care for seniors, and all Canadians,” Green says. “The research that CIHI makes available is an important tool in supporting Infoway’s ability to develop and execute a strategy that will realize healthier Canadians through innovative digital H health solutions.” ■ www.hospitalnews.com
Stroke rehabilitation orientation program: Turning an inspirational idea into reality By Lila Zitouni and Debbie Gravelle atients are admitted to the Bruyère Continuing Care (Bruyère) stroke rehabilitation program after having experienced a major life-changing event – one that not only affects the person having suffered the stroke, but also the family and friends who support them. Following a stroke, a patient’s condition is stabilized in an acute care setting before they are admitted to Bruyère’s stroke rehabilitation program, where their recovery journey begins in preparation for their return home. In the past, patients have been so ill in acute care, that by the time they arrived in rehabilitation, they reported a sense of uncertainty, a lack of understanding about what’s happened to them and about what the future holds for them and their loved ones. This resulted in patients and families having many questions about Bruyère’s rehabilitation program upon admission. To alleviate their uncertainties, Bruyère held focus groups and interviews with patients and caregivers to understand what really mattered to them. Some of the recurring themes expressed included: • Being familiar with what their new healthcare environment had to offer them • Learning about the next steps in their stroke rehabilitation journey • Finding out about the community resources available to support their return home This key information, combined with a long-standing desire to address the needs expressed, inspired clinical manager Lila Zitouni to implement a tailored and welcoming orientation program that better addresses the needs of our patients and families. Lila and the committed members of the interprofessional care team collaborated with patients and care-
Part of the stroke rehabilitation team – Isabel Chung, volunteer; Hosana Yadeta, registered nurse; Andebrehan Simret Hagos, registered nurse; Lila Zitouni, clinical manager; Tony Zabchuk, patient; Sherine Bisson, registered practical nurse; André Carbonneau, volunteer.
SINCE RETURNING HOME IS A PRIORITY FOR PATIENTS, THEIR ORIENTATION CONTENT ALSO INCLUDES INFORMATION ABOUT THE HOME FIRST PHILOSOPHY AND ABOUT COMMUNITY RESOURCES AVAILABLE TO HELP SUPPORT THEIR RETURN HOME givers to co-design the program. The orientation is conducted weekly and infuses knowledge about the stroke rehabilitation program, hope about the future and concrete steps that patients and caregivers can take to prepare for their return home. The program also includes an orientation to the unit and an early introduction to the care team members. Information from various trusted sources was compiled to develop this new program – delivered in part by Bruyère’s volunteer ambassadors. These specially-trained volunteers take pride in welcoming new patients, answering their non-medical
questions and providing them with a guided tour of their unit and of the hospital’s common areas. Part of the program is also delivered by the clinical manager, who welcomes new patients and families, and explains the roles and expectations of the care team. The unit’s social worker and nurses deliver their part of the program by using a PowerPoint presentation that allows time for discussion. Since returning home is a priority for patients, their orientation content also includes information about the Home First Philosophy and about community resources available to help support their return home.
We hold the weekly orientation session on the unit immediately after lunch so it is convenient for new patients and families to attend. The session lasts approximately 30 minutes, with an additional 15 minutes that allows team members to circulate and answer questions. We record all questions from the patients and families and the appropriate care team member is responsible for following up. We offer refreshments, which gives patients and families an opportunity to socialize and share their story. We consider attendance at orientation a priority as part of a patient’s ongoing therapy. Not only do we invite family members to attend, but we encourage them to. We hand out a comprehensive information package to each new patient. It contains a list of staff, a copy of the Heart and Stroke’s publication titled Your Stroke Journey, a map of the unit, instructions on how to reach the clinical manager and who to contact if they have any questions or concerns. Because remaining positive is one of the contributing factors to a successful recovery, we also post inspirational quotes on several of the unit walls – to help motivate patients and caregivers. After completing the program, patients and families fill out an evaluation, which is used to continually improve the orientation. The results have been overwhelmingly positive with patients and families reporting leaving the sessions feeling empowered and motivated to achieve their rehabilitation goals. Over a four-month period, 98 patients and 57 family members attended the orientation. When possible at a later date, Bruyère stroke survivors and their families are invited to return to the unit to share their experience. Other patients admitted in our care have found that listening to their perspective and recovery journey has been a valuable and inspirational H experience. ■
Lila Zitouni, BSc, PT is clinical manager, Stroke Rehabilitation and Ambulatory Stroke Clinic and Debbie Gravelle, RN, BSCN, MHS is senior vice-president, Clinical Programs, chief nursing executive and chief of Allied Health Professions at Bruyère Continuing Care. 14 HOSPITAL NEWS MARCH 2018
Jim walks the walk.
Jim Vigmond’s handshake is as firm as his commitment to helping his personal injury clients receive fair verdicts. This founding partner is also committed to his philanthropic pursuits. Among his many charitable organizations, Jim raises funds and travels to Cambodia every year to assist underprivileged women house themselves while giving them the opportunity to go to law school. Lending a hand comes naturally. With exceptional experience in spinal cord and brain injury law, Jim knows that his legal contributions will make a profound difference in the outcome of his client’s life. For Jim, their right to fair compensation isn’t just of vital importance; it’s his professional mission. Jim doesn’t have to be in court to talk the talk. Jim would be quick to tell you that despite all his success, nothing compares to the joy of actually being able to make a difference in someone’s life.
To learn more about Jim visit www.oatleyvigmond.com/jim Proud Member
FROM THE CEO’S DESK
The tipping is here:
Reimagining healthcare By: Jo-anne Marr here is a revolution happening in healthcare and its tipping point is here. The confluence of affordable, accessible digital technology, consumer/patient demand and a health system focus on integrated care is the catalyst we needed to reimagine how care is provided at Markham Stouffville Hospital. The changing demographics and the aging population are also big drivers for the need to make changes to keep the system sustainable and accessible. The new era of highly connected and informed patients who walk through our doors expect much more than our system has traditionally been able to provide. But that is changing. Increasingly, we are embracing the, not so subtle, push from our patients and their families, and charting a course for Markham Stouffville Hospital that we hope will exceed the expectations of those requiring our care and that will help the system as a whole. One way we are harnessing this new reality has been to create an Office of Innovation. One of the first of its kind in the province, named SmartCare, it will enable us to deliver patient care that capitalizes on new technologies that lead to enhanced efficiency, convenience and improved system coordination for patients. Early progress has already been made in our patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma. The hospital has partnered with Cloud DX, Closing the Gap Healthcare and Women’s College Hospital Institute for Health System Solutions and Virtual Care to offer patients and their caregivers a solution to better
self-manage their condition at home to avoid unnecessary visits to the hospital. From the comfort of their home, patients use a tablet and tools to measure their vital signs including oxygen saturation, blood pressure, heart rate, and weight and then automatically, it is sent to the patient’s care team at the hospital to monitor their health condition, prevent flare-ups, and reduce the risk of emergency visits. Another leap forward has been the adoption of the Patient Oriented Discharge Summary (PODS) in our surgical areas. Our engaged patients want to be part of their own healthcare journey. PODS was co-developed by patients, caregivers and healthcare providers at the University Health Network’s OpenLab. It is a tool that provides patients with clear and easy-to-understand instructions that allow patients to manage their care after leaving the hospital. The overall aim is to improve transitions from the hospital, reduce readmissions and foster better outcomes for patients. DashMD is a new app that allows patients to download discharge instructions post emergency visit, a great way to address lost paper notes and forgotten instructions during what is often a stressful situation. Finally, we have initiated a navigator role in our hospital. Over years of silo-driven expansion in healthcare, our system is now a complex set of organizations that, historically, have not worked together to manage the transitions faced by patients requiring a broad range of health services. This too is changing. Our focus today puts the patient at the centre of the system and works to have the services wrapped around them.
Jo-anne Marr is President and CEO, Markham Stouffville Hospital. Our focus on improved navigation has started with patients that have chronic, complex medical conditions that require frequent emergency room visits. The navigator establishes a relationship and is available to assist with the transitions between Markham Stouffville Hospital to home and community services. It is early days, but feedback from patients and their family has been incredibly positive. We believe this new model of care is just the beginning of an integrated system of care for patients in our community. Expansion of the navigator role to all patients that may benefit from its hands-on service will support patients in accessing care when and where they need it and will keep patients in their home or in long-term care homes where they are most comfortable. If we are going to reimagine healthcare that reflects the rapid changes
occurring in patient/consumer demand and the digital health ecosystem, as hospitals we must also evolve our organizations to accept change, manage risk and listen rather than tell patients – allowing them to lead us in a new, more responsive and modern direction. We can’t turn back the technological tide, nor do we want to, but altering the course of a hospital entrenched in decades of process and policies is something that today’s hospital leaders don’t get to chose. If we agree that the tipping point is here, then our path is clear. We must be laser focused on driving a better patient experience and outcomes by using all available and affordable health technologies at our disposable. It won’t be easy, nothing this important ever is, but I believe Markham Stouffville Hospital is well H on its way. ■
Jo-anne Marr is President and CEO, Markham Stouffville Hospital. 16 HOSPITAL NEWS MARCH 2018
Wounds cost the Canadian health system
cost of a diabetic foot ulcer is $21,371
If the wound becomes chronic, the cost over three years climbs to
The total direct-care cost of diabetic foot ulcers to the Canadian health-care system was determined to be
In Canada, the prevalence of pressure ulcers is estimated to be
25.1% in acute care hospitals and
in long-term care facilities
MARCH 2018 HOSPITAL NEWS 17
Taking the pressure off patients and hospital staff Wound care best practices minimize incidence and prevalence of pressure ulcers By Brenda Mundy and Michelle Lee Hoy ressure injuries, more commonly known as pressure ulcers or bedsores, have a significant impact on a person’s well-being. These hospital-acquired pressure injuries can affect several aspects of a patient’s life, from physical and social, to psychological and financial. Additionally, the impact it has on the healthcare sector means more costs involved and resources used. It is estimated that treatment costs of a single pressure injury can range from US$10,000 to US$86,000 and result in increased nursing time by up to 50 per cent.
ability to mobilize and maintain independence. Especially in the elderly who are hospitalized, quality of life is significantly impacted along with prolonged hospitalization. So, how do we address this issue to the best of our abilities? Proactive and routine assessments and diligent risk management are the best defenses against pressure wound development. According to Accreditation Canada, the prevention of pressure injuries is a required organizational practice. Additionally, the Canadian Patient Safety Institute have identified the development of stage three and greater
PROACTIVE AND ROUTINE ASSESSMENTS AND DILIGENT RISK MANAGEMENT ARE THE BEST DEFENSES AGAINST PRESSURE WOUND DEVELOPMENT
The senior population is a particularly vulnerable population with respect to risk of skin breakdown and the ability to recover from pressure injury. Aging of the skin coupled with reduced mobility and prolonged pressure on bony areas of the body such as the heels, coccyx, elbows, shoulders and the back of the head results in an increased likelihood for pressure injury development. Patients with pressure injuries are more prone to encountering serious complications such as infections of the bone or blood, known as sepsis, and once developed, these injuries can impact a person’s
pressure injuries acquired in hospital to be a never event. All patients admitted to hospital should be assessed for risk of skin breakdown that can occur while under acute care. In addition to demographic factors, some causes for pressure injuries include pressure from devices worn, prolonged stay in one position, poor nutrition, and moisture build up from bodily fluids. Evaluation tools such as the Braden Scale Risk Assessment guide nurses in their assessments by providing the criteria to determine the risk level each patient is at upon admission and throughout their acute care. Criteria
include sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The total score a patient receives indicates the level of risk the patient is at, but the individual scores inform the healthcare team on what strategies to focus on to prevent skin breakdown and development of pressure injuries. Routinely changing position in a chair or bed, utilizing cushioning devices such as pressure relieving heelboots to help reduce pressure caused from prolonged laying down or air beds to help increase air flow and promote dryness, and mobilizing the patient if possible are but a number of ways to help keep a pressure injury from forming. Brenda Mundy, Manager of the Skin and Wound Program at Southlake Regional Health Centre, stresses the importance of being proactive in skin assessments and interventions: “Upon admission, all of our patients are assessed for risk and then appropriate interventions are implemented to prevent pressure injury development. Daily checks are then performed to ensure we can be proactive should there become a risk for pressure injury development while the patient is in hospital.” Hospitals may conduct annual prevalence assessments for pressure wound incidences to inform them of adjustments in care necessary to reduce the rate of risk. Most organizations will also have a wound care specialist on-site to make the necessary recommendations for treatment once a pressure wound has developed. Southlake’s Skin and Wound Program aims to educate all nursing staff on the proper assessment,
prevention and treatment of hospital acquired pressure injuries. In 2013, Southlake developed a quarterly prevalence and incidence study tool for use at the bedside. Implementation of this tool resulted in a significant reduction of pressure injuries and provided the evidence needed to support the purchase for new pressure relieving mattresses throughout the hospital, including models specifically designed for high risk patients. This data also supported the case for pressure relieving heelboots, which help keep feet off the bed and prevent heel pressure injuries from developing. From 2011, Southlake’s pressure injury incidence rates went from 20 per cent down to as low as 2.1 per cent at the lowest by present day. “We found quarterly pressure injury incidence studies to be especially impactful, because they provided our staff with the data to inform their decisions around strategies for prevention more immediately,” added Mundy. “Factors including bath products used as well as environmental circumstances such as having patients in overcensed areas have been identified as contributing to an increased rate in pressure injuries – learning this has enabled us to implement changes to reduce avoidable risk factors in a shorter period of time.” Due diligence for assessing pressure injuries requires empowering the entire nursing staff with the knowledge and resources to confidently make clinical judgments on the course of action required to minimize risk and maximize patient quality of life while they are receiving acute care in the H hospital. ■
Brenda Mundy is the Manager of the Skin and Wound Program at Southlake Regional Health Centre. She is also the manager of Professional Practice and Student Placements. Michelle Lee Hoy is a Strategic Communications Consultant at Southlake Regional Health Centre. 18 HOSPITAL NEWS MARCH 2018
Novel muscle pump activator device
speeds wound healing By Diana Swift ecent studies and a compelling case report show how an innovative hemodynamic add-on device (originally developed to prevent deep vein thrombosis) can reduce the healing time of new leg ulcers before they become chronic. The wireless, wearable, wristwatch-size gekoTM Wound Therapy device marshals the bodyâ€™s own biomechanical mechanisms to boost blood flow and promote healing. Activating calf and foot muscle pumps through stimulation of the common peroneal nerve below the knee, the device boosts blood volume and velocity in the super-
ficial femoral vein and artery, and systemically when worn on both legs. â€œThat results in improved microcirculation to the skin and tissue, which is the wound bed,â€? explains Connie Harris, RN, a specialist in wound care and tissue repair since 1992 and a consultant for the muscle pump activatorâ€™s distributor. â€œIn the first study to look at using the device in new leg wound patients, we found an average weekly reduction in wound surface of 36.5 per cent in this group, which is really unbelievable,â€? Harris says. â€œIn a prior study of patients with chronic non-healing wounds we saw a reduction of roughly
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0591%% 6JG 'PVGTQUVQOCN 6JGTCR[ 0WTUG '60 YKNN DG MPQYP CU p0WTUG 5RGEKCNK\GFKP9QWPF1UVQO[%QPVKPGPEGq 0591% Enterostomal Therapy Nurses or Nurses Specialized in Wound, Ostomy & Continence, are the only registered nurses in Canada who have Canadian Nurses Association (C.N.A.)
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nine per cent per week, which was also pretty amazing.â€? The costs of treating chronic wounds are enormous: in 2016, wound care cost the Canadian healthcare system almost $4 billion and chronic non-healing wounds affect as many as 500,000 Canadians. Testifying to the deviceâ€™s applicability in wound healing is the 2017 case of a 74-year old woman from Cambridge, Ont., who sustained a deep laceration to her right lower leg when it was struck on the outer side by the pedal of an elliptical exercise machine at a seniorsâ€™ recreation centre. Continued on page 20
WOUND CARE Continued from page 19
Muscle pump activator A large flap of skin and tissue was torn away and blood and loss was significant. The flap was sutured in place in a hospital emergency room and the sutures were removed by her family doctor after 10 days. At that time, the patient received a topical antibiotic cream, but when the dressing was changed the next day, the wound edges had reopened, revealing several sutures still in place. An additional 12 sutures were removed in the ER and an antimicrobial silver dressing was applied and changed at seven and 14 days. At that time the woman entered the Waterloo Wellington Local Health Integration Network (LHIN) Home and Community Care Program. Her wound measured 6 cm long by 1.7 cm wide by 0.3 cm deep (3 cm3). After the wound was debrided of yellow slough for a second time, it measured 4.5 cm by 1.5 cm by 0.5 cm (3.375 cm3), representing a 9.7 per cent per week increase in size since entering the program. The patient was then fitted with the geko™ device and taught how to apply, properly set, and remove it after each six-hour treatment, given five days a week. A strong foot twitch in response to stimulation suggested she was a good candidate and would have an optimal hemodynamic response. She was advised to turn the device off while driving in order to prevent a potentially risky involuntary movement of her pedal foot. A single-layer tubular compression stockinette of 8-10 mmHg was added to her therapy to help reduce edema and provide some surface protection. Three weeks and four days later, the wound had closed, for a rapid 100 per cent reduction in wound size at a weekly rate of about 28 per cent. “A normally healing new leg ulcer would be expected to heal by 12 to 24 weeks,” Harris says. The patient was able to go on a planned vacation and even swim in the ocean. “If it weren’t for this device, I’d still have a big hole in my leg,” she says, crediting the muscle pump
Wound on appearance day of geko™ start; and then closed at 3.5 weeks with geko™ therapy. activator for the rapid resolution of her leg wound. Combined with best practices used for chronic non-healing venous leg ulcers, the device has shown benefit in other patients with new wounds. Last year, the Waterloo Wellington LIHN and Home and Community Care Program evaluated the device in 10 new wound patients, a largely elderly group that included the 74-year-old in the case study and had a total of 16 leg recent ulcers.
(range 2.29–100). In nine patients, the average time to complete wound closure was 3.03 weeks (range 5 days to 9 weeks). One obese patient with diabetes, who had developed multiple infections over time, failed to heal but did show improvement. “The device really sped up healing in people with comorbidities who looked as though they were not going to heal. One lady who was going out of the country healed in a week,” says Donna Radul, RN, wound care lead
THE WIRELESS, WEARABLE, WRISTWATCHSIZE GEKOTM WOUND THERAPY DEVICE MARSHALS THE BODY’S OWN BIOMECHANICAL MECHANISMS TO BOOST BLOOD FLOW AND PROMOTE HEALING. With a mean Home and Community Program stay of 23 days, the patients had experienced an average weekly increase in wound size of 79.29 per cent (range 618–27.7). After the addition of geko™, wound size decreased by a weekly average of 36.5 per cent
at the Cambridge LHIN clinic, adding that the device creates the same circulatory effect as walking three hours day. “And patients who were less mobile said their legs felt better. It gives them hope they’ll get better.” The adjunctive device also increased
urine output and reduced edema and lymphedema came down within a week. The device also helped another woman who had to postpone needed surgery because of wounds. “In situations where we need to heal wounds before patients can have needed surgery I think muscle pump activators really should be considered,” says Radul. In another setting, the device was recently evaluated in a randomized controlled trial in kidney and pancreas transplant patients at Ontario’s London Health Sciences Centre. Patients were randomized either to standard care with compression stockings plus intermittent pneumatic compression pump or to the geko™ applied on each side. The results were positive and will be published in two articles, one looking at the device’s impact on wound healing and the other on prevention of edema. For Harris, with her more than 25 years’ experience in wound care, the hemodynamic approach is “truly the most exciting thing I’ve seen in all that time. I believe it can be a life changer H for many patients.” ■
Diana Swift is a freelance writer in Toronto. 20 HOSPITAL NEWS MARCH 2018
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MARCH 2018 HOSPITAL NEWS 21
Preventing diabetic foot ulcers By Ann Besner n a spring day in Halifax in 2017, groups of physicians, chiropodists, educators, industry and government representatives, and advocates crowd around tables in a hotel meeting room. They have gathered for a policy roundtable, hosted by Diabetes Canada. The participants share stories and discuss their experiences working in the field of, and, in some cases, living with, diabetes. The conversation turns to amputation prevention, including best practices in screening, foot care, and education, and by the end of the session, a series of recommendations had been developed to guide Diabetes Canada in its future research and advocacy work. Fast forward to the fall of 2017, where conversations with similar stakeholders also took place at three
subsequent Diabetes Canada roundtables in Winnipeg, Edmonton and Victoria. Across the country, preventative foot care is a critical issue for diabetes practitioners, policy makers, health organizations and patients alike. This is because in Canada, diabetes is the leading cause of non-traumatic lower limb amputation, one of the most debilitating and feared complications among people with the disease. Approximately 85 per cent of amputations that occur in people with diabetes follow foot ulcers, which are often the result of neuropathy and/or peripheral vascular disease, known complications of sub-optimally controlled diabetes. A diabetic foot ulcer (DFU) is extremely costly to the healthcare system. In Nova Scotia, the overall annual cost of DFUs is around $30 million, while larger provinces like Ontario
PROMOGRAN PRISMA ™
WOUND BALANCING MATRIX
Did you know... 90% of wounds with elevated protease activity will not heal without proper interventions.
How are you managing them? To learn how PROMOGRAN PRISMA™ can help, please contact your KCI representative at 800-668-5403 or visit systagenix.ca NOTE: Speciﬁc indications, contraindications, warnings, precautions and safety information may exist for Systagenix and KCI (Acelity companies) products. Please consult a healthcare provider and product instructions for use prior to application. Reference: Serena T, Cullen B, Bayliff S et al. Protease activity levels associated with healing status of chronic wounds [abstract] Serena T, Cullen B, Bayliff S et al. Wounds UK 2011. Copyright 2018 KCI Licensing, Inc. All rights reserved. Unless otherwise designated,all trademarks are proprietary to KCI Licensing, Inc., its afﬁliates and/or licensors. PRA001634-R0-CA, EN (02/18)
22 HOSPITAL NEWS MARCH 2018
DIABETES IS THE LEADING CAUSE OF NON-TRAUMATIC LOWER LIMB AMPUTATION, ONE OF THE MOST DEBILITATING AND FEARED COMPLICATIONS AMONG PEOPLE WITH THE DISEASE cite costs that exceed $400 million per year. People with diabetes are over 20 times more likely to be hospitalized for non-traumatic lower limb amputation secondary to an ulcer compared to the general population. Moreover, DFUs pose a tremendous physical and emotional encumbrance to individuals and their families. They often cause great pain and discomfort, decrease mobility, and interfere with sleep and other activities. Research suggests an increased incidence of anxiety and depression, and feelings of powerlessness in people with a DFU. The overall impact of ulcers is significant and troubling. Proper treatment of foot ulcers can relieve some of the burden on the healthcare system and improve productivity and quality of life for people living with diabetes. From Diabetes Canada’s 2017 policy roundtables series, participants unanimously supported immediate public funding of offloading devices – specially fitted equipment that alleviates pressure from foot wounds, thereby allowing for better and faster healing – in each of their provinces for medically eligible people, to decrease risk of amputation. Fewer ulcers and amputations would save millions in direct and indirect healthcare costs, and represent less time for patients and healthcare providers spent on DFU treatment in clinics and emergency departments. In November 2017, the Government of Ontario announced that it would devote funding over the next
three years to cover specialized casts for those with a DFU, and to support wound care training and education for healthcare workers. This is the first, and only, province to date to take this action. Diabetes Canada is calling for other governments to follow suit. With respect to DFU care, best practice guidelines also recommend that “individuals who develop a foot ulcer should be managed by a multidisciplinary healthcare team with expertise in the management of foot ulcers to prevent recurrent foot ulcers and amputation”. Ideally, DFUs should be prevented. To this end, regular foot examinations for people living with diabetes, education on proper foot care and foot wear, and timely referrals to trained specialists are advised. One way to promote best practice is to embed evidence-based guidelines in electronic medical record systems to remind healthcare providers to perform regular foot assessments on their patients with diabetes. Access to education, medications, devices and services that help Canadians to achieve and maintain good diabetes control also goes a long way to preventing the complications that can lead to foot wounds. Finally, an interdisciplinary approach to diabetes treatment, including coordination of care and communication between healthcare professionals, is necessary to decrease the prevalence of DFUs and to support people living with diabetes to H reach their health potential. ■
Ann Besner MScA, RD, CDE is Manager, Research and Policy Analysis at Diabetes Canada.
THE V.A.C. VERAFLO™ DRESSING THAT IS MAKING A BIG SPLASH! V.A.C. VERAFLO CLEANSE CHOICE™ Dressing • When used in conjunction with V.A.C. VERAFLO™ Therapy, the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing can help facilitate the removal of wound exudate and infectious material such as thick ﬁbrinous exudate and slough.
• Ideal for wound cleansing when surgical debridement must be delayed or is not possible or appropriate.
To learn more about V.A.C. VERAFLO CLEANSE CHOICE™ Dressing or about V.A.C VERAFLO™ Therapy and for an evaluation, please contact your local Acelity Representative at 800-668-5403 or visit VERAFLO.com NOTE: Speciﬁc indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a clinician and product instructions for use prior to application. Copyright 2016, 2017 KCI Licensing, Inc. All trademarks designated herein are proprietary to KCI Licensing, Inc., its afﬁliates and/or licensors. PRA001633-R0-CA, EN (10/17)
The pressure’s on:
Seeking better options for bed sore prevention By Barbara Greenwood Dufour ost of us don’t have to worry about pressure ulcers, or “bed sores.” But for people who stay in the same position for long periods of time without shifting their weight or repositioning themselves — such as wheelchair users and those confined to bed due to an injury or surgery – they’re a very serious concern. In Canada, the prevalence of pressure ulcers is estimated to be 25.1 per cent in acute care hospitals and 29.9 per cent in long-term care facilities. Once pressure ulcers form, they can be hard to treat and can lead to severe medical complications, including infection, sepsis, and death. Therefore, healthcare providers try to prevent them from developing in the first place by regularly repositioning their patients, choosing support surfaces (beds and chairs) that might reduce or redistribute pressure on areas of the body most susceptible to skin and tissue damage, and inspecting skin regularly for signs of damage. However, despite these measures, pressure ulcers remain common in atrisk individuals, leading healthcare providers to seek better ways to prevent them. Over the years, CADTH has looked at what the evidence says about the effectiveness of some of the preventive technologies. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, and procedures to help Canadian healthcare decision-makers.
In 2015, CADTH looked for evidence specifically related to people who use wheelchairs. One review, focused on wheelchair selection, found evidence that points to the importance of a formal assessment of a patient’s unique physical attributes and lifestyle when choosing a wheelchair. The second review, which looked at evidence-based guidelines for pressure ulcer prevention, found that, in addition to individualized assessments, measures related to education and self-management; weight management and nutrition; pressure mapping; proper bed positioning and patient repositioning; and mobility, activity, and conditioning are recommended. For patients with limited mobility confined to beds, repositioning is an important aspect of pressure ulcer prevention. Repositioning can be performed manually, but special turning devices are available to help healthcare providers reposition patients more easily and more regularly. Similarly, “positioning chairs” are available that allow for frequent repositioning of seated patients and can be either designed as wheelchairs or, for more mobile individuals who sit for long periods of time, stationary chairs. CADTH looked for evidence of the effectiveness of turning devices in 2013 and of positioning chairs in 2017 but found that no studies had yet been published. Materials such as incontinence underpads (also called soaker pads)
and natural sheepskins are sometimes placed on top of a patient’s bed or other support surface in an attempt to prevent pressure ulcers. CADTH looked into both these interventions in 2017. No evidence was found on the effectiveness of incontinence underpads; however, if they are to be used, disposable underpads might result in significantly fewer pressure ulcers than the reusable variety, according to a CADTH review of the evidence comparing the two. CADTH’s review of natural sheepskins found low-quality evidence suggesting that they might reduce the risk of pressure ulcers although some patients might find the woolly sheepskins too warm. In addition to the established methods for preventing pressure ulcers, there are some newer interventions. Used in patients with spinal cord injuries, electrical muscle stimulation delivers periodic electrical pulses to the buttock muscles in an attempt to simulate the subconscious fidgeting and shifts in body position that those without mobility issues make. A 2016 CADTH review found that it isn’t yet clear if this technology is effective. Wound dressings are typically used to treat pressure ulcers after they’ve developed but are sometimes used to protect areas of the body vulnerable to pressure ulcers due to friction and shear, such as the base of the spine and the heels. In 2016, when CADTH looked at the effectiveness of newer
polyurethane film dressings, some evidence was found to suggest that they might be an effective for preventing pressure ulcers. Polyurethane foam dressings are another newer option. Like film dressings, they protect the skin from friction and shear; however, they also provide cushioning, which may help redistribute pressure and manage moisture levels to keep skin healthy. A 2017 CADTH review of found that, for at-risk adults in most settings, they may be an effective option for preventing pressure ulcers. Several other new innovations have come on the market, including advanced support surfaces that control skin temperature and moisture, sensors that monitor how often patients move, and smart textiles that can sense when pressure ulcers may be forming. Finding better ways to prevent pressure ulcers is and will continue to be important to improving patient care, and research is needed to determine what the best practices should be and which new technologies live up to their promise. If you’d like to read any of the CADTH reviews mentioned in this article – or those on a variety of drugs, devices, or procedures – they are freely available at www.cadth.ca/reports. To learn more about CADTH, visit www. cadth.ca, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: www.cadth. H ca/contact-us/liaison-officers. ■
Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. 24 HOSPITAL NEWS MARCH 2018
Early-detection improves foot surveillance for patients with diabetes By Kelly O’Brien ore than three million Canadians have diabetes, a number that has nearly doubled since 2002 and continues to grow. They have tools to manage their glucose levels, but not to manage foot wounds that often lead to infection and amputation. MIMOSA (Multispectral Mobile Tissue Assessment Device) is an early-detection tool developed by Dr. Karen Cross, a surgeon-scientist at
St. Michael’s Hospital, and Dr. General Leung, a magnetic resonance physicist at St. Michael’s. The device detects poor blood circulation in the feet, which can lead to diabetic foot ulcers, by photographing the skin with near-infrared light. “It’s just beyond the range of human vision , so it’s safe, but also it has deep penetration into the skin, so it’s going to get below that top layer,” says Dr. Cross. Continued on page 26
Photo courtesy of St. Michael’s Hospital
Dr. General Leung with the MIMOSA device which detects poor blood circulation in the feet, which can lead to diabetic foot ulcers, by photographing the skin with near-infrared light.
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MARCH 2018 HOSPITAL NEWS 25
WOUND CARE Continued from page 25
Early-detection “It can see things that we can’t.” Dr. Cross likened the light MIMOSA uses to the technology used to discover that Leonardo da Vinci was the artist behind The Adoration of the Magi, the painting most often attributed to Filippino Lippi. The light allowed art historians to view the different layers of the painting without damaging it. “We’re doing the same thing,” says Dr. Cross. “Before, to see how much hemoglobin you have, you’ve got to take blood. You’re damaging something by putting a needle in there. We can actually do it by not damaging anything.” Between 15 and 25 per cent of people with diabetes will have a foot ulcer at some point. These ulcers often become infected and as a result, diabetics are 23 times more likely than the general population to have a lower limb amputation. The technology MIMOSA uses to monitor wounds was originally developed as an early detector and triage tool for determining burn depth. But what has changed is the size of the tool. “Because of the way the technology’s changed, and because we have so much computing power in our pockets and our cell phones, we’re able to shrink it down,” says Dr. Leung. “So now it’s evolved from being 10 or 12 feet tall to being a little clip-on device.” The device is designed to work for all diabetics, no matter their age or level of mobility. “This is something you could put on a selfie stick and put it down below and take a picture,” says Dr. Cross. The team has already seen success using MIMOSA to monitor wound development in a recently completed pilot study, and will soon begin work on a two-year, multicentre randomized controlled trial. Evidence has also shown prevention strategies such as MIMOSA can result in a 20 to 40 per cent reduction in treatment costs. “Diabetes is a global tsunami,” she says. “More than 300 million people worldwide have diabetes, and that number is only growing. So something that can be made quite simply and can reduce those costs is an easy sell. H That’s what we want to do.” ■ 26 HOSPITAL NEWS MARCH 2018
Hyperbaric: A fresh approach for the non-healing wound By Dr. Anton Marinov here are few conditions more disturbing, demoralizing and debilitating than complex non-healing wounds that persist for months, and sometimes years. The toll on the patients’ quality of life and the costs to the healthcare system are significant. According to the Government of Canada, the annual cost of wound care exceeds 3.9 billion. Morbidity is high. Diabetic foot ulcer patients, for example, carry a three-year mortality rate of 26.4 per cent, and following amputation, the five-year mortality rate climbs to as high as 50 per cent. Traditionally, the treatment of infected, chronic, or re-opened surgical wounds has been the domain of surgical debridement, infection control and meticulous wound care with frequent dressing changes. Advances, such as
negative-pressure wound therapy and specialized wound dressings have had a positive impact, and are now among the most effective tools in wound treatment. Despite these gains, the most problematic wounds still fail to heal and it is here that hyperbaric oxygen therapy has gained popularity, as a treatment adjunct. When Karen Trace, a resident of Scarborough, Ontario, walked through the doors of Rouge Valley Hyperbaric Medical Centre, she had been told by her doctors that her only option was to have an amputation. “Understandably, I was scared,” she later confessed. Not ready to settle, she approached the recently-opened hyperbaric medical centre, located in the medical building of the Scarborough and Rouge Hospital’s Centenary Site. “My doctor was aware of the treat-
ment but cautious about how it would work for me. After consultations and several treatments, the wound completely healed and my foot was saved,” she went on. Karen is one of a growing number of patients who have benefited from hyperbaric oxygen.
SNAKE OIL There are few treatments less understood in the medical community than hyperbaric oxygen therapy. Having been in existence since the seventeenth century, it has been used for the treatment of a vast array of conditions. Today, the scientific evidence for many is lacking, but for a select few it is convincing enough to be approved by Health Canada and covered under the Ontario Health Insurance Plan. Complex wounds, diabetic foot ulcers, non-healing radiation damaged tissue, www.hospitalnews.com
and compromised flaps and grafts are all approved indications for treatment with hyperbaric oxygen. The body of knowledge regarding the effects of hyperbaric oxygen has steadily grown and today we find ourselves in what can be best described as a renaissance in the field. Numerous in vitro and animal experiments have revealed that hyperbaric oxygen works by promoting tissue growth factors, drives the formation of new blood vessels, mobilizes stem cells from the bone marrow, and diminishes the inflammatory response. At the same time, clinical studies have revealed that hyperbaric oxygen can prevent amputations in select diabetic patients and result in savings to the healthcare system.
HYPERBARIC PRACTICE TODAY Not long ago, perhaps 10 to 15 years, there were a handful of academic hospital-based hyperbaric centres
scattered across the country – Halifax, Quebec City, Ottawa, Toronto, Hamilton, Vancouver. In recent years however, driven by the accumulated knowledge base and renewed public interest, new hyperbaric treatment facilities, such as the Rouge Valley Hyperbaric Medical Centre where Karen received her treatment, have opened their doors. The typical treatment is conducted in individual acrylic-walled chambers, where the patient breathes 100 per cent oxygen at a pressure of 2 to 2.5 atmospheres for ninety minutes. The treatment regimen consists of a series of sessions, the number being determined by patient response and the indication for treatment. There are 14 conditions currently approved by Health Canada. In addition to problem wounds the list also includes osteomyelitis, sudden hearing loss, burns, severe anemia, carbon monoxide poisoning, decompression sickness, necrotizing soft tissue infections, crush
THERE ARE FEW TREATMENTS LESS UNDERSTOOD IN THE MEDICAL COMMUNITY THAN HYPERBARIC OXYGEN THERAPY injuries and arterial gas emboli. In the majority of these conditions, hyperbaric oxygen is utilized as an adjunct to mainstream treatment. In the case of chronic wounds, this includes debridement, infection control, specialized dressings and offloading.
FUTURE TRENDS Despite the advances in technology and science there is still much we do not know about this promising form of treatment. Dr. Rita Katznelson, a physician and researcher at the University Health Network is actively investigating the hyperbaric oxygen effects on patients suffering from stroke and those with spinal cord ischemia.
Research from around the world is contributing to a growing body of evidence that hyperbaric oxygen can be helpful in other conditions ranging from traumatic brain injury and avascular hip necrosis to interstitial cystitis. National meetings of the Canadian Undersea and Hyperbaric Medical Association, are fostering deeper collaboration in clinical research. Meanwhile, the front line hyperbaric physicians and technologists at the Rouge Valley Hyperbaric Medical Centre along with their colleagues across the country are laying the foundation of modern hyperbaric medicine by outreach, education and evidence-based H practice. ■
Dr. Anton Marinov is the Medical Director of the Rouge Valley Hyperbaric Medical Centre.
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WOUND CARE Valérie Chaplain an Enterostomal therapy (ET) Nurse at Hôpital Montfort in Ottawa often explains wounds to staff with the help of fruit.
A wound care hero By Gabrièle Caza-Levert rom fixing holes in walls, to fixing patients’ wounds, Valérie Chaplain, Enterostomal Therapy (ET) Nurse at Hôpital Montfort, in Ottawa, has a passion for helping others. It has been quite the journey for Valérie to become an ET Nurse. After high school, Valérie completed a bachelor’s degree in biology, thinking she would go on to do her Master’s and possibly teach biology. However, somehow, life had a different path for her. She decided to become a contractor and work in construction. For 12 years, she did everything from roofing, to changing windows, to installing hardwood and ceramic floors. Often having to lift objects that were heavier than she was, she even-
28 HOSPITAL NEWS MARCH 2018
tually felt the toll this line of work was having on her body. That’s when she decided to look into going back to school. Not sure what she would be interested in yet, she took a little while to explore her options. Around the same time, two of her close friends suffered from cancer. Valérie accompanied her friends and their families throughout this very difficult journey, offering comfort and support. After her second friend passed away, Valérie left on an adventure to Laos (South East Asia) with a group of tourists to explore on foot the most secluded areas of the country. Once, in an isolated village, a local mom came with her baby to seek help: her child had an enormous abscess. Valerie was carrying
a large first-aid kit and being a mom of four herself, she offered to help. Valérie remembers the scene like it was yesterday. “I sat on the ground, washed my hands thoroughly with hand sanitizer and told the mother to hold her baby tightly, as this would hurt. I pressed on the abscess and a fountain of pus came out. It was such a relief. I heard cheering from the villagers and my group, which was a great moment for me. I then proceeded to clean the wound and wash my hands. When I got up and turned around, what I saw shocked me. There was a long line of people who wanted me to care for them as well. I helped as much as I could.” When she came back to Canada, Valérie immediately started her education to become a specialized enterosto-
mal therapy nurse. After completing her nursing bachelor’s degree, she took a 13-month training offered by Nurses Specialized in Wound, Ostomy, and Continence Canada, then applied for the official certification in enterostomal specialization with the Canadian Nurses Association. What is enterostomal therapy? It’s three expertise combined in one speciality: wound, ostomy and continence care. An enterostomal therapy nurse takes care of people who eliminate through a stoma. They also take care of people with wounds that don’t heal well and those that have continence issues. Although not a large percentage of the population will have to be hospitalized because of a wound, the complexity of these cases and the impact www.hospitalnews.com
WOUND CARE on the healthcare system is important. Not only are the costs associated with wound care very high, the impact on the quality of life of affected patients is significant. Prevention is key, and that’s also where the enterostomal therapy nurse comes in. When there is a wound, early intervention will help reduce the risk of infection and delays in healing, and therefore, associated costs of complications. Enterostomal therapy nurses can also reduce the number of emergency department visits from the stoma clientele. For five years now, Valérie has been the only enterostomal therapy nurse at Montfort, offering care, information and education to her patients as well as training, advice and best practices to her colleagues. She started a clinic to follow up regularly with her stoma patients. Annually, she helps approximately 400 hospitalized patients and 150 patients in her clinic, amounting to over 1300 visits (including multiple visits with the same patients).
NOT ONLY ARE THE COSTS ASSOCIATED WITH WOUND CARE VERY HIGH, THE IMPACT ON THE QUALITY OF LIFE OF AFFECTED PATIENTS IS SIGNIFICANT “In wound care, there is no magical recipe. Every case is different. There is a plethora of factors that require you to evaluate each wound and each case individually,” explains Valérie. “The biggest challenge in wound care is that it is a dynamic speciality that is ever-changing, and therefore, you must constantly readjust your clinical judgment and re-evaluate the wound as it evolves. Knowing how to heal a wound and which bandage to use comes with experience and that is why every hospital can benefit from the expertise of an enterostomal nurse.” Working with ostomy patients in a hospital setting, ET nurses have a fleeting role in the lives of their patients. They make sure that everything
goes well during their stay and they know what to do with their stoma. However, they cannot offer long-term support with this condition and that is why Valérie opened an ostomy outpatient clinic at Montfort, shortly after her arrival. “It was essential to me to ensure patients, some of whom will have to live with a stoma this their entire life, had appropriate follow-ups and support.” What does it take to be a nurse specialized in wound, ostomy and continence? “It takes a lot of leadership skills. Everyone wants your opinion, from surgeons to fellow nurses, to patients and their families. You need to have confidence in yourself, your knowledge and your skills to offer ad-
vice and training. You need to be compassionate, considering you are working with a vulnerable clientele. Finally, you need to be curious and humble, knowing your field is constantly evolving and wanting to stay up-to-date with best practices,” she says. Valérie is passionate about research. She published an article in the Journal of Wound Ostomy & Continence Nursing, she validated the French translation of a skin tears classification tool with 92 nurses, and she will soon begin a research project, funded by the hospital’s knowledge institute, the Institut du Savoir Montfort, to validate a more efficient way to measure pH levels in wounds. Currently completing her Master’s in wound care, Valérie is also dedicated to education. Whether through her monthly educational e-newsletter, her yearly wound care fair or her regular classes to train wound care “champions,” Valérie is an inspiration for her peers and a shining star H at Montfort. ■
Gabrièle Caza-Levert is a Communications Advisor aat Hopital Monfort.
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MARCH 2018 HOSPITAL NEWS 29
Gaining the patient perspective through age related training By Taylor Grant or most of us, getting dressed, paying for items at a store or following instructions can be done without much thought. As we age, various conditions can make these everyday tasks much more difficult. Steven Hodge, Clinical Nurse Educator at the North Bay Regional Health Centre’s (NBRHC) Kirkwood Campus had the opportunity to experience for himself exactly how difficult it can be. Wearing special glasses to blur his vision, plastic gloves with tissue in the finger tips and headsets with static background noises, Hodge tried to follow simple instructions like buttoning a shirt, counting money and
opening commonly found items on a patient meal tray. “It was a really eye opening experience,” he says. “I was trying to manipulate the activities the best I could, but all I could think about was how difficult it really was.” That was exactly the point. The frailty simulation was part of the Health Centre’s Senior Friendly Care (SFC) Advocate Program – an educational opportunity for staff to increase their knowledge and expertise in providing quality care to older adults. Melissa Hallett, Elder Life Coordinator at NBRHC explains the exercise Hodge and other staff participated in was designed to allow healthcare providers to walk a mile in the shoes of
many of the seniors in their care: the glasses simulated various eye conditions such as glaucoma, the gloves limited dexterity and the headphones reduced hearing. “Geriatric patients often have more complex medical conditions that are different from younger people, with other factors that need to be considered,” explains Hallett. “As healthcare providers, it’s important to understand these unique healthcare needs to enable seniors to maintain optimal health and function while they are hospitalized, so that they can transition successfully home or to the next appropriate level of care.” The SFC Advocate Program en-
courages staff to identify quality improvement opportunities to positively impact the experience and well-being of older adults. The curriculum requirements draw from online resources such as the Nurses Improving Care for Healthsystem Elders (NICHE) program and Change Foundation, and are tailored to suit the specific duties of different service providers. “Seniors are the most frequent users of hospital services and also stay longer once admitted to hospital. As the population ages, the number of people needing support is expected to grow,” says Debbie Hewitt Colborne, Registered Nurse and chair of the
Taylor Grant is a Communications Assistant at North Bay Regional Health Centre. 30 HOSPITAL NEWS MARCH 2018
Embracing innovation: The next step in seniors care
(left to right) Felix Miteo, Registered Nurse, Steven Hodge, Clinical Nurse Educator and Melissa Hallett, Elder Life Coordinator perform certain everyday tasks with simulated impairments.
By Dr. Laurent Marcoux
THE FRAILTY SIMULATION WAS PART OF AN EDUCATIONAL OPPORTUNITY FOR STAFF TO INCREASE THEIR KNOWLEDGE AND EXPERTISE IN PROVIDING QUALITY CARE TO OLDER ADULTS
Senior Friendly Hospital Committee at the NBRHC. “Older adults receive care throughout the entire hospital, so it’s important to ensure all staff are equipped with the knowledge and understanding needed to meet the current and future health care needs of our older patients.” The SFC Advocate Program was designed to build capacity in staff who were interested in adding to their skills and knowledge in providing quality care to older adults at the Health Centre. “This voluntary program allows participants to tailor their own learning around the core curriculum focused on delirium, functional decline and senior sensitivity,” Hewitt Colborne says. “It’s not only about gaining knowledge and skill, but also about participants applying their learning within their work setting and acting as a resource to peers.” In the first year over 90 staff members graduated from the program from across the organization and disciplines. As a registered nurse (RN) in the Health Centre’s emergency department (ED), Kayla Budd knew it was important to take the program – seniors make up as much as 30 per cent of the patients seen in ED, more than any other age group. “Through the program I learned ways I could better approach the care I provide as a bedside nurse,” explains Budd. “For example, at one point I thought it was better to have lights dim so it wasn’t hard on their eyes, but in reality it was shown through the course www.hospitalnews.com
that older adults need that extra light to properly see my face and read my facial expressions.” The SFC Advocate Program is offered mainly online and runs twice a year with three months provided to complete the program requirements. Budd credits this flexibility and the easy to follow modules for increasing her interest in the program. “I work in the ED, I also have a parttime job with the university teaching on the medical floor and I am also currently working on my masters, so I’m pretty busy. The ability to learn from home or during down time was very helpful,” says Budd. “The program reinforced those little things we sometimes forget when we nurse, and I am now able to teach my students to increase the knowledge of the whole discipline.” Hodge too found the SFC Advocate Program better prepared him to work with staff and identify quality improvement opportunities in his area. “For me the reality of not being able to understand what was being said, and not being able to hear or see properly hit home during the frailty simulation. It showed me how important it is to have empathy and patience,” says Hodge. “It helped me recognize that while I want to make sure our senior patients remain as independent as possible, it might mean modifying my behaviour or their physical environment so they can reach their maximum H potential.” ■
he pressure on the hospital system sees no sign of abating. With a healthcare system that’s in desperate need of refreshing, hospital administrators, physicians, nurses, allied health professionals, and others – likely find themselves frustrated with persistent overcrowding. Canada’s healthcare providers constantly deal with this issue, which can often lead to stress, burnout and, worst of all, patients not receiving the excellent care they’ve come to expect. The number of Canadians over 65 continues to grow, and seniors often find themselves in acute care beds as they wait for more appropriate settings such as home or residential care. As a result, they’re vulnerable to hospital-acquired illnesses and disabilities such as delirium, deconditioning and falls. We know that things need to change. We know that we can all do better – so, where do we begin? A portion of this problem is resource related. According to the Conference Board of Canada’s report entitled Sizing Up the Challenge, Canada will need an additional 199,000 long-term care beds by 2035, nearly doubling current long-term care capacity. This number almost seems hyperbolic – it’s hard to grasp for the average Canadian. Long-term facilities can be a more efficient means of caring for our family members, and can help relieve pressure on the hospital system. Ensuring seniors have the appropriate infrastructure in place means a more effective use of healthcare resources. In Ontario, according to one estimate from Northeastern Ontario Healthcare Update, the daily cost of keeping a patient in acute care is $842, while in a long-term care facility the amount drops to $126. Caring for a loved one at home brings the
cost down to an estimated $42 per day, and, perhaps most importantly, it allows seniors to be amongst their loved ones. Any approach to care must be patient-centred and collaborative in nature. It’s the approach taken by the Nova Scotia Health Authority’s Care by Design program. With the support of an active and engaged group of physicians, pharmacists, nurses, paramedics and other healthcare professionals, Care by Design is able to offer long-term care residents access to high-quality primary healthcare. This program has delivered real results, including a 36 per cent reduction in transfer from long-term care to the emergency department (ED). This reduces ED resources and minimizes unnecessary stress on seniors. This is a powerful demonstration of how collaboration between governments, healthcare providers and patients can yield significant improvements in care. Care by Design is expected to be expanded across the country, with British Columbia slated to be the next province to implement this program. The time has come to embrace innovative and creative solutions to our healthcare dilemmas. There needs to be the right balance between adopting new technologies and developing patient centered care. Healthcare providers and patients share a common objective of improving care for Canadians. This must take place in the form of a national seniors plan – a comprehensive framework for improving quality of life for seniors. More than 60,000 Canadians are supporting this call to action at part of the CMA’s Demand a Plan campaign. It’s critical that we work together to push for better care for our seniors, and, as a result, improved care for all H Canadians. ■
Dr. Laurent Marcoux is President, The Canadian Medical Association. MARCH 2018 HOSPITAL NEWS 31
Understanding transitions from hospital to retirement homes By Bonnie Rose he Retirement Homes Regulatory Authority (RHRA) oversees the safety and wellbeing of over 60,000 seniors living in almost 750 retirement homes across Ontario. During the past few months, in my role as Registrar, I have met with Local Health Integration Networks (LHINs) across the province to better understand some of the emerging issues related to transitions between hospitals and retirement homes. Healthcare professionals have long known that coordination is key to ensuring safe transitions of patients as they move back and forth between care settings when their health needs change. And I am truly impressed by the unwavering commitment I see, across Ontario’s health system, to work together in ways that benefit patients and enable safe, successful transitions. Retirement homes are becoming an increasingly important part in the care of continuum. As the sector regulator, the RHRA is committed to helping both hospitals and homes support effective transitions. Most recently, we have been proactively communicating information about transitional care and retirement homes that is intended to help all system partners understand each other’s accountabilities, responsibilities and underlying interests. I want to share some of those key facts. For example, you may not know that under their legal obligations as “landlords,” retirement homes must allow residents to return home from hospital. At the same time, retirement homes can only provide care services they are legally permitted to deliver, and only then with appropriately trained staff and certain care standards in place. Collaboration between the patient and his or her family or substitute de-
HOSPITAL DISCHARGE PLANNERS CAN EASILY FIND OUT MORE ABOUT WHICH RETIREMENT HOMES ARE LICENSED AND THE SERVICES THEY OFFER: INFORMATION READILY AVAILABLE ON THE PUBLIC REGISTER AT WWW.RHRA.CA cision maker, the hospital, the LHIN and the retirement home on an updated patient assessment and plan of care will also help ensure the retirement home is truly able to meet the person’s current assessed care needs: either through services already provided by the home and outlined in the lease agreement, or availability of purchased services through an external provider or provided by the LHIN. In addition, if an individual’s assessment indicates he or she may be eligible for long-term care, the retirement home must provide information about applying to a long-term care (LTC) home.
Incidentally, each retirement home in Ontario chooses which of 13 care services it makes available to all of its residents. Care services that are provided to the individual and the costs must be listed in the residential agreement. Hospital discharge planners can easily find out more about which retirement homes are licensed and the services they offer: information readily available on the Public Register at www.rhra. ca. Only licensed retirement homes are covered under the Retirement Homes Act. One issue being looked at by RHRA and Ontario’s retirement
homes is the need for short-term resident agreements for transitional care. This would protect residents from out-of-pocket costs for terminating their lease agreements early/ or paying for retirement home care services and accommodation once they are eligible and waiting for a LTC bed (which is subsidized). Ongoing, the RHRA is also meeting with government and other stakeholders to explore potential new options for retirement homes, for instance as places in the continuum of care patients might go for transitional stays. More information on transitioning from hospital and the community to a retirement home is available on the RHRA website. RHRA will also continue to actively seek new opportunities to provide information, resources and guidance to support all stakeholders as they collaborate to make transitions safer between all H care settings. ■
Bonnie Rose is President and CEO of the Retirement Homes Regulatory Authority, which protects the rights and wellbeing of seniors living in Ontario’s retirement homes. 32 HOSPITAL NEWS MARCH 2018
Senior-friendly strategies for an accessible hospital Continued from page 8
As part of West Park’s commitment to help patients reclaim their lives now, and for decades to come, the new West Park campus will consist of two major capital projects – a New Hospital and a Non-Hospital development. It will bring together specialized rehabilitative, complex continuing, ambulatory and long-term care, along with independent living opportunities and community-based services, on one integrated site.
NEW SERVICES AND FEATURES BENEFITTING SENIORS The contemporary approximately 730,000 square foot New Hospital will accommodate major growth and greater visibility of outpatient services, satellite hemodialysis, and a Geriatric Day Hospital for diagnostic, rehabilitative and therapeutic services to seniors living in the community. Building on this, senior-friendly design features throughout will include spacious, flexible patient rooms with thoughtful, well-planned elements such
as wider doorways and turning radius for large wheelchairs, more power-door operators with hands-free operation, and patient lifts in all rooms. And 13 purposeful outdoor therapy “destinations”, terraces on every floor, and easy access to the outdoors from anywhere in the building. This will enhance therapy options and proximity to the healing effects of nature for all patients, regardless of age or mobility. The Non-Hospital Development will be a vibrant, active and healthy, mixuse space with close access to medical services, nature, recreation and social engagement for seniors and persons with disabilities. Non-Hospital services will strengthen and complement existing West Park programs, and may include supportive housing, a hospice, community-based services, and primary care all located on an inviting, nurturing site. It will enable an aging population to remain healthy, active and connected to their community while promoting their physical, emotional and social well-being.
INCLUSIVE DESIGN, ADVANCED ACCESSIBILITY “The new campus promises to be fully accessible and adaptable, with flexible space and opportunities for everyone,” says Lorie Pella, Director of Campus Development. “Developed with accessibility specialists and a West Park accessibility working group, the entire campus was reviewed with a senior-friendly hospital lens. This meant incorporating building code changes under the Accessibility for Ontarians with Disabilities Act (AODA), Code+Plus evidence-based design, staff and patient input on room mock-ups, learnings from comprehensive site visits, and requirements for physical design, furnishings, fixtures and equipment,” he said. Integrated and embodied into the plans were also the seven principles of Universal Design supporting accessibility – that design be equitable, flexible and simple and intuitive to
use; perceptible information; tolerance for error; low physical effort; and size and space for approach and use. The physical, cognitive, social and emotional capabilities, limitations, needs and wants of all people who occupy, work within or visit West Park have been considered. The new site will offer upgraded therapy areas on every floor; assistive listening equipment to amplify sound directly to hearing aids in areas such as the auditorium and reception desks; frequent rest areas along public paths of travel; simple wayfinding with accessible signage and digital options; and integrated bedside terminals, among other advancements. The long-anticipated West Park integrated campus of care will be a realization of years of careful thought and planning. With it, West Park looks forward to helping more seniors and other patients get back to community, back to family, and back H to life. ■
leads to better patient care By Emily Dawson he family of an older woman who had fallen twice in relative short order at home brought her to the Emergency Department at St. Michael’s Hospital in downtown Toronto to see if there was some underlying health problem. A physician ran a battery of tests but found no sign she had suffered a stroke or other acute incident. Rather than admit her to the acute care hospital for further observation, the physician was able to transfer her directly to a more appropriate setting, Providence Healthcare, a rehab hospital, where she immediately began active therapy to regain mobility while being monitored in a safe environment. Previously, Providence would have been able to admit this patient only from a bed at St. Michael’s, meaning she would have moved from the ED to an inpatient unit to wait for referral. This process could take several days, delaying the start of active rehab. Thanks to a new patient access and flow strategy of the new network between Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s, teams on the ED of the two acute care hospitals can now liaise directly with Providence’s patient flow team to jump-start the process to bring them to Providence. “This is incredibly beneficial for our patients, because they’re receiving exactly the kind of care they need which means better health outcomes,” says Maggie Bruneau, vice-president, clinical programs and chief nursing executive. “On the hospital side, there are fewer inpatient admissions so we can concentrate on providing acute care to those who really need it.” In addition to the new admit from ED strategy, St. Michael’s and St. Joseph’s have processes in place to create more seamless transitions of care.
Photo courtesy of Providence Healthcare
Getting an early start in active rehab can help seniors return home sooner and with better health outcomes.
ALC ROUNDS AT ST. MICHAEL’S Like most programs at St. Michael’s, General Internal Medicine has a lot to cover during its daily and weekly rounds. Many of its patients have complex and concurrent illnesses and some require continued care after they leave the hospital. So in addition to case managers, clinical leader managers and directors, the program’s weekly ALC rounds are attended by team members from partner hospitals and representatives of the Toronto Central Local Health Integration Network. The result has been improved communication and understanding between the program and its partners and a faster transition for patients who are ready to recover at home or elsewhere in the community. This collaboration helps ensure that patients transition safely with the support they require and also frees up beds for new patients.
“These meetings are very important because we are looking at each person as an individual and helping support what they need for their care,” says Leighanne MacKenzie, program director, Inner City Health. “Our goal is to help identify and then break through the barriers to get our patients to the level of care that meets their needs.”
EARLY DISCHARGE PLANNING AT ST. JOSEPH’S The healthiest place for most people to be is in their own home. That’s why as soon as patients are admitted to St. Joseph’s Health Centre, teams are planning for their discharge. The goal is to get them back to an environment where they’re comfortable and functional as quickly as possible. To help make that happen, an interprofessional team in the ED works with the medical team to help patients get the care they need and then plan their next steps. This team includes a
transition planner, occupational therapist and geriatric emergency medicine nurse. If a patient doesn’t need to be admitted, this means helping him or her be discharged straight from the ED. If the patient does require further care, the team starts planning where he or she will go after the hospital stay, even before the patient is admitted to the hospital. When a patient moves on to a unit, conversations about discharge happen with physicians, members of the patient’s care team and their family so everyone is aware of the plan and can help provide support. “Helping patients move to the appropriate level of care is one of the ways we support our patients and their families,” says Dr. Peter Nord, vice-president, clinical programs and chief medical officer. “We’re excited to be able to work closely with our Network partners to leverage each others’ unique skill sets which ultimately benefits those who come to us H for care.” ■
Emily Dawson is a senior communications adviser at Providence Healthcare. 34 HOSPITAL NEWS MARCH 2018
DATA PULSE In a new video series on cihi.ca, Tracy Johnson, CIHI’s director of Health System Analysis and Emerging Issues, addresses the survey’s findings in 4 key areas: access to specialists, mental health, home care, and end-of-life planning.
Seniors are satisfied with their health, but not with the quality of their care New international survey results shed some light on how older Canadians navigate the healthcare system By Riley Denver anadian seniors reported the lowest satisfaction with the overall quality of the healthcare they received in the latest Commonwealth Fund survey. The international survey also revealed that Canada’s seniors felt better about their health than seniors in the other countries surveyed did. The Canadian Institute for Health Information’s analysis of the survey results shows that only two out of three Canadian seniors were satisfied with the quality of the healthcare they received, compared with an average of 76 per cent of seniors in all surveyed countries. When it comes to perceived health, four out of five Canadian seniors surveyed described their health as “excellent,” “very good” or “good.”
Results From the Commonwealth Fund’s 2017 International Health Policy Survey of Seniors looks at how Canada and the provinces compare to the international average. “We learn so much from examining how Canadian seniors interact with their health system and by comparing their experiences with those of seniors from other comparable countries,” she says.
FOCUSING ON CANADIAN PRIORITIES CIHI’s coverage of the survey results also put an emphasis on four areas of particular interest to Canadians: access to specialists, mental health, home care and end-of-life planning. This focus unearthed some interesting information.
ACCESS TO SPECIALISTS
“We see some encouraging signs, particularly in the realm of end-of-life planning and home care, where Canadian seniors largely report that their needs are being met,” says Tracy Johnson, CIHI’s Director, Health System Analysis and Emerging Issues. The 2017 edition of the survey focused on the views and experiences of seniors (age 65 and older) in 11 developed countries. How Canada Compares:
Canadian seniors think coordination of specialist care could be improved. • More than half (59%) of Canadian seniors surveyed said that they waited at least four weeks for a specialist visit – the highest rate among 11 countries. • Five per cent said their specialist did not have basic medical information from their regular doctor.
• 13 per cent said their regular doctor did not seem informed about the specialist care they received.
MENTAL HEALTH Canadian seniors have to cope with mental health challenges, on top of other medical issues. • Almost one out of five Canadian seniors surveyed had experienced emotional distress in the past two years, which they found difficult to cope with by themselves. • 17 per cent of Canadian seniors reported feeling isolated some of the time or often.
HOME CARE Canadian seniors want to stay at home for as long as possible. • More than four out of five Canadian seniors surveyed (86%) who received publicly funded home care said that the services helped them remain at home. • Three per cent of Canadian seniors felt they needed publicly funded home care services but did not receive them. • 11 per cent of Canadian seniors had help with certain activities of daily living, with four out of five receiving it from a family member or friend.
END-OF-LIFE PLANNING More seniors in Canada have engaged in end-of-life care planning than those in other countries. • 12 per cent of Canadian seniors or one of their family members have talked to a healthcare provider about access to medical assistance in dying. • Almost two-thirds of Canadian seniors surveyed (64%) are confident that they would be able to obtain medical assistance in dying in their community.
CIHI’S COMMITMENT TO SENIORS CIHI is an independent, not-forprofit organization that provides essential information on Canada’s health systems and the health of Canadians. This new report supports CIHI’s commitment to help stakeholders better understand Canada’s senior’s population, as outlined in CIHI’s strategic plan. CIHI is focusing its efforts on influencing and improving Canada’s health systems, guided by key themes and key populations that our stakeholders told us were important. Look for more work from CIHI focusing on seniors and their experiences in the Canadian healthcare H system. ■
Riley Denver is a Communications Specialist at The Canadian Institute for Health Information (CIHI). www.hospitalnews.com
MARCH 2018 HOSPITAL NEWS 35
Minding your heart:
At St. Joseph’s Health Care London, the heart-brain connection is top of mind in the care of cardiac rehabilitation patients.
36 HOSPITAL NEWS MARCH 2018
Cardiac rehabilitation By Dahlia Reich reatment for heart disease conjures up a myriad of medical interventions – from the heroic at the time of a heart attack, to angioplasty, heart surgery or medications. But that’s only the physical side of heart disease. Your heart and mind are always speaking to each other, and listening to their dialogue is crucial, explains Dr. Peter Prior, clinical psychologist at St. Joseph’s Hospital in London. The ancient Greeks recognized that chest pain (angina), now known to be a symptom of coronary heart disease, had some connection to temperament. However, research into behavioural and emotional contributors to cardiovascular risk first emerged in the 1950s, and has bloomed since then, explains Dr. Prior. “For example, we now also know that people with heart disease are at greater risk of certain mental health conditions, such as depression or anxiety, and science has begun to explain these linkages.” “It’s a bit of a chicken and egg question – what comes first, the psychological factors or the heart disease?” says Dr. Prior. “But the evidence says it can work in either direction. On one hand, intense or long-term stress, depression, anxiety, hostility and anger, or social isolation can each contribute to the risk of a first-time or recurrent cardiac event. This connection could operate through indirect behavioural ways like smoking, unhealthy eating or drinking to cope with stress, or through direct physiological routes, such as influences of clinical depression on heart rhythm or inflammation. On the other hand, cardiac events are often frightening and traumatic, so they can cause significant psychological suffering. There’s a two way conversation going
on between heart and mind. Patients and healthcare professionals alike may often overlook this.” The evidence and role of psychology are growing in acceptance and appreciation in different areas of chronic disease management, including cardiac care. Yet many cardiac rehabilitation programs have not integrated psychological services into their care of heart patients. In matters of the heart, St. Joseph’s Health Care London is ahead of the curve. Psychological care is fully integrated into Joseph’s Cardiac Rehabilitation and Secondary Prevention Program (CRSPP). At CRSPP, men and women with known heart disease – for example, those who have had a heart attack, angina, angioplasty or heart surgery – work with the care team to create and follow an individualized program. The team is comprised of cardiologists, a cardiac rehab specialist, registered nurses, kinesiologists, a dietitian, clinical psychologist and support staff. During the six-month program, patients receive medical management, an exercise program, cardiac risk factor counselling and education sessions. Overall, CRSPP is dedicated to helping patients heal and recover (rehabilitation) from their cardiac events so that they can resume a productive, active and satisfying lifestyle, and to manage their cardiovascular risk factors to reduce the risk of recurrence (secondary prevention). The philosophy at CRSPP is to view both rehabilitation and secondary prevention from a whole-person perspective, considering both heart and mind. All those referred to CRSPP are screened to gauge their need for psychological care, explains Dr. Prior. They may receive psychological treatment for conditions such as anxiety, www.hospitalnews.com
depression or post-traumatic stress disorder, learn skills for stress management, approaches to enhance motivation and adherence to therapies, or to change other behaviours that increase their risk of having another heart event. “We can take our hearts for granted,” says Dr. Prior, who edited and authored the national guidelines and contributed to the provincial standards for cardiac rehabilitation in the area of psychological and behavioural care. “For most of our lives, our hearts are extremely reliable and very strong, and we may not think about them very much until something happens. Then, an event like a heart attack or cardiac arrest can really change our basic assumptions about life. Recovery and adjustment to heart disease is a learning curve. We have good approaches to help people get through that.” The emotional toll of heart disease can be difficult for anyone, but may be particularly heavy on younger patients,
THE EVIDENCE AND ROLE OF PSYCHOLOGY ARE GROWING IN ACCEPTANCE AND APPRECIATION IN DIFFERENT AREAS OF CHRONIC DISEASE MANAGEMENT, INCLUDING CARDIAC CARE he adds. Younger people are more likely to be in the middle of their careers, supporting families, and may have to make more substantial adjustments to their new reality. It may also be their first face-to-face encounter with their mortality. Psychologists within cardiac care programs are uniquely positioned to be well informed about cardiovascular medicine and can help patients navigate both the emotional fall-out and behaviours associated with heart disease, says Dr. Prior. “It’s very progressive for cardiac care to incorporate psychology in terms of both clinical care and research, as we do at St. Joseph’s Hospital.”
At CRSPP, psychological outcomes are systematically measured. From the time patients arrive to when they complete the program, “we see significant decreases in patients’ emotional distress and improvements in their health-related quality of life” says Dr. Prior. “It is well established in research that heart patients who participate actively in cardiac rehabilitation, compared to those who don’t, have a substantial reduction in risk of future cardiovascular events and mortality. But it’s also important to focus on the psychological health of heart patients, for its own sake.”
Long before any sign of heart disease, however, Dr. Prior’s advice is for everyone to understand the psychological and behavioural contributors to cardiovascular risk: chronic or repeated stress, whether in the workplace, family or elsewhere; clinical depression even if mild; excessive or chronic anxiety; social isolation; a pattern of anger and hostility; low fitness from lack of exercise and physical activity; smoking; unhealthy diet; poor sleep habits; or harmful use of alcohol. Research shows that for everyone, including people who have a family history or genetic background of heart disease, changing or reducing these risk factors is effective in reducing chances of heart attack. “The thoughts we think and the emotions we feel do indeed influence our physical being, and vice versa,” says Dr. Prior. “To remain heart-healthy, or to live well with heart disease, everyone should tune into the conversation H between mind and heart.” ■
Dahlia Reich works in Communications and Public Affairs at St. Joseph’s Health Care London.
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Left, Dr. Douglas McKim is Medical Director of the CANVent program, the sleep program at The Ottawa Hospital, and Professor of Medicine at the University of Ottawa. Right, Having a ventilator available 24 hours-a-day helps Marty Meech, who has ALS, live comfortably at home.
CANVent noninvasive ventilators help patients breathe easily at home
By Season Osborne arty Meech eyes the small square machine on his living room coffee table. It is key to his independence because it will help him breathe. Meech was diagnosed with Amyotrophic Lateral Sclerosis (ALS) 5.5 years ago. This wasting disease, caused by the gradual death of the nerves that control the muscles, slowly paralyzes such patients so they cannot walk, swallow or breathe. Meech initially carried on with his life after diagnosis, working at Pepsi. However, after suffering a blood clot in his lungs in November 2016, followed by inflammation around his heart, Meech’s breathing became seriously impaired. He needed a ventilator upstairs in his bedroom at night to help him breathe. He could no longer work and had to retire, spending his days in his suburban Ottawa home. Recently, Meech’s breathing became more difficult during the day, which is why he has a ventilator sitting on his coffee table. He puts the ventilator tube’s mouthpiece in his mouth and takes a deep breath.
WHEN NEUROMUSCULAR PATIENTS HAVE 24HOUR BREATHING ISSUES, A HOLE IS USUALLY MADE SURGICALLY IN THEIR WINDPIPE AND A TUBE INSERTED THAT IS HOOKED UP TO A VENTILATOR, TO HELP THEM BREATHE “I’ve been going upstairs at nine o’clock and going to sleep early because I need the breathing machine,” says Meech. “Whereas now, with this new ventilator I can stay down here and watch TV, talk to my family, or go outside. I should gain so much more independence – freedom to do other things.” When Meech had his last assessment at the CANVent Clinic, Dr. Douglas McKim, Medical Director of the CANVent Program, recommended that Meech use a second ventilator during the day. Equipment was ordered from the Ontario Ministry of Health Ventilator Equipment Pool and delivered to his house. Then Respiratory Therapist Kathy Walker visited Meech at home to set it up and teach him how to use it. This makes it easier for patients
like Meech, who no longer need to go to the clinic in The Ottawa Hospital Rehabilitation Centre, to learn about the equipment and set it up correctly themselves at home. Usually, when neuromuscular patients have 24-hour breathing issues, they receive what’s called a tracheostomy – a tube called a ‘surgical airway’ is inserted in their windpipe and hooked up to a ventilator, to help them breathe. However, once patients have a tracheostomy, they often remain in hospital because of the complex care required. Tracheostomies are still widely performed at health centres across Canada for long-term ventilation. In 2008, the Ontario Ministry of Health found that about 25 per cent of long-term ventilated patients in Toronto had tracheostomies. In London
it was 35 per cent. In Ottawa it was only four per cent. The noninvasive approaches in the CANVent program, including mouthpiece ventilation, likely contribute to these differences. “It was developed here at The Ottawa Hospital really out of a need,” says Dr. McKim, “At the Rehabilitation Centre, we would see all patients in the region with challenging neuromuscular disorders. And nobody was really looking after their respiratory issues, which can be the major cause of mortality. For example, with ALS, 85 to 90 per cent of patients die of respiratory failure, so respiratory care is critical.” In 1993, Dr. McKim set up a program that offered patients with serious respiratory complications, noninvasive (nonsurgical), supports to help them breathe. Since then, for example, no patients at The Ottawa Hospital with Duchenne Muscular Dystrophy have had permanent tracheostomies. In 2012, the program became CANVent, an acronym for Canadian Alternatives in Noninvasive Ventilation. Doctors refer patients who may be at risk for respiratory complications to the program. Continued on page 45
Season Osborne is Publications Officer for The Ottawa Hospital Foundation. 38 HOSPITAL NEWS MARCH 2018
HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE AND EXHIBITION
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MARCH 2018 HOSPITAL NEWS 39
HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2018
LEADERSHIP THROUGH ADAPTATION Zach Pocklington Co-Chair, Healthcare Supply Chain Network
“Our annual HSCN conference is an excellent enabler for healthcare supply chain professionals and leaders to share best practices through collaboration with Canada’s thought leaders and their peers from across the country.” A member of the HSCN Board of Directors since 2012, Zach Pocklington is Vice President Surgical Centers, Medline Industries.
WHY IS INNOVATION PROCUREMENT IMPORTANT?
There are many benefits to innovation procurement. For procuring organizations: innovation procurement allows an organization to potentially identify a new solution that better meets user needs and ultimately leads to increased end-user satisfaction and quality service delivery. For suppliers: innovation procurement can provide early visibility about user needs and help suppliers to better anticipate demand for new products. For society: innovation procurement can lead to economic benefits like the development of more effective services and new markets, and tackle environmental and social challenges through new and innovative practices. 40 HOSPITAL NEWS MARCH 2018
ealthcare Supply Chain Network (HSCN) is Canada’s national association for healthcare supply chain professionals. Dedicated to advancing healthcare through supply chain excellence, impacting cost, quality and outcomes at every level, HSCN is focused on evolving in the face of a change in Canada. The unique membership mix of providers and suppliers has contributed to individual and collective success in weathering political and economic turbulence with strength and resilience. On May 14–16, 2018, HSCN holds its annual national Conference for healthcare supply chain professionals. “Leadership Through Adaptation” will provide an opportunity to gain insights into some of the industry’s most innovative approaches to transformation. The HSCN Conference is the “must attend” event within the healthcare supply chain community and is an excellent way to hear about and discuss current issues and leading practice innovation within the industry while networking with colleagues across the country and connecting with suppliers at the exhibition. Notable keynotes, diversified learning opportunities, industry topics, networking opportunities and supply chain insights to the future. Susan Smith, HSCN General Manager, has seen the Conference grow every year to become the foremost gath-
ering place for healthcare supply chain professionals and leaders. “Our first Conference was held at the Harbourfront Hotel in downtown Toronto, 11 years ago. I recall a single room with about 50 people attending and a very large pillar in the centre of the room, making it almost impossible to get a good view of the speaker! “Today, we host the event in the largest conference centre and hotel in the Toronto airport vicinity and draw more than 350 delegates from across the country.” HSCN 2018 will feature topical presentations by quality speakers and networking opportunities that allow delegates to experience cross-Canadian perspectives. “Industry specific activities contribute to the success of the Conference but the key ingredient is the active uptake and engagement by industry stakeholders. This is an event planned by them and for them – a testimonial to the forward-thinking healthcare supply chain professionals within Canada.” Jay Ayres, Director, Group Purchasing and Materials Management, St Joseph’s Health System, agrees. He has witnessed the exponential growth of HSCN and its national Conference. “Their success comes from the fact that they continue to be one step ahead in identifying the constant changes that are happening in healthcare and then bringing forward new information so that we can be at the forefront in our H supply chain activities.” ■ www.hospitalnews.com
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HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2018
LEADERSHIP THROUGH ADAPTATION
In addition to the roster of speakers, there are networking opportunities through-out the Conference to augment the generation of new ideas he Conference features two days of lively and stimulating sessions, with expert speakers sharing best practices, many of which were discovered through collaboration with their colleagues and peers. These best practices aim to improve healthcare supply chain processes and implement new technologies to help address accountable care challenges and align with strategic priorities.
Don Cummer Co-Chair, Healthcare Supply Chain Network
“The HSCN conference is Canada’s premier health care supply chain event. I appreciate the opportunity to find out about new ideas and leading practices that are delivering results within our expansive supplier and provider network.”
SESSION SPEAKERS INCLUDE:
Don Cummer has served on the HSCN Board since 2012. He has held leadership roles at Plexxus in Purchasing, IT, Logistics and Customer Relationship Management.
■ Grant Hunt and Gus Estrada of BCCSS who will speak about partnering with the Island Health Authority (IHA) to open up two new hospitals on the North Island in a centralized distribution model. ■ Paul A. Sullivan, Brokerage Manager, HIROC, will highlight the growing threat of cyberware attacks on healthcare organizations and how to take measures to present a healthcare supply chain disruption. ■ Gary Melling, President, CIQ, will explain how using Artificial Intelligence can create supply chain optimization to ensure optimized quality patient care during the entire patient life cycle.
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■ Michelle Gronning, Partner, PwC, will address strategic management in procurement and supply chain, examining solution-based case studies that focus on driving value and innovation across the continuum of care. ■ Renée McIntyre, Director of Supply Chain, TransForm SSO, and Melissa Sharpe-Harrigan, Program Manager, TransForm SSO, will explain how to forge strategic partnerships in a world of innovation procurement. ■ Christine Donaldson, VP Pharmacy Service, HealthPRO will demonstrate how supply chain transformation can be achieved in all healthcare sectors, while capturing measur-able results. ■ Dr. Tania Massa, Director, Innovation Procurement, Ontario Centres of Excellence, will moderate a panel on building institutional capacity in the area of Innovation Procure-ment across Canada. ■ Rahul Singh, Founder, Global Medic, will describe how his organization uses innovative solutions to provide efficient and cost-effective disaster relief in the immediate aftermath of a catastrophe.
HEALTHCARE SUPPLIERS EXHIBITION he exhibit floor at the Conference provides an excellent opportunity for participants to connect with vendors from across Canada and view the latest in healthcare products, services and technology. This year, there will be 34 exhibitors including CMEPP,
HealthPRO, and Mohawk Medbuy. GS1 Canada is one of many regular exhibitors at the Conference. According to Art Smith, President and CEO, “There’s no better place to have your peers and competitive solution providers come together and talk about what H is best practice in Canada.” ■
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HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2018
KEYNOTE SPEAKERS FOUNDER AND PAST CEO OF COSTCO CANADA LOUISE WENDLING SHARES HER BUSINESS PHILOSOPHY hen the opening keynote speaker addresses delegates at HSCN 2018 they will hear about the impact Costco had on the retail landscape in Canada and its influence on supply chain. Louise Wendling is, after all, one of the founders and a past CEO of Costco Canada. What they may be surprised to know is that life could have taken a very different turn. “I was a hippy in the sixties and I wanted to live in a commune,” laughs Wendling. Instead she earned a degree in English, taught ESL, and worked for the federal government on job creation programs. Her retail career started at the Hudson’s Bay Company and it was with two colleagues from Hudson’s Bay in 1986 that she founded Price Club where she developed and implemented the warehouse club concept. Employee engagement was crucial from the start. “We believed that if you take care of the employees they will take care of your business, and that’s remained an important part of Costco’s culture.”
Louise Wendling was named Vice-President Merchandising, Eastern Canada in 1986, and promoted to Senior Vice-President, Eastern Canada in 1994. In 2001, she was named Country Manager for Costco Wholesale Canada and during her tenure helped grow company sales from $18 million to $22 billion. She has served as Chair of the Canadian Board of Costco and on the Executive
Committee of Costco Wholesale International. What was the best advice she received in her career? “It was from Costco CEO, Craig Jelinek. He said don’t think of the job you want to have but rather do the job that you have now very well and the future will take care of itself.” Heeding that advice, Wendling became an integral part of the Costco brand in Cana-
da, leading the company to record growth. At HSCN 2018, Wendling will describe to supply chain professionals how Costco’s adaptable approach and innovative culture changed the retail landscape in Canada. “What I can share from my experience is how to buy better, negotiate better, and save money which ultimately benefits the H customer.” ■
VISIONARY LEADER STUART KNIGHT LISTS FIVE KEY DECISIONS THAT WINNERS MAKE fter working with some of the world’s biggest companies and speaking to countless audiences, Stuart Knight has distilled the five key decisions people need to make in order to be true leaders in business. He will share those lessons as keynote speaker on Day Two of the HSCN Conference. “Do you know why some companies are more successful than others? It has nothing to do with their people waking up earlier, working harder or having prestigious degrees. They simply make five decisions, and they make them consistently,” says Knight. The award winning entrepreneur, critically acclaimed author, and hit producer has written, produced and starred in live presentations that have
been seen worldwide. Each year he speaks internationally helping some of the world’s biggest companies reach new levels of success. When not on the road speaking, he is often a guest on Canadian radio and TV discussing high level communication. A world traveller, avid reader and music composer, Knight is also the founder of one Canada’s biggest speaking extravaganzas, The Top Ten Event. As a renegade visionary, Knight has taken major risks and today, with entertaining stories and thought provoking insights, he shares the lessons he has learned helping people and companies succeed. What motivates this motivational speaker? “It’s when I hear from people who have taken the message I have
provided and actually used it. We’ve all sat in the speeches and then gone home and not tried what was suggested. It’s exciting when someone messages me out of the blue and says they tried that one thing I told them to do and H that it changed their life. I love this!” ■
INNOVATION PROCUREMENT EXPANDED TOOLKIT PLACES EMPHASIS ON PATIENT, PROVIDER AND SYSTEM OUTCOMES ith the rapid advancement of new technologies and solutions occurring in the Canadi-an healthcare environment, there is a heightened awareness of the impact innovative technologies have on patient, provider and system outcomes. Recognizing the significance of procurement in facilitating the adoption and dissemina-tion of innovative solutions, in 2014 Healthcare Supply Chain Network (HSCN) created an Innovation Procurement Toolkit to support the healthcare sector in leveraging pro-curement as a tool to drive innovation. The initiative was funded by the OntarioBuys program under the Min-
44 HOSPITAL NEWS MARCH 2018
istry of Government and Consumer Services (MGCS). Since then, MGCS released the interim BPS Primer on Innovation Procurement (Primer). The Primer contains guidance on innovation pro-curement, including seven early market engagement strategies and six innovation pro-curement models intended to encourage the adoption of innovation by Ontario’s broader public sector (BPS). The next phase in the evolution of the innovation procurement toolkit, enabled through MGCS’ funding, is to expand the existing materials to offer more comprehensive tools. The expanded toolkit will provide
healthcare supply chain professionals with a single point of referral and resources to support their activities in developing and conducting procurements for innovative solutions. The toolkit will include updates based on leading practices gleaned from global research, the Primer, and incorporating recent learnings from Ontario and other jurisdictions. The emphasis of the updates will target outcomes at provider, patient and system level. “The innovation procurement RFP and Agreement templates developed by HSCN will be compliant with Ontario’s BPS Procurement Directive and relevant trade agreements,” explains
Project Manager Sarah Friesen, who will provide an update on the project at the HSCN 2018 Conference. “The tools created are meant to provide support to BPS organizations in their quest to procure innovative solutions.” “We are very excited about the imminent launch of the expanded toolkit,” says Susan Smith, General Manager, HSCN. “In May, June, and September we will be presenting a series of free workshops and a webinar training. We are confident that the toolkit will enhance the capabilities of health service providers to deliver value to their organizations while also enH abling improved patient outcomes.” ■ www.hospitalnews.com
CANVent ventilators Continued from page 38 This includes patients with ALS, muscular dystrophy, spinal cord injury, multiple sclerosis, post-polio syndrome and many others. “We can identify patients at risk and reduce the likelihood of them having to come to the Emergency Department, or worse the ICU [intensive care unit], and having tracheostomy invasive ventilation. That is our raison d’être,” says Dr. McKim, who has delivered more than 30 international presentations about noninvasive airway management. The CANVent Program has between 600 and 700 patient visits each year, including about 150 new consultations. “It’s an opportunity for patients to gain more autonomy and an opportunity to become more independent,” says Walker. “We can provide 24-hour ventilation noninvasively to large numbers of patients, so they don’t need a tracheostomy. They don’t need surgery. Plus, they do not get all the complications that go along with tracheostomy care. And patients can stay at home.” Dr. McKim pointed out that The Ottawa Hospital is one of the few centres in the country that has expertise in mouthpiece ventilation and has published the experience. “Every patient who is on a mouthpiece, versus the tracheostomy, is probably saving the healthcare system $200,000 a year.” Often, patients who have a tracheostomy remain in hospital or long-term care for the rest of their lives, some entirely in ICU. Dr. McKim said one patient was referred from Toronto who was told he needed a tracheostomy. He was given a noninvasive ventilator and mouthpiece at the CANVent clinic and didn’t need a tracheostomy for 11 years. Dr. McKim calculated that this case alone likely saved the healthcare system $2.2 million. “Not only is this remarkably cost-effective and improves patients’ quality-of-life,” says Dr. McKim, “but patients feel better because they are not attached to a tracheostomy. Their lives are less complicated. They have fewer hospitalizations as a result.” The CANVent program is sharing this knowledge with practitioners around the country, and the world, so that neuromuscular patients like Marty Meech do not have to suffer the fate of preventable respiratory failure and ICU H admission. ■ www.hospitalnews.com
Patient care management system helps medically complex patients navigate road to recovery By Carla Wintersgill eorges Maalouf entered Runnymede Healthcare Centre’s Medically Complex program after a month in acute care following a severe stroke that rendered him completely immobile and unable to even breathe or eat solid food. “I felt totally destroyed,” Georges says. Runnymede’s Medically Complex program provides care for patients with multiple medical needs that may result from acute injury, chronic illnesses or disabilities. The treatment programs, rehabilitation and aroundthe-clock care provided by the hospital’s highly skilled clinical team goes beyond what is available to patients at home. While his medical needs were significant, Runnymede’s interprofessional team had one unwavering vision: to get Georges home. The hospital is a site of transitional care for patients who are recovering from injury or surgery – even for highly complex patients such as Georges. By working together as one team and staying focused on the end goal, Georges was able to be successfully discharged. “Our staff team is dedicated to providing excellent, highly individualized care,” says Sharleen Ahmed, vice president of quality, strategy, and clinical programs. “We’re here to help patients transition to the next step in their recovery journey, whether that is home or to another facility and we are always working toward continuous improvement.” At admission, the social work team had a big picture of Georges’s case. They identified his barriers to getting home and focused on ensuring all the pieces were in place to ready him for discharge. The family’s expectations were high – their main goal was to see Georges
Georges Maalouf and his wife, Najla. A year after being admitted to Runnymede Healthcare Centre in the medically complex program, Georges was able to return home. back on his feet again and able to care for himself. They suffered some initial discouragement when Georges wasn’t mobile within weeks. The social work team stepped in to restore hope to the family. They held regular meetings with Georges and his wife and were instrumental in helping keep their spirits up. They helped them to understand that the progress they were seeing was significant. The social work team worked with the family to help illustrate what the recovery journey ahead looked like. To achieve Georges’s end goal of full independence, a lot of mobility functions needed to be in place. Achievements such as being able to sit up were major milestones that should be celebrated. There were two major obstacles to Georges’s discharge: mobility and tracheostomy. Working with the physiotherapy, occupational therapy and speech language pathology teams to address these challenges, the interprofessional team gathered to discuss Georges’ progress in daily rounds.
They took his ultimate goal of returning home and broke it down into manageable steps. First, his mobility was restored significantly. Georges could sit without needed support from a mechanical lift. Then his strength was built up to the point where he could use a wheelchair. Then he transitioned to a walker before being able to stand without support. The major turning point came after the social work team made arrangements for the tracheostomy to be removed at one of Runnymede’s partner hospitals. Once it was out, the stage was set for Georges to go back home. A year after first being admitted, Georges’s independence had not only been restored, he was able to return back to the life he wanted to lead. His long road to recovery was made possible by the dedication of a unified team’s commitment to reaching one milestone at a time. “I look forward to seeing my grandkids,” Georges says. “I’m very optimistic about my future thanks to my care H at Runnymede.” ■
Carla Wintersgill is a Communications Specialist at Runnymede Healthcare Centre. MARCH 2018 HOSPITAL NEWS 45
Healing the scars of service A unique London clinic specializes in treating psychological injuries among military personnel and RCMP By Daniel Punch ometimes all it took was a smell to jolt Jackie Buttnor back to the day of the crash. If she caught a whiff of burning aviation fuel, she would “zone out” and find herself back in Wainwright, Alta. in July 1993. She would see the explosion, watch the Hercules C-130 military transport plane fall from the sky, and remember the people who lost their lives that terrible day. In the years after the crash, Buttnor’s flashbacks came often, and caused her to disassociate completely from reality. “People would have to walk up and tap me on the shoulder or wave in front of my face,” she recalls. “I would completely disappear.” And in many ways, Buttnor says the person she was before the crash disappeared when that plane went down. She grew up as an athletic introvert on military bases across Canada and Germany. Her father was in the Royal Canadian Air Force, and she seemed destined to follow in his footsteps. After high school, she signed up for the Canadian Forces as a medical technician. ‘Medics’ are not required to have a healthcare background, but are educated as part of their military training to deliver in-the-field healthcare, as well as preventive medicine and therapeutic drugs. In the summer of 1993, Buttnor was providing medical coverage during an Army Jump School training exercise in eastern Alberta when things went tragically wrong. She was one of the first responders on the scene after the plane hit the ground, killing five of her colleagues. She felt numb at first. Then within a few weeks of the crash, she started feeling depressed and uneasy. Her symptoms only got worse as time went on. She started getting frequent, vivid flashbacks. She avoided the people around her, and would fly into uncharacteristic fits of rage. Her
PATIENTS ARE OFTEN EXTREMELY SYMPTOMATIC WHEN THEY FIRST COME TO THE CLINIC, SO THEY ARE TAUGHT SKILLS TO HELP THEM GAIN MORE CONTROL OF THEIR EMOTIONS depression deepened, and she had thoughts of suicide. “I was desperately trying to hide,” she remembers. She was officially diagnosed with post-traumatic stress disorder (PTSD) in 1995 but says her recovery began in earnest in 2006, when she was referred to the operational stress injury (OSI) clinic at St. Joseph’s Health Care London. In the years following her diagnosis, she was medically released from the armed forces and moved to southwestern Ontario to study horticulture. She’d been receiving treatment for years, but something was different about the OSI clinic’s staff of nurses, psychologists, psychiatrists, physicians and social workers. “It was obvious they were there to listen (and) they cared,” she says. Based out of St. Joseph’s Parkwood Institute location, the clinic is one of only 10 outpatient clinics across Canada specializing in treating military and RCMP officers with OSI – an umbrella term for conditions like PTSD, anxiety disorders, depression, and other psychological injuries that occur in the line of duty. RN Jane Gallimore, a member of the clinic’s nursing team, comes from a military family and served parttime in the army reserves from 1986 to 1994. She cherishes her time in the military and the people she met, but says she also saw a lot of tragedy during that time. A number of her colleagues suffered from OSI, and a few even took their own lives. So she feels honoured to have spent the past 10 years helping this unique population. “They came into their jobs intending
to make the world a better place,” Gallimore says. “I think it’s very important they get the help they need.” Military personnel are not your typical patients. Their training teaches them to put their country and fellow soldiers first, and so Gallimore says some are reluctant to talk about themselves. Many patients fear the stigma that comes with being diagnosed with a mental health condition. And some carry tremendous guilt about what they’ve witnessed. All this makes it essential to establish trust early, and Gallimore says that starts with the clinic’s nurses. Initial assessments are conducted by nurses, who also do case management and check in with patients throughout their treatment. “It’s important nurses start by being genuine, listening, and showing they care,” Gallimore says. The type of treatment a patient receives can include psychotherapy, medication, consultations with other care providers, and referrals to other services, such as sleep studies or addiction services. But the first step is almost always to stabilize their symptoms. Patients are often extremely symptomatic when they first come to the clinic, so they are taught skills to help them gain more control of their emotions. “Stabilization means different things to different people,” says NP Jennifer Safadi. “It’s about moving (patients) toward having a quality of life where they are able to function with their family and within society.” Safadi became the clinic’s first NP in 2015, and meets with patients to
review their medication histories, talk about nutrition and sleep, discuss their current symptoms, and establish treatment goals. She is also able to order blood work and ECG tests. Though Buttnor first visited the clinic in 2006, it took a while for her to feel she was headed in the right direction. She says the turning point in her recovery came around Christmas 2010. For some reason, her depression and flashbacks intensified over the holidays that year. “Everything finally came to a head,” she says. “I knew I had to do something (or) I was going to wind up dead.” The clinic’s MySelf therapy group helped her turn things around. Run by Gallimore and other clinic staff, the MySelf group is the first of its kind in Canada. It brings people with OSI together for activities like tai chi, arts and crafts, and pool therapy, and has been shown to reduce OSI symptoms and improve quality of life. “It woke up some things (in me),” she says. “And suddenly I was able to start to feel a bit better somehow.” But Buttnor could not imagine how far that momentum would take her. Two years ago, a friend encouraged her to sign up for the Invictus Games, an international sporting competition for injured soldiers. The 2017 games were held in Toronto, and Buttnor was chosen to compete for Team Canada in the heavyweight powerlifting, wheelchair rugby and stationary rowing events. She competed and she walked away with a silver medal. It’s something Buttnor would never have dreamed was possible 10 years ago. Leaving the house was difficult enough back then. And she says this specialized clinic was instrumental in helping her get to where she is today. “To put it bluntly, without the people I’ve worked with at the OSI clinic, I wouldn’t have lived to make it to this point.” ■ H
Daniel Punch is staff writer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the November/December 2017 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO). 46 HOSPITAL NEWS MARCH 2018
13th Annual Hospital News
NURSING HERO AWARDS Nominate A Nursing Hero!
Along with having their story published, the winner also will take home: CASH PRIZES
1st PRIZE: $1,000 2nd Prize: $500 3rd Prize: $300
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MARCH 2018 HOSPITAL NEWS 47
DID YOU KNOW? 34%
of NURSES reported physical assault from a patient over the past year in their workplace. (Statistics Canada Health Reports Volume 20)
Violence in the workplace cannot be tolerated Safe workers mean better care. Letâ€™s work together to reduce violence in healthcare.
Focus: Gerontology, Alternate Level of Care, Rehab & HSCN Conference. Special Wound Care Issue